What is the treatment for low iron and low B12 levels?

Treatment for Low Iron and Low B12 Levels

For patients with both iron deficiency and vitamin B12 deficiency, treatment should include oral iron supplementation (ferrous sulfate 200 mg twice daily) and vitamin B12 supplementation (oral vitamin B12 2,000 mcg daily), with treatment continued for at least 3 months after correction of deficiencies to replenish stores. 1

Iron Deficiency Treatment

Oral Iron Therapy

• First-line treatment for iron deficiency is oral iron supplementation to correct anemia and replenish body stores 1
• Recommended oral iron options:
  • Ferrous sulfate 200 mg twice daily (contains approximately 65 mg elemental iron per tablet) 1
  • Alternative formulations for those with intolerance: ferrous gluconate, ferrous fumarate, or liquid preparations 1
• Oral iron should be continued for 3 months after correction of anemia to replenish iron stores 1
• Taking iron with ascorbic acid (vitamin C) may enhance absorption 1, 2

Monitoring Response to Iron Therapy

• Expect hemoglobin rise of at least 10 g/L after 2 weeks of daily oral iron therapy 1
• If no response after 2 weeks, consider alternative treatment options 1
• Once normal, hemoglobin concentration and red cell indices should be monitored at 3-month intervals for the first year, then after another year 1

Parenteral Iron Options

• Consider intravenous iron for patients who:
  • Are intolerant to oral iron
  • Show insufficient response to oral iron within 2 weeks
  • Have severe anemia (hemoglobin <10 g/dL)
  • Have pronounced disease activity 1
• Available IV iron preparations include:
  • Iron sucrose (Venofer): 200 mg over 10 minutes
  • Ferric carboxymaltose (Ferinject): 1000 mg over 15 minutes
  • Iron dextran (Cosmofer): 20 mg/kg over 6 hours 1

Vitamin B12 Deficiency Treatment

Oral B12 Therapy

• For most patients with B12 deficiency without pernicious anemia:
  • Oral vitamin B12 (cyanocobalamin) 2,000 mcg daily for 3 months 1
  • Alternative dosing schedule: 2,000 mcg on days 1,3,7,10,14,21, then monthly 1

Intramuscular B12 Therapy

• For patients with pernicious anemia or severe B12 deficiency:
  • Initial treatment: 100 mcg daily for 6-7 days by intramuscular injection
  • Followed by 100 mcg on alternate days for seven doses
  • Then every 3-4 days for 2-3 weeks
  • Maintenance: 100 mcg monthly for life 3
• Patients with pernicious anemia should be informed they will require monthly injections for life 3

Monitoring B12 Therapy

• Monitor hematocrit and reticulocyte counts daily from the fifth to seventh days of therapy until hematocrit normalizes 3
• Assess for correction of vitamin deficiency after 3 months 1

Special Considerations

Combined Deficiencies

• When both iron and B12 deficiencies are present, treat both simultaneously 4
• In patients with pernicious anemia who also have iron deficiency (occurs in up to 75% of cases), intravenous iron supplementation may be more effective than oral iron 4
• Folic acid should be administered concomitantly if needed 3

Cautions

• Vitamin B12 deficiency left untreated for longer than 3 months may produce permanent degenerative lesions of the spinal cord 3
• Doses of folic acid greater than 0.1 mg per day may result in hematologic remission in patients with vitamin B12 deficiency but will not prevent neurologic manifestations 3
• Blood transfusion should be restricted to situations with acute severe anemia with hemodynamic instability or when other treatments have failed 1

Follow-up

• For iron deficiency: monitor hemoglobin and red cell indices every 3 months for one year, then after a further year 1
• For B12 deficiency: monitor B12 levels at least annually 1
• If deficiencies recur, further investigation may be warranted 1