What is the recommended treatment for a patient with a low ferritin level of 37.3 and iron deficiency indicators?

Treatment for Iron Deficiency with Ferritin Level of 37.3

Oral iron supplementation is recommended for this patient with a ferritin level of 37.3, which indicates early iron deficiency despite normal CBC values. 1, 2

Assessment of Iron Status

• The patient's laboratory values show:

  • Ferritin: 37.3 μg/L (low)
  • Iron: 131 μg/dL (normal)
  • TIBC: 431 μg/dL (normal to slightly elevated)
  • UIBC: 300 μg/dL
  • Iron saturation: 30% (normal)
  • CBC: normal 1

• A ferritin level below 50 μg/L is indicative of early iron deficiency, even with normal hemoglobin levels 2

• Iron deficiency without anemia is defined as low serum ferritin (<35 μg/L) with normal hemoglobin values 1

Treatment Recommendations

First-Line Treatment:

• Oral iron supplementation is the recommended first-line treatment for non-anemic iron deficiency 1
• Standard oral iron preparations contain 324 mg of ferrous sulfate, equivalent to 65 mg of elemental iron 3
• A reasonable dose is 28-50 mg of elemental iron daily to minimize gastrointestinal side effects while maintaining efficacy 4

Dietary Recommendations:

• Integrate heme iron (from meat and seafood) regularly into the diet 1
• Co-ingest vitamin C with non-heme iron sources to enhance absorption 1
• Avoid foods or beverages that impair iron absorption (tea, coffee) around meal times 1

Monitoring and Follow-up

• Repeat basic blood tests (ferritin, hemoglobin, MCV, MCHC) after 8-10 weeks of treatment to assess response 1, 4
• A successful response should show an increase in ferritin levels 4
• If there is not a 1-2 g/dL increase in hemoglobin after one month (if anemia develops), consider possibilities such as malabsorption, continued bleeding, or unknown lesions 5

Common Pitfalls and Considerations

• Gastrointestinal side effects are common with oral iron (constipation, nausea, diarrhea) 1

  • Taking iron every other day may improve absorption and reduce side effects 1
  • Taking with food may reduce GI symptoms but also reduces absorption

• Intravenous iron is generally not indicated for this patient as:

  • The patient has normal hemoglobin (not anemic) 1
  • Oral iron is effective for mild iron deficiency 1
  • IV iron should be reserved for patients with clinically active inflammatory disease, previous intolerance to oral iron, or hemoglobin below 100 g/L 1

• Long-term daily oral iron supplementation in the presence of normal or high ferritin values is not recommended and potentially harmful 4

• For patients with repeatedly low ferritin despite treatment, consider intermittent oral supplementation to preserve iron stores and long-term follow-up every 6-12 months 4