What is the treatment for iron deficiency in teenagers?

Treatment of Iron Deficiency in Teenagers

Treat iron deficiency in teenagers with oral iron supplementation at 60-120 mg of elemental iron daily, given as a single morning dose on alternate days to maximize absorption and minimize side effects, combined with dietary counseling to increase iron-rich food intake. 1

Initial Treatment Strategy

Oral iron supplementation is the first-line treatment for iron deficiency in adolescents, with specific dosing based on severity 1, 2:

• Dosage: 60-120 mg of elemental iron daily for adolescent females with iron deficiency anemia 1
• Alternative dosing for iron deficiency without anemia: 3-6 mg/kg of elemental iron per day 2
• Timing: Administer as a single morning dose on alternate days rather than daily dosing 3
  • This alternate-day schedule maximizes fractional iron absorption because oral iron doses ≥60 mg stimulate hepcidin elevation that persists 24 hours but subsides by 48 hours 3
  • Morning dosing is preferred over afternoon/evening administration due to circadian hepcidin patterns 3

Optimizing Iron Absorption

To enhance iron absorption and tolerability 1, 4:

• Take iron between meals or on an empty stomach when possible to maximize absorption 1
• Add vitamin C (ascorbic acid) to enhance absorption, particularly if response is poor 1, 3
• If gastrointestinal side effects occur, consider taking iron with meals despite reduced absorption 1
• Try alternative formulations if tablets are not tolerated, such as ferrous gluconate, ferrous fumarate, or liquid preparations 1

Available Iron Formulations

Common ferrous salts include 5, 6, 7:

• Ferrous sulfate: 324 mg tablet contains 65 mg elemental iron (most cost-effective) 5, 2
• Ferrous gluconate: 324 mg tablet contains 38 mg elemental iron 6
• Newer formulations like ferric maltol or sucrosomial iron are available but ferrous salts remain first-line 7

Dietary Counseling

Concurrent dietary modification is essential 1, 2:

• Counsel patients to consume iron-rich foods, particularly heme iron from meat sources which has superior bioavailability compared to plant-based non-heme iron 8, 4
• Adolescents following vegetarian/vegan diets require increased total iron intake due to decreased bioavailability of non-heme iron 4
• Recommend foods rich in vitamin C with meals to enhance iron absorption 8
• The recommended daily allowance is 15 mg/day for ages 14-18 years, but athletes and those with risk factors should consume 22 mg/day 8

Monitoring and Duration

Follow-up is critical to ensure treatment success 1:

• Repeat hemoglobin measurement after 4 weeks of treatment to assess response 1
• Continue iron supplementation for an additional 2-3 months after hemoglobin normalizes to replenish iron stores 1
• Target ferritin level of ≥20 ng/mL before discontinuing therapy 4
• Reassess hemoglobin approximately 6 months after successful treatment completion 1

When Oral Iron Fails

Consider further evaluation and alternative approaches if 1:

• No response after 4 weeks despite documented compliance: Obtain additional laboratory tests including MCV, RDW, and serum ferritin 1
• Intolerance to at least two oral iron preparations 1
• Conditions with compromised absorption such as inflammatory bowel disease with active inflammation 1
• Severe and/or symptomatic iron deficiency anemia 4

Intravenous iron therapy should be reserved for these specific situations and is not first-line therapy, as it is more expensive, painful, and carries risk of anaphylactic reactions, with no faster hemoglobin rise than oral preparations in most cases 1, 4

Risk Factors Requiring Screening

Annual screening for anemia is recommended for adolescents with 8, 1:

• Heavy menstrual blood loss (≥80 mL/month), affecting approximately 10% of adolescent females 8
• Low dietary iron intake (only 25% of adolescent girls meet recommended dietary allowance) 8
• Intrauterine device use (associated with increased menstrual blood loss) 8
• Restrictive diets (vegetarian/vegan) 4
• Disordered eating habits 4
• Chronic health conditions (inflammatory bowel disease, heart failure) 4
• High-level athletic activity 8, 4

Common Pitfalls

• Avoid divided daily dosing: Multiple daily doses increase hepcidin and reduce overall absorption 3
• Do not use parenteral iron as first-line therapy unless specific contraindications to oral therapy exist 1
• Do not stop treatment when hemoglobin normalizes: Continue for 2-3 months to replenish stores 1
• Recognize that oral contraceptive use decreases iron deficiency risk in menstruating females 8