What is the treatment for iron deficiency anemia?

Treatment of Iron Deficiency Anemia

The treatment of iron deficiency anemia primarily consists of oral iron supplementation at a dose of 60-120 mg elemental iron daily for adults, continued for 2-3 months after hemoglobin normalizes to replenish iron stores. 1

Oral Iron Therapy

Adult Dosing

• 60-120 mg elemental iron daily (a 325 mg ferrous sulfate tablet provides 65 mg elemental iron) 1
• Alternative dosing: 200 mg elemental iron daily in 2-3 divided doses 1
• Single daily dose of ferrous sulfate 200 mg (65 mg elemental iron) may be better tolerated 1
• Take on an empty stomach (2 hours before or 1 hour after meals) for optimal absorption 1
• Add vitamin C 250-500 mg with each dose to enhance absorption 1
• Continue therapy for 2-3 months after hemoglobin normalizes to replenish iron stores 1

Special Populations

• Pregnancy: 30 mg/day at first prenatal visit; increase to 60-120 mg/day if anemia develops 1
• Pediatric: 2-3 mg/kg/day of elemental iron 1
• Athletes/active women: May require higher daily iron intake (22 mg/day) 1
• Plant-based diets: Require approximately 1.8 times more dietary iron due to lower bioavailability 1

Intravenous Iron Therapy

Indications for IV Iron

IV iron is indicated as first-line therapy for patients with:

• Active infection
• Hemoglobin below 10 g/dL
• Need for rapid correction of anemia
• Previous intolerance to oral iron
• Chronic kidney disease on hemodialysis 1, 2
• Inflammatory bowel disease or post-bariatric surgery 1
• Ongoing blood loss exceeding intestinal absorption capacity 3

IV Iron Dosing

Based on weight and hemoglobin level:

• For Hb 10-12 g/dL (women): 1000-1500 mg based on weight
• For Hb 10-13 g/dL (men): 1500 mg
• For Hb 7-10 g/dL: 1500-2000 mg based on weight 1

For patients with chronic kidney disease on hemodialysis:

• Adult dose: 10 mL (125 mg elemental iron) per dialysis session 2
• Pediatric dose (≥6 years): 0.12 mL/kg (1.5 mg/kg elemental iron) per dialysis session 2

Monitoring Response to Therapy

• Check hemoglobin after 2-4 weeks of treatment (expect increase of ~2 g/dL) 1
• Monitor hemoglobin and red cell indices every 3 months for 1 year, then after another year 1
• Target values:
  • Hemoglobin >12 g/dL for women and >13 g/dL for men
  • Ferritin >100 μg/L
  • Transferrin saturation >20% 1
• Consider switching to IV iron if hemoglobin increase is <1.0 g/dL after 14 days of oral therapy 4

Dietary Recommendations

• Increase intake of iron-rich foods:
  • Heme iron: red meat, poultry, fish (better absorbed)
  • Non-heme iron: leafy greens, legumes, fortified cereals
• Consume vitamin C-rich foods with meals to enhance absorption 1

Common Pitfalls to Avoid

1. Stopping treatment too early before iron stores are replenished 1
2. Failing to add vitamin C to enhance absorption 1
3. Administering oral iron with absorption inhibitors (tea, coffee, calcium) 1
4. Using parenteral iron when oral therapy would be effective 1
5. Inadequate dosing that underestimates total iron deficit 1
6. Delaying iron treatment until underlying condition resolves 1
7. Failure to investigate underlying causes of iron deficiency anemia, especially in men and postmenopausal women 1, 5
8. Inadequate monitoring of response to therapy 1

Evaluation of Underlying Causes

• Men and postmenopausal women with iron deficiency anemia should undergo gastrointestinal endoscopy 6
• Common causes include:
  • Bleeding (menstrual, gastrointestinal)
  • Impaired iron absorption (atrophic gastritis, celiac disease, bariatric surgery)
  • Inadequate dietary iron intake
  • Pregnancy 5

The treatment approach should be tailored based on severity of anemia, patient tolerance, and underlying conditions, with early consideration of IV iron for those who fail to respond to oral therapy 5.