What treatment is recommended for hypoferritinemia (low serum iron level)?

Treatment for Low Serum Iron (Hypoferritinemia)

For a serum iron level of 7.8 umol/L, oral iron supplementation with 100-200 mg of elemental iron daily is recommended as first-line treatment to restore iron stores and prevent progression to anemia. 1, 2

Diagnosis and Assessment

• Low serum iron (7.8 umol/L) indicates iron deficiency, which requires treatment even without anemia to prevent fatigue, reduced cognitive function, and decreased physical performance 2
• Complete iron status evaluation should include:
  • Serum ferritin (most specific indicator of iron stores) 1
  • Transferrin saturation (reflects iron available for erythropoiesis) 1
  • Complete blood count to assess for anemia 1
• A serum ferritin <30 μg/L in adults >15 years confirms iron deficiency, even with normal hemoglobin 2
• For children 6-12 years, a ferritin cut-off of 15 μg/L is recommended, while for adolescents 12-15 years, 20 μg/L is appropriate 2

Treatment Approach

First-Line Treatment: Oral Iron Therapy

• Oral iron supplementation with 100-200 mg/day of elemental iron in divided doses is recommended 1, 2
• Reasonable preparations contain 28-50 mg of elemental iron per dose to minimize gastrointestinal side effects while maintaining efficacy 2
• Common formulations include:
  • Ferrous sulfate (most commonly used) 3
  • Iron polysaccharide complex (may have fewer GI side effects) 4

Dietary Recommendations

• Increase consumption of iron-rich foods, particularly heme iron sources (red meat) 1
• Co-ingest vitamin C with non-heme iron sources to enhance absorption 1
• Avoid tea, coffee, and calcium-containing foods around iron-rich meals as they impair absorption 1
• Avoid iron-fortified foods if already taking supplements to prevent excessive intake 1

Administration Guidelines

• Take oral iron between meals for optimal absorption, but if GI side effects occur, take with meals 4
• Do not take iron supplements within 2 hours of tetracycline antibiotics due to reduced absorption 4
• Monitor for side effects including nausea, constipation, or diarrhea 4

Monitoring and Follow-up

• Repeat basic blood tests (serum iron, ferritin, hemoglobin) after 8-10 weeks of treatment to assess response 1, 2
• Expect a hemoglobin increase of 1-2 g/dL within one month if iron deficiency is the sole cause of anemia 5
• If no improvement after appropriate oral therapy, consider:
  • Poor compliance
  • Ongoing blood loss
  • Malabsorption of oral iron
  • Other underlying conditions 5, 6

Special Considerations

• For patients with malabsorption or severe iron deficiency not responding to oral therapy, intravenous iron may be considered 2, 7
• Intravenous iron should be reserved for cases with:
  • Documented failure of oral therapy
  • Intolerance to oral preparations
  • Conditions with impaired iron absorption from the gut (e.g., celiac disease) 1
• Long-term daily iron supplementation in the presence of normal or high ferritin is not recommended and potentially harmful 1, 2
• Low serum iron is associated with increased mortality and hospitalization in hemodialysis patients, making treatment particularly important in this population 8

Common Pitfalls

• Failure to treat non-anemic iron deficiency, which can still cause significant symptoms including fatigue 2, 7
• Overlooking the need for investigation of underlying causes of iron deficiency, especially in men and post-menopausal women 1
• Continuing iron supplementation despite normal or high ferritin levels 1
• Inadequate duration of therapy—iron stores take months to replenish even after hemoglobin normalizes 2