Treatment of Iron Deficiency Anemia
Start oral ferrous sulfate 200 mg once daily on an empty stomach, add vitamin C 500 mg with each dose to enhance absorption, and continue for 3 months after hemoglobin normalizes to replenish iron stores. 1
Immediate Treatment Approach
Your labs show classic iron deficiency anemia: low iron (32), elevated TIBC (175), low iron saturation (18.43%), and low hemoglobin (12.4 g/dL). This pattern indicates depleted iron stores with compensatory increase in transferrin production.
Oral iron is first-line therapy for mild-to-moderate iron deficiency anemia when disease is clinically inactive and no prior intolerance exists. 2
Specific Oral Iron Regimen
- Ferrous sulfate 200 mg (containing 65 mg elemental iron) once daily is the preferred formulation due to effectiveness and low cost 1, 3
- Take on an empty stomach for optimal absorption, though taking with food is acceptable if gastrointestinal side effects occur 1
- Add vitamin C (ascorbic acid) 500 mg with each iron dose to enhance absorption—this is particularly critical given your severely low transferrin saturation of 18.43% 1
- Once-daily dosing is superior to multiple daily doses, improving tolerability while maintaining effectiveness 1, 4
- Consider alternate-day dosing (120 mg every other day) if daily dosing causes intolerable side effects, as this maximizes fractional absorption 4
Expected Response and Monitoring
- Hemoglobin should rise by approximately 2 g/dL after 3-4 weeks of treatment 1
- If no response occurs within 4 weeks, assess for non-adherence, malabsorption, or ongoing blood loss 1
- Continue oral iron therapy for 3 months after anemia correction to fully replenish iron stores 1
- Monitor hemoglobin and red cell indices every 3 months for the first year, then again after another year 1
When to Switch to Intravenous Iron
Consider IV iron if you meet any of these criteria:
- Intolerance to at least two different oral iron preparations (ferrous sulfate, ferrous gluconate, or ferrous fumarate) 1
- Hemoglobin below 10 g/dL (yours is 12.4 g/dL, so this does not apply) 2
- Inadequate response to oral iron after 4 weeks of appropriate therapy 1
- Conditions affecting iron absorption such as inflammatory bowel disease with active inflammation, celiac disease with ongoing gluten exposure, or post-bariatric surgery 1
IV iron formulations that can replace deficits with 1-2 infusions are preferred, such as ferric carboxymaltose (500-1000 mg single doses) 1
Identify and Treat Underlying Cause
You must investigate the source of iron deficiency while supplementing:
- For premenopausal women, assess menstrual blood loss first, as menorrhagia accounts for iron deficiency in 5-10% of menstruating women 1
- Screen for celiac disease with antiendomysial antibody and IgA measurement, as this is a common cause of malabsorption 1
- For men and postmenopausal women, perform bidirectional endoscopy (upper endoscopy and colonoscopy) to evaluate for gastrointestinal blood loss 2
- Test for H. pylori and celiac disease non-invasively before proceeding to endoscopy 2
Critical Pitfalls to Avoid
- Do not use multiple daily doses—once-daily or alternate-day dosing is better tolerated with similar efficacy 1
- Do not stop iron therapy when hemoglobin normalizes—continue for 3 months to replenish stores 1
- Do not overlook vitamin C supplementation when oral iron response is suboptimal, as this significantly enhances absorption 1
- Do not fail to identify and treat the underlying cause while supplementing iron 1
- Do not continue oral iron indefinitely without response—reassess after 4 weeks and switch to IV iron if hemoglobin fails to rise 1
Failure to Respond
If anemia does not resolve within 6 months despite appropriate iron therapy: