What is the treatment for iron deficiency anemia with a serum ferritin level of 30.6?

Treatment for Serum Ferritin of 30.6 ng/mL

Oral iron supplementation is the recommended first-line treatment for a ferritin level of 30.6 ng/mL, as this indicates iron deficiency that requires repletion, with the goal of normalizing both hemoglobin and iron stores. 1

Initial Assessment Required

Before initiating treatment, you must determine:

• Current hemoglobin level - this dictates treatment urgency and route 2
• Presence of inflammation - check C-reactive protein, as ferritin is falsely elevated during inflammation 1
• Clinical disease activity - particularly if the patient has inflammatory bowel disease, chronic kidney disease, or other chronic conditions 2
• Gastrointestinal symptoms - active disease may require intravenous rather than oral iron 2

Treatment Algorithm Based on Clinical Scenario

For Patients WITHOUT Active Inflammatory Disease

Start with oral iron supplementation:

• Dosing: 100-200 mg elemental iron daily 1
• Alternate-day dosing (every other day) shows better absorption and fewer side effects than daily dosing 1
• Co-administer with vitamin C (250-500 mg) to enhance absorption 1
• Take on empty stomach when possible, or with meals if better tolerated 2

For Patients WITH Active Inflammatory Disease or Specific Conditions

Consider intravenous iron as first-line treatment if:

• Clinically active inflammatory bowel disease is present 2
• Hemoglobin is below 100 g/L (10 g/dL) 2
• Previous intolerance to oral iron 2
• Malabsorption conditions exist (celiac disease, gastric bypass) 2, 1
• Ongoing blood loss is present 1
• Rapid iron repletion is needed 1

IV Iron Dosing (if indicated)

Dosing based on body weight and hemoglobin: 1

• Body weight <70 kg with Hb 100-120 g/L (women) or 100-130 g/L (men): 1000 mg total dose
• Body weight ≥70 kg with Hb 100-120 g/L (women) or 100-130 g/L (men): 1500 mg total dose
• Body weight <70 kg with Hb 70-100 g/L: 1500 mg total dose
• Body weight ≥70 kg with Hb 70-100 g/L: 2000 mg total dose

Ferric carboxymaltose can be given as 1000 mg over 15 minutes 1

Monitoring Treatment Response

• Recheck blood tests at 8-10 weeks after initiating treatment, measuring hemoglobin, ferritin, and transferrin saturation 1
• Do NOT recheck ferritin immediately after IV iron - it will be falsely elevated 1
• Expected response: Hemoglobin should increase by at least 2 g/dL within 4 weeks of treatment 2

Long-Term Maintenance Strategy

After successful correction of iron deficiency:

• Monitor for recurrence every 3 months for the first year, then every 6-12 months 2, 1
• Re-treat when ferritin drops below 100 ng/mL or hemoglobin falls below 12 g/dL (women) or 13 g/dL (men) 2, 1
• Investigate underlying cause - particularly gastrointestinal blood loss in men and postmenopausal women 2, 3

Critical Safety Considerations

Common pitfall: A ferritin of 30.6 ng/mL definitively indicates iron deficiency in the absence of inflammation 2, 1. However, in patients with inflammatory conditions (IBD, CKD, heart failure), iron deficiency can exist even with ferritin levels up to 100 ng/mL 2. In these cases, confirm with transferrin saturation <20% 2.

Never supplement iron when ferritin is normal or elevated without clear indication, as this can be harmful 1. Upper safety limits are transferrin saturation 50% and ferritin 800 ng/mL 1.