What is the recommended iron dosage for a 46-year-old female with moderate anemia?

Iron Dosing for Moderate Anemia in a 46-Year-Old Female

For a 46-year-old woman with hemoglobin 9.0 g/dL, prescribe oral iron supplementation at 60-120 mg of elemental iron daily, continuing treatment for 2-3 months after hemoglobin normalizes. 1

Initial Treatment Approach

Start with oral iron therapy at 60-120 mg of elemental iron per day. 1 This is the CDC's recommended dose for treating anemia in nonpregnant women of childbearing age with presumed iron-deficiency anemia.

Practical Dosing with Ferrous Sulfate

• Each ferrous sulfate 324 mg tablet contains 65 mg of elemental iron 2
• Administer 1-2 tablets daily (providing 65-130 mg elemental iron) to achieve the recommended 60-120 mg range 2
• Take tablets whole without crushing or chewing 2
• Alternative dosing: 100-200 mg elemental iron daily is also supported, with lower doses if side effects occur 3

Concurrent Dietary Counseling

Counsel the patient about correcting iron deficiency through dietary modifications in addition to supplementation. 1 Iron-rich foods and foods that enhance iron absorption should be emphasized.

Follow-Up Protocol

Initial Response Assessment

• Recheck hemoglobin after 4 weeks of treatment 1
• Expected response: hemoglobin should increase by at least 1 g/dL 1
• If no response despite compliance and absence of acute illness, proceed to further evaluation 1

Extended Treatment Duration

Continue iron supplementation for 2-3 months after hemoglobin normalizes to replenish iron stores. 1 This extended duration is critical and distinguishes treatment in women of childbearing age from other populations.

When to Escalate Evaluation

Non-Response Criteria

If anemia persists after 4 weeks of compliant therapy:

• Order additional laboratory tests: MCV, RDW, and serum ferritin 1
• Consider hemoglobinopathies (thalassemia minor, sickle cell trait) particularly in women of African, Mediterranean, or Southeast Asian ancestry 1
• Evaluate for malabsorption (celiac disease, atrophic gastritis), chronic inflammation, or ongoing blood loss 3

Alternative: Intravenous Iron

When to Consider IV Iron

Intravenous iron should be considered if:

• Oral iron causes intolerable side effects 3
• Oral therapy lacks efficacy despite compliance 3
• Intestinal malabsorption is present 3
• Rapid correction is needed (though less urgent at Hb 9.0 g/dL) 4

IV Iron Dosing Protocol

• Calculate total iron deficit: Weight (kg) × (Target Hb - Actual Hb) × 2.4 + 500 mg for stores 4
• Iron sucrose maximum single dose: 200 mg per session, administered IV over 10 minutes 4
• Dosing schedule: 200 mg twice weekly until total calculated deficit is administered 4
• Monitor vital signs during and for 30 minutes after infusion due to hypersensitivity risk 4

Common Pitfalls to Avoid

• Do not stop treatment when hemoglobin normalizes—continue for 2-3 additional months to replenish stores 1
• Do not assume all anemia is iron-deficiency—confirm diagnosis and evaluate non-responders thoroughly 1, 3
• Do not overlook underlying causes—investigate for sources of blood loss, malabsorption, or chronic disease 3, 5
• Oral iron side effects (22-29% incidence) can be mitigated by reducing dose or switching to IV formulation 4, 3