What is the recommended dosage of ferrous ascorbate (iron supplement) for a 20-year-old female with anemia (hemoglobin level of 7.8 gm%) and weighing 60 kg?

Recommended Dosage of Ferrous Ascorbate for Iron Deficiency Anemia

For a 20-year-old female with hemoglobin of 7.8 gm%, prescribe ferrous ascorbate containing 100-200 mg of elemental iron daily, which translates to approximately one tablet of ferrous ascorbate (typically containing 100 mg elemental iron) once or twice daily. 1, 2

Dosing Strategy

Standard Oral Iron Therapy

• Elemental iron requirement: 100-200 mg daily is the recommended dose for treating iron deficiency anemia 2, 3
• Ferrous ascorbate formulation: Most ferrous ascorbate tablets contain approximately 100 mg elemental iron with 75 mg ascorbic acid per tablet
• Practical dosing: Start with one tablet daily; if well-tolerated, may increase to twice daily for faster correction 1
• Lower doses may be equally effective and better tolerated, particularly if gastrointestinal side effects occur 1

Why Ferrous Ascorbate is Appropriate

• Ascorbic acid enhances iron absorption and should be considered when response is needed 1
• The combination formulation provides both iron and vitamin C (250-500 mg ascorbic acid enhances absorption) 1
• For this patient with Hb 7.8 gm%, the enhanced absorption from ascorbic acid is beneficial 1

Expected Response and Monitoring

Timeline for Improvement

• Hemoglobin should rise by 2 g/dl after 3-4 weeks of treatment 1
• If no response after 4 weeks despite compliance, further evaluation is needed (check MCV, RDW, serum ferritin) 1
• Continue iron for 3 months after correction of anemia to replenish iron stores 1

Follow-up Schedule

• Recheck hemoglobin at 3-4 weeks to confirm response 1
• Once normalized, monitor hemoglobin and red cell indices every 3 months for one year, then annually 1

Important Clinical Considerations

When to Consider Alternative Routes

Intravenous iron is indicated if: 1, 3

• Intolerance to at least two oral iron preparations
• Poor absorption (celiac disease, inflammatory bowel disease)
• Non-compliance with oral therapy
• Ongoing blood loss
• Need for rapid correction

Common Pitfalls to Avoid

• Do not stop iron when hemoglobin normalizes - continue for 3 months to replenish stores 1
• Failure to respond is usually due to poor compliance, continued blood loss, malabsorption, or misdiagnosis 1
• Investigate the underlying cause - a 20-year-old female with Hb 7.8 gm% requires evaluation for menorrhagia, dietary deficiency, malabsorption (celiac disease), or gastrointestinal blood loss 1, 2, 3

Specific to Young Women

• Menstrual loss is the most common cause in premenopausal women 1
• Women of reproductive age with heavy menstrual bleeding may require 50-100 mg elemental iron daily for maintenance 1
• Bidirectional endoscopy is not routinely required in premenopausal women under 40 years unless there are gastrointestinal symptoms 2
• Screen for celiac disease with transglutaminase antibody if no obvious cause identified 2

Dosing Tips for Tolerability

• Take on alternate days if daily dosing causes gastrointestinal side effects - this may be equally effective 1
• Take with citrus fruits/drinks to enhance absorption 1
• Separate iron and calcium supplements by 1-2 hours 1
• Liquid preparations may be better tolerated than tablets 1