What is the management plan for a 38-year-old female with iron deficiency anemia (IDA) indicated by low ferritin levels, low iron levels, and low transferrin saturation?

Management of Iron Deficiency in a 38-Year-Old Female

Oral iron supplementation with ferrous sulfate 324 mg (65 mg elemental iron) once or twice daily is the recommended first-line treatment for this patient with iron deficiency indicated by low ferritin, low iron, and low transferrin saturation. 1

Diagnosis Confirmation

• The patient's laboratory values confirm iron deficiency with:
  • Normal Hb and MCV (non-anemic iron deficiency)
  • Low ferritin (28 μg/L) - below the recommended threshold of 30 μg/L 2
  • Low serum iron (6.7 μmol/L)
  • Low transferrin saturation (9.6%) - well below the normal range of 20-50% 1

Treatment Approach

First-Line Treatment: Oral Iron Therapy

• Dosing recommendation: Ferrous sulfate 324 mg (65 mg elemental iron) once or twice daily 1, 3

  • Lower doses may be better tolerated and equally effective 1
  • Consider alternate-day dosing for better absorption and fewer side effects 1, 2

• Duration of treatment: Continue oral iron for 3 months after iron deficiency has been corrected to ensure replenishment of iron stores 1

• Absorption enhancers:

  • Take with vitamin C (250-500 mg) to enhance absorption 1
  • Take on an empty stomach if tolerated 1
  • Consider taking with meat protein to improve absorption 1

Monitoring Response

• Repeat basic blood tests (Hb, ferritin, iron studies) after 8-10 weeks of treatment 1, 2
• Expected response: 1-2 g/dL increase in hemoglobin (if anemic) and normalization of iron studies 4
• Long-term follow-up: Monitor iron status at 3-month intervals for 1 year, then after a further year 1

Alternative Approaches for Non-Responders

• If oral iron is not tolerated or ineffective after 8-10 weeks, consider:
  • Different oral iron formulations (ferrous fumarate, ferrous gluconate) which may be better tolerated 1
  • Parenteral iron therapy (intravenous) for those with persistent intolerance or non-response 1
    • Options include iron sucrose, ferric carboxymaltose, or iron dextran 1

Additional Considerations

• Investigate underlying cause: Consider evaluation for:

  • Menstrual blood loss (common in premenopausal women) 1, 5
  • Dietary factors (vegetarian/vegan diet, inadequate iron intake) 1, 2
  • Malabsorption (celiac disease, H. pylori infection) 1

• Dietary recommendations:

  • Increase dietary iron intake, particularly heme iron sources (meat) 1
  • Avoid inhibitors of iron absorption (tea, coffee, calcium) when taking supplements 1, 2
  • Premenopausal women may need higher daily iron intake (18-22 mg/day) 1

• Potential pitfalls:

  • Long-term daily iron supplementation with normal or high ferritin is not recommended and potentially harmful 1, 2
  • Avoid iron supplementation without addressing underlying cause 1, 5
  • Be aware that gastrointestinal side effects (constipation, nausea, diarrhea) may reduce compliance 1

Special Considerations for Premenopausal Women

• All premenopausal women with iron deficiency should be screened for celiac disease 1
• Further GI investigations should be based on clinical judgment and response to therapy 1
• Consider higher iron requirements due to menstrual blood loss 1, 5