Does a patient with iron deficiency anemia require treatment?

Yes, Your Patient Requires Treatment

Your patient has clear iron deficiency anemia (iron saturation 9%, serum iron 32 μg/dL, TIBC 354 μg/dL) and should be started immediately on oral ferrous sulfate 200 mg once daily to correct the anemia and replenish iron stores. 1

Interpretation of Laboratory Values

Your patient's labs confirm iron deficiency anemia:

• Iron saturation of 9% is severely low (normal >20%) 2
• Serum iron of 32 μg/dL is low
• TIBC of 354 μg/dL is elevated, indicating iron deficiency
• UIBC of 322 μg/dL is elevated, consistent with depleted iron stores

These values definitively indicate iron deficiency requiring treatment. 2

First-Line Treatment Regimen

Start ferrous sulfate 200 mg once daily as the preferred oral iron formulation due to its effectiveness and low cost. 1 Once-daily dosing is superior to multiple daily doses because it improves tolerance while maintaining effectiveness. 1

Add vitamin C (ascorbic acid) 500 mg with each iron dose to enhance absorption, which is particularly important given your patient's severely low iron saturation of 9%. 3, 1

Alternative formulations (ferrous gluconate or ferrous fumarate) are equally effective if ferrous sulfate is not tolerated. 3, 1

Expected Response and Monitoring

Hemoglobin should rise by approximately 2 g/dL after 3-4 weeks of treatment. 3, 1 If this doesn't occur, consider poor compliance, misdiagnosis, continued blood loss, or malabsorption. 3

Continue oral iron therapy for 3 months after anemia correction to fully replenish iron stores—do not stop when hemoglobin normalizes. 1

Monitor hemoglobin and red cell indices every 3 months for the first year, then again after another year. 1

When to Switch to Intravenous Iron

Consider IV iron if your patient:

• Cannot tolerate at least two different oral iron preparations 1
• Has inadequate response after 4 weeks of appropriate oral therapy 1
• Has conditions affecting iron absorption (inflammatory bowel disease with active inflammation, celiac disease, post-bariatric surgery) 1
• Has ongoing gastrointestinal blood loss exceeding oral replacement capacity 1

Investigate the Underlying Cause

While treating with iron, you must identify and address the source of iron deficiency. 1 This is critical to prevent recurrence and identify potentially serious pathology.

For a female patient, assess:

• Menstrual blood loss patterns (most common cause in premenopausal women) 2
• Gastrointestinal sources if postmenopausal or if menstrual losses don't explain severity 1
• Celiac disease screening with antiendomysial antibody and IgA measurement 3, 1

If the patient is over 45 years old, perform both upper endoscopy with small bowel biopsy and colonoscopy to exclude gastrointestinal malignancy. 3

Common Pitfalls to Avoid

• Don't prescribe multiple daily doses—this increases side effects without improving efficacy 1
• Don't stop iron when hemoglobin normalizes—continue for 3 months to replenish stores 1
• Don't fail to add vitamin C when iron saturation is this severely low 3, 1
• Don't continue oral iron indefinitely without response—reassess after 4 weeks and switch to IV iron if hemoglobin fails to rise 1
• Don't treat iron deficiency without investigating the underlying cause, as this may delay diagnosis of serious conditions like gastrointestinal malignancy 1

Failure to Respond

If anemia does not resolve within 6 months despite appropriate iron therapy:

• Reassess for ongoing blood loss 1
• Evaluate for malabsorption syndromes (celiac disease, atrophic gastritis, inflammatory bowel disease) 4, 2
• Verify patient adherence to therapy 1
• Consider further gastrointestinal investigation 1
• Consider hematology consultation for complex cases 1