What is the recommended treatment for a patient with iron deficiency anemia, characterized by low iron levels, low ferritin, and increased total iron-binding capacity?

Treatment for Iron Deficiency Anemia

Oral iron supplementation is the first-line treatment for patients with iron deficiency anemia characterized by low iron levels, low ferritin, and increased total iron-binding capacity. 1

Diagnosis Confirmation

• Iron deficiency anemia is characterized by low serum iron, low ferritin, and increased total iron-binding capacity (TIBC) 1
• Ferritin is the preferred initial diagnostic test, with levels <30 ng/mL typically confirming iron deficiency in adults without inflammatory conditions 2
• Transferrin saturation (iron/TIBC × 100) less than 20% is also diagnostic of iron deficiency 1, 2

Treatment Approach

First-Line Therapy: Oral Iron

• Oral iron supplementation with ferrous sulfate is the recommended first-line treatment 2, 3
• Standard dosing is ferrous sulfate 325 mg daily (containing 65 mg of elemental iron) or on alternate days 4, 2
• Alternate-day dosing may improve absorption and reduce gastrointestinal side effects 1
• Treatment should continue until iron stores are replenished, typically requiring 3-6 months of therapy 5

Monitoring Response

• Repeat hemoglobin levels after 4 weeks of treatment; expect a 1-2 g/dL increase if treatment is effective 6
• Recheck iron studies (ferritin, TIBC, transferrin saturation) after 8-10 weeks of therapy 1, 5
• If there is inadequate response, investigate for ongoing blood loss, malabsorption, or non-adherence 6

Special Considerations

• For patients with gastrointestinal side effects (nausea, constipation, diarrhea), consider:
  • Lower doses (28-50 mg elemental iron) 5
  • Alternate-day dosing regimen 1
  • Taking with food (though this may reduce absorption) 3

When to Consider Intravenous Iron

Intravenous iron should be considered in cases of:

• Oral iron intolerance 2, 3
• Malabsorption conditions 2
• Ongoing blood loss 2
• Chronic inflammatory conditions (IBD, CKD, heart failure) 2, 7
• Need for rapid iron repletion 1, 3

Dietary Recommendations

• Increase intake of iron-rich foods (red meat, poultry, fish, beans, leafy greens) 5
• Include vitamin C-rich foods with meals to enhance iron absorption 5
• Avoid tea, coffee, and calcium supplements with meals as they inhibit iron absorption 5

Common Pitfalls to Avoid

• Failing to investigate the underlying cause of iron deficiency, especially in men and postmenopausal women 2, 6
• Continuing iron supplementation despite normal or high ferritin levels, which can be harmful 1, 5
• Misinterpreting ferritin levels in the presence of inflammation (ferritin is an acute phase reactant) 1
• Inadequate duration of therapy leading to recurrence of iron deficiency 5

Follow-up

• Long-term follow-up with repeat iron studies every 6-12 months is recommended for patients at risk of recurrent iron deficiency 5
• For patients with persistent or recurrent iron deficiency, intermittent oral supplementation may be beneficial to maintain iron stores 5