What is the treatment for iron deficiency anemia?

Treatment of Iron Deficiency Anemia

Oral iron supplementation with ferrous sulfate 200 mg once daily is the first-line treatment for iron deficiency anemia due to its effectiveness and low cost. 1

First-Line Treatment: Oral Iron Therapy

• Ferrous sulfate 324 mg (providing 65 mg of elemental iron) is the preferred oral formulation 1, 2
• Once-daily dosing is recommended over multiple daily doses to improve tolerance while maintaining effectiveness 1
• Continue oral iron therapy for 3 months after correction of anemia to fully replenish iron stores 1
• Expect hemoglobin to rise by approximately 2 g/dL after 3-4 weeks of effective treatment 1, 3
• Alternative oral iron formulations (ferrous gluconate, ferrous fumarate) may be better tolerated in some patients with similar effectiveness 1, 4
• Adding vitamin C (ascorbic acid) can enhance iron absorption when response is poor 1

Monitoring and Response Assessment

• An increase in hemoglobin of at least 1 g/dL within 14 days indicates adequate response to oral iron therapy 3
• Hemoglobin response <1.0 g/dL at day 14 identifies patients who should be transitioned to IV iron 3
• Monitor hemoglobin and red cell indices at 3-month intervals for the first year after correction 1
• Further investigation is recommended if anemia doesn't resolve within 6 months 1, 5

Indications for Intravenous Iron

• Patients who cannot tolerate oral iron despite trying at least two different oral preparations 1, 6
• Inadequate response to oral iron therapy after 4 weeks 7, 1
• Conditions affecting iron absorption, such as:
  • Inflammatory bowel disease with active inflammation 7
  • Celiac disease with ongoing gluten exposure 7
  • Post-bariatric surgery 7
• Severe anemia (Hb <10 g/dL) in patients with inflammatory bowel disease 7
• Portal hypertensive gastropathy with ongoing bleeding unresponsive to oral iron 7

Special Populations

Pregnant Women

• Start oral low-dose (30 mg/day) iron supplements at first prenatal visit 7
• For anemia treatment, prescribe oral dose of 60-120 mg/day of iron 7
• When hemoglobin normalizes for gestational stage, decrease dose to 30 mg/day 7
• Refer pregnant women with Hb <9.0 g/dL for further medical evaluation 7

Inflammatory Bowel Disease

• IV iron is recommended as first-line treatment in patients with clinically active IBD and Hb <10 g/dL 7
• Treat underlying inflammation to enhance iron absorption and reduce iron depletion 7
• IV iron has shown greater efficacy and better tolerability than oral iron in IBD patients 7

Celiac Disease

• Ensure adherence to a gluten-free diet to improve iron absorption 7
• Consider IV iron therapy if iron stores do not improve with oral supplementation 7

Common Pitfalls to Avoid

• Failing to treat the underlying cause of iron deficiency while supplementing iron 1, 5
• Continuing oral iron despite poor tolerance or inadequate response 1, 6
• Using multiple daily doses of oral iron, which increases side effects without improving efficacy 1, 4
• Overlooking the need for vitamin C supplementation to enhance iron absorption 1
• Failing to continue iron therapy for 3 months after correction of anemia 1, 5
• Not evaluating for gastrointestinal blood loss in men and postmenopausal women with iron deficiency 5, 8