From the Guidelines
If your hemoglobin is normal but iron is slightly low, I recommend taking an iron supplement such as ferrous sulfate 325 mg once daily with vitamin C to improve absorption, as this will help prevent the progression to iron deficiency anemia and its associated morbidity and mortality. According to the British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults 1, iron deficiency should be confirmed by iron studies prior to investigation, and serum ferritin is the single most useful marker of IDA. The European Crohn's and Colitis Organization (ECCO) guidelines also support the use of iron supplementation in patients with iron-deficiency anemia 1.
When taking the supplement, it is best to take it between meals or at bedtime on an empty stomach for optimal absorption, but if stomach upset occurs, it can be taken with food. It is essential to continue supplementation for 3-6 months to replenish iron stores completely, even after symptoms improve. This approach is crucial in preventing the progression to anemia, which can significantly impact quality of life. Iron is vital for hemoglobin production, energy metabolism, and immune function, and low iron can eventually lead to anemia if not addressed. Common causes of low iron include insufficient dietary iron intake, blood loss (including heavy menstrual periods), pregnancy, or malabsorption issues.
While supplementing, it is also beneficial to incorporate iron-rich foods like lean red meat, beans, spinach, and fortified cereals into your diet. If symptoms like fatigue persist or worsen despite supplementation, it is crucial to follow up with your healthcare provider for further evaluation. The ECCO guidelines also recommend monitoring serum ferritin levels and hemoglobin to determine the need for re-treatment with intravenous iron 1. By prioritizing iron supplementation and dietary changes, individuals can effectively manage iron deficiency and prevent its associated complications, ultimately improving morbidity, mortality, and quality of life.
From the Research
Hemoglobin Norms and Iron Levels
- Hemoglobin levels are used to diagnose iron deficiency anemia, which is confirmed by low iron stores and a hemoglobin level two standard deviations below normal 2.
- Iron deficiency is the most common nutritional disorder worldwide, accounting for approximately one-half of anemia cases 2.
- Women should be screened for iron deficiency during pregnancy, and children should be screened at one year of age 2.
Iron Deficiency Diagnosis and Treatment
- Iron deficiency is diagnosed by low serum ferritin (typically <30 ng/mL) in individuals without inflammatory conditions or by transferrin saturation (iron/total iron binding capacity × 100) less than 20% 3.
- Oral iron (ferrous sulfate 325 mg/d or on alternate days) is typically first-line therapy for iron deficiency 3.
- Intravenous iron is indicated for patients with oral iron intolerance, poor absorption, chronic inflammatory conditions, ongoing blood loss, and during the second and third trimesters of pregnancy 3, 4.
Iron Supplementation Response
- Hemoglobin response at day 14 of oral iron may be useful in assessing whether and when to transition patients from oral to intravenous (IV) iron 5.
- A ≥1.0-g/dL increase in hemoglobin on day 14 most accurately predicted satisfactory overall hemoglobin response to oral iron on day 42/56 5.
- Iron-replacement therapy improved quality of life and reduced fatigue 5, 6.
Iron Deficiency Prevention and Treatment
- Interventions addressing iron deficiency should be based on prevention rather than on treatment of anemia 6.
- Supplementing with 30 mg/d of elementary iron, either as ferrous sulfate or iron bis-glycinate chelate for 90 days, showed positive effects on increasing ferritin concentration in schoolchildren with low iron stores 6.
- Intravenous iron therapy is reserved for iron deficiency anemia patients with intolerance or unresponsiveness of oral iron, and may also be preferred when rapid correction of the iron deficit is required 4.