What is the treatment for a 16-year-old female with iron deficiency anemia, as indicated by low ferritin (Ferritin) levels, mild anemia (Hemoglobin 12), and microcytic hypochromic anemia (Mean Corpuscular Volume (MCV) 76, Mean Corpuscular Hemoglobin (MCH) 23.4, Mean Corpuscular Hemoglobin Concentration (MCHC) 30.8)?

Treatment of Iron Deficiency Anemia in a 16-Year-Old Female

This patient requires oral iron supplementation with ferrous sulfate 200 mg three times daily, continued for three months after correction of anemia to replenish iron stores. 1

Diagnostic Confirmation

This patient has clear iron deficiency anemia based on:

• Ferritin 11 ng/mL (well below the threshold of <15 ng/mL for iron deficiency) 1
• MCV 76 fL (microcytic, <76 fL cutoff) 1
• MCH 23.4 pg and MCHC 30.8 g/dL (hypochromic indices) 1
• Hemoglobin 12 g/dL (mild anemia for a 16-year-old female) 1

The elevated platelet count (466) and RDW (15.9) are consistent with iron deficiency anemia. 2

First-Line Treatment: Oral Iron Supplementation

Ferrous sulfate 200 mg three times daily is the most appropriate, cost-effective first-line therapy. 1 Alternative ferrous salts (ferrous gluconate or ferrous fumarate) are equally effective if the patient experiences intolerance. 1

Optimizing Oral Iron Absorption

• Take iron on an empty stomach when possible for better absorption 1
• Add vitamin C 500 mg (ascorbic acid) to enhance iron absorption, particularly if response is poor 1
• If gastrointestinal side effects occur, taking iron with meals or switching to alternate-day dosing may improve tolerance 1
• Consider liquid preparations if tablets are not tolerated 1

Common Pitfall to Avoid

Do not prescribe excessive elemental iron doses (>50 mg per dose), as this increases gastrointestinal side effects without improving efficacy and reduces compliance. 3

Duration of Treatment

Continue oral iron for three months after correction of anemia to adequately replenish iron stores. 1 This extended duration is critical—stopping treatment when hemoglobin normalizes without replenishing stores leads to recurrence.

Evaluation for Underlying Cause

As a premenopausal 16-year-old female, the most likely causes are: 1

• Menstrual blood loss (especially menorrhagia, occurring in 5-10% of menstruating women) 1
• Dietary insufficiency (inadequate iron intake, vegetarian/vegan diet) 3, 4
• Increased physiological demands during adolescence 3

Extensive gastrointestinal investigation is NOT indicated in this age group unless there are specific symptoms (changed bowel habits, rectal bleeding, abdominal pain) or failure to respond to iron therapy. 1 The British Society of Gastroenterology guidelines specifically note that menstrual loss, pregnancy, and breastfeeding are usually responsible for iron deficiency in premenopausal women. 1

Follow-Up Monitoring

Monitor hemoglobin and red cell indices: 1

• At 8-10 weeks to assess treatment response 3
• Every 3 months for one year, then annually 1
• Check ferritin if hemoglobin or MCV falls below normal 1

Expected response includes hemoglobin increase of approximately 1-2 g/dL within 8-10 weeks. 3, 2

When to Consider Intravenous Iron

Intravenous iron is NOT first-line for this patient but should be considered if: 1

• Intolerance to at least two different oral iron preparations 1
• Non-compliance with oral therapy 1
• Failure to respond to adequate oral iron therapy after 8-10 weeks 3
• Ongoing heavy menstrual bleeding that cannot be controlled 4

Additional Considerations

Assess menstrual blood loss using history (though unreliable for quantification) or pictorial blood loss assessment charts (80% sensitivity and specificity for menorrhagia). 1 If menorrhagia is confirmed, gynecologic evaluation and management may be needed concurrently.

Dietary counseling should emphasize heme iron sources (meat, poultry, fish) and avoiding iron absorption inhibitors (calcium, tea, coffee) with iron-rich meals. 3