What is the treatment for a patient with iron deficiency anemia?

Treatment of Iron Deficiency Anemia

The first-line treatment for iron deficiency anemia is oral iron supplementation at a dose of 60-120 mg of elemental iron daily, which should be continued for 2-3 months after hemoglobin normalizes to replenish iron stores. 1

Oral Iron Therapy

Dosing and Administration

• Standard adult dosing options:
  • Ferrous sulfate 325 mg (providing 65 mg of elemental iron) 2
  • 200 mg of elemental iron daily in 2-3 divided doses
  • Single daily dose of ferrous sulfate 200 mg with vitamin C 1

Optimization Tips

• Take iron on an empty stomach (2 hours before or 1 hour after meals) for optimal absorption 1
• Add vitamin C 250-500 mg to each dose to enhance absorption 1
• Consider alternate-day dosing if daily dosing causes significant side effects 3

Monitoring Response

• 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 4, 1
• Target values:
  • Hemoglobin >12 g/dL for women and >13 g/dL for men
  • Ferritin >100 μg/L
  • Transferrin saturation >20% 1

Intravenous Iron Therapy

Indicated for patients with:

• Active infection
• Hemoglobin below 10 g/dL requiring rapid correction
• Previous intolerance to oral iron
• Conditions with impaired oral iron absorption (celiac disease, post-bariatric surgery)
• Chronic inflammatory conditions (inflammatory bowel disease, chronic kidney disease)
• Ongoing blood loss exceeding intestinal absorption capacity 1, 5, 3

IV Iron Options

• Ferric carboxymaltose: Up to 1000 mg in a single 15-minute infusion
• Iron sucrose: 200 mg over 10 minutes
• Iron dextran: 20 mg/kg over 6 hours 1

Special Populations

Pregnant Women

• Start with 30 mg/day at first prenatal visit
• Increase to 60-120 mg/day if anemia develops
• Decrease to 30 mg/day once hemoglobin normalizes 1

Patients with Chronic Kidney Disease

• Oral iron may be less effective
• Consider IV iron if serum ferritin is >100 ng/mL 1

Patients with Inflammatory Bowel Disease or Post-Bariatric Surgery

• IV iron is preferred due to absorption issues 1

Common Pitfalls to Avoid

1. Stopping treatment too early before iron stores are replenished 1
2. Failing to investigate underlying causes, especially in men and postmenopausal women 1, 3
3. Not adding vitamin C to enhance absorption 1
4. Administering oral iron with absorption inhibitors (tea, coffee, calcium) 1
5. Using parenteral iron when oral therapy would be effective 1
6. Inadequate dosing that underestimates total iron deficit 1

Dietary Recommendations

• Increase intake of iron-rich foods:
  • Heme iron: red meat, poultry, fish
  • Non-heme iron: leafy greens, legumes, fortified cereals
• Consume vitamin C-rich foods with meals 1
• Plant-based diets require approximately 1.8 times more dietary iron 1

Remember that the goal of treatment is not just to correct anemia but to replenish iron stores completely, which requires continuing therapy for 2-3 months after hemoglobin normalizes 4, 1. Failure to do so may result in recurrence of iron deficiency anemia.