What is the approach to diagnosing iron deficiency anemia (IDA)?

From the Guidelines

The workup of iron deficiency anemia should begin with a ferritin level, and a cut-off value of 45 ng/mL is recommended for diagnosis in patients with anemia, as suggested by the American Gastroenterological Association 1. When evaluating iron deficiency anemia, it is essential to identify the underlying cause. The following steps should be taken:

• In patients with anemia, diagnose iron deficiency if ferritin < 45 ng/mL, and consider additional laboratory tests in patients with underlying inflammation or chronic kidney disease 1.
• Test for celiac disease with serology first, and consider small bowel biopsy only if serology is positive 1.
• Consider bidirectional endoscopy in patients with iron deficiency anemia, particularly in asymptomatic postmenopausal women and men, as it is recommended over no endoscopy by the AGA 1. Key considerations in the workup of iron deficiency anemia include:
• Evaluating dietary iron intake and reviewing menstrual blood losses in premenopausal women 2.
• Searching for gastrointestinal conditions leading to poor iron absorption or blood loss, including Helicobacter pylori infection 2.
• Considering multidisciplinary management, including gastroenterologists, hematologists, and nutritionists, in complex cases 2. Treatment of iron deficiency anemia should involve oral iron supplementation, with a goal of increasing hemoglobin by approximately 1-2 g/dL every 2-3 weeks, and continuing iron therapy for 3-6 months after hemoglobin normalization to replenish iron stores 2.

From the Research

Treatment Options for Iron Deficiency Anaemia

• Oral iron supplementation is the first line of treatment for iron deficiency anaemia, with ferrous sulfate being the most commonly prescribed drug 3.
• Other oral iron formulations, such as ferric maltol and sucrosomial iron, have also been developed and are available for use 3.
• The optimal dosage and frequency of oral iron supplementation are still being researched, with some studies suggesting that alternate-day dosing and morning single doses may be more effective in increasing iron absorption and reducing side effects 4, 5.

Comparison of Oral and Intravenous Iron Supplementation

• Both oral and intravenous iron supplementation can be effective in correcting iron deficiency anaemia, but intravenous iron may restore iron stores faster than oral iron 6.
• Intravenous iron supplementation may be preferred in certain situations, such as when oral iron is contraindicated or when rapid iron repletion is necessary 3, 7.
• The safety and efficacy of different intravenous iron formulations have been reviewed, with some formulations being associated with a higher risk of adverse reactions 7.

Dosing Regimens for Oral Iron Supplementation

• The optimal dosing regimen for oral iron supplementation is still being researched, with some studies suggesting that doses of 60-120 mg of elemental iron per day may be effective in increasing iron absorption and reducing side effects 4.
• The use of ascorbic acid with oral iron supplementation may also help to increase iron absorption 4.
• Alternate-day dosing regimens may be more effective than daily dosing regimens in increasing iron absorption and reducing side effects 4, 5.