First-Line Treatment for Iron Deficiency Anemia (IDA)
The initial treatment of Iron Deficiency Anemia (IDA) should be with one tablet per day of ferrous sulfate, fumarate or gluconate, along with addressing any underlying cause of iron loss. 1
Oral Iron Therapy
- Oral iron supplementation is the first-line treatment for most patients with IDA due to its effectiveness, low cost, and safety 1
- Standard dosing is ferrous sulfate 200 mg (containing 65 mg elemental iron) once daily 1, 2
- Treatment should continue for approximately 3 months after normalization of hemoglobin levels to ensure adequate replenishment of iron stores 1
- Patients should be monitored in the first 4 weeks for hemoglobin response to oral iron therapy 1
- Ascorbic acid (vitamin C) may enhance iron absorption and can be considered when response to iron therapy is poor 1
Special Considerations for First-Line Treatment
Intravenous iron should be considered as first-line treatment instead of oral iron in specific situations:
- Patients with clinically active inflammatory bowel disease 1
- Previous intolerance to oral iron preparations 1
- Hemoglobin below 10 g/dL 1
- Patients who need erythropoiesis-stimulating agents 1
- Cases where oral iron absorption is likely to be impaired 1, 3
Management of Oral Iron Intolerance
If standard dosing is not tolerated, consider these alternatives:
- Reduced dose of one tablet every other day 1
- Alternative oral iron preparations (ferrous gluconate, ferrous fumarate, liquid preparations) 1
- If still not tolerated, parenteral (intravenous) iron should be considered 1
Addressing Underlying Causes
- While initiating iron therapy, the underlying cause of IDA should be investigated and treated 1
- Iron replacement therapy should not be deferred while awaiting investigations unless colonoscopy is imminent 1
- In men and postmenopausal women, gastroscopy and colonoscopy should generally be the first-line GI investigations 1
Follow-up and Monitoring
- Hemoglobin should rise by approximately 2 g/dL after 3-4 weeks of treatment 1
- Failure to respond is usually due to poor compliance, misdiagnosis, continued blood loss, or malabsorption 1
- Once normalized, hemoglobin concentration should be monitored at intervals (suggested every 3 months for 1 year, then after a further year) 1
Common Pitfalls to Avoid
- Deferring iron therapy while awaiting investigations (except when colonoscopy is imminent) 1
- Discontinuing iron therapy too early (before iron stores are replenished) 1
- Overlooking the need to treat the underlying cause of iron deficiency 1
- Using blood transfusions as first-line therapy (should be reserved for patients with or at risk of cardiovascular instability due to severe anemia) 1