Iron Supplementation for Adolescents with Normal Hemoglobin, Low Ferritin, and Dizziness
Iron supplementation is strongly recommended for a 14-year-old with normal hemoglobin, ferritin of 35 ng/mL, and dizziness, as this represents non-anemic iron deficiency that can cause symptoms and should be treated to prevent progression to iron deficiency anemia.
Diagnosis Assessment
The patient's presentation represents a case of non-anemic iron deficiency:
- Normal hemoglobin (no anemia)
- Low-normal ferritin (35 ng/mL)
- Symptomatic (dizziness)
Diagnostic Considerations:
- For adolescents aged 12-15 years, ferritin cutoffs of 20 μg/L are recommended to diagnose iron deficiency 1
- While the patient's ferritin is above this strict cutoff, the presence of symptoms (dizziness) suggests functional iron deficiency
Treatment Recommendations
First-Line Treatment:
- Oral iron supplementation with ferrous gluconate 324 mg (38 mg elemental iron) once daily 2
- Take on an empty stomach with vitamin C (250-500 mg) to enhance absorption 3
- Continue for 3 months to replenish iron stores 4
Dosing Considerations:
- Moderate dosing (28-50 mg elemental iron) is appropriate to minimize gastrointestinal side effects while providing adequate supplementation 1
- Daily dosing is preferred over alternate-day dosing for adolescents with symptoms 5
Monitoring and Follow-up
- Repeat ferritin and hemoglobin after 8-10 weeks of treatment to assess response 6
- Target ferritin level should be 50-100 μg/L 6
- Continue monitoring every 3-6 months after normalization 6
- Discontinue supplementation once ferritin reaches normal levels to avoid iron overload 6
Dietary Recommendations
In addition to supplementation:
- Increase dietary intake of iron-rich foods (red meat, poultry, fish, beans, leafy greens)
- Combine with vitamin C-rich foods to enhance absorption
- Avoid calcium, tea, coffee, and dairy products within 2 hours of iron intake as they inhibit absorption 1
Special Considerations for Adolescents
- Adolescents are at higher risk for iron deficiency due to rapid growth and development 6
- Female adolescents have additional risk due to menstrual blood loss 6
- Even without anemia, iron deficiency can impair cognitive function, physical performance, and energy levels 1
Common Pitfalls to Avoid
- Ignoring non-anemic iron deficiency - Iron deficiency without anemia can still cause symptoms and should be treated 1
- Inadequate treatment duration - Continuing treatment for 3 months after symptom resolution is necessary to replenish stores 4
- Excessive supplementation - Long-term daily supplementation beyond normalization of ferritin is potentially harmful 1
- Poor adherence management - Gastrointestinal side effects can reduce compliance; using moderate-dose preparations and taking with food if necessary can improve adherence 4
By following these recommendations, the patient's iron stores should be replenished, symptoms should resolve, and progression to iron deficiency anemia can be prevented.