No Iron Supplementation Needed
This elderly male with hemoglobin of 13 g/dL, normal iron studies, and normal red blood cell indices does not require iron supplementation. 1
Rationale for No Supplementation
Hemoglobin is Normal
- His hemoglobin of 13 g/dL meets the threshold for normal in adult males (≥13 g/dL), so he does not have anemia by standard definitions 1
- The British Society of Gastroenterology defines anemia as hemoglobin below 130 g/L (13 g/dL) in men, and this patient meets that threshold 1
- Without anemia present, there is no indication for iron therapy 1
Iron Studies are Normal
- Normal iron studies indicate adequate iron stores and no iron deficiency 1
- Iron supplementation in the presence of normal or high ferritin values is not recommended and is potentially harmful 1, 2
- The 2020 Gastroenterology guidelines specifically state that iron deficiency anemia requires both low hemoglobin AND ferritin <45 ng/mL - this patient has neither 1
Risks of Unnecessary Supplementation
- Preventative iron administration in the presence of normal stores is inefficient, has side effects, and appears harmful 2
- Long-term iron supplementation with normal ferritin values is potentially dangerous and should be avoided 1, 2
Recommended Next Steps
Monitor Hemoglobin Periodically
- For elderly patients, check hemoglobin at least annually to monitor for development of anemia 1
- More frequent monitoring (every 3 months) would only be indicated if he develops chronic kidney disease with GFR <30 mL/min/1.73 m² 1
Investigate Only If Anemia Develops
- If hemoglobin drops below 13 g/dL in the future, then perform complete anemia workup including repeat iron studies 1
- For men who develop iron deficiency anemia, bidirectional endoscopy is strongly recommended to evaluate for gastrointestinal pathology including malignancy 1