How do you treat low ferritin (iron) levels with iron supplementation?

From the Guidelines

Low ferritin levels should be treated with oral iron supplementation as the first-line treatment, with intravenous iron formulations considered for those who cannot tolerate oral iron or have conditions where oral iron is not likely to be absorbed. The standard treatment for low ferritin levels involves oral iron supplements, such as ferrous sulfate (200 mg twice daily) or ferrous fumarate (200 mg), which can help correct anaemia and replenish body stores 1. It is essential to continue oral iron supplementation for 3 months after the iron deficiency has been corrected to ensure that stores are replenished 1. For patients who cannot tolerate oral iron or have conditions where oral iron is not likely to be absorbed, intravenous iron formulations like iron sucrose or ferric carboxymaltose may be used 1.

Some key points to consider when treating low ferritin levels include:

• Oral iron supplements should be taken on an empty stomach with vitamin C to enhance absorption, and away from calcium, dairy, coffee, tea, and antacids which can reduce absorption.
• Treatment usually continues for 3-6 months, even after blood counts normalize, to replenish iron stores.
• Side effects may include constipation, nausea, and black stools.
• Regular monitoring of ferritin levels is important to assess treatment effectiveness.
• The underlying cause of iron deficiency should also be identified and addressed, whether it's blood loss, poor dietary intake, or malabsorption.

Intravenous iron supplementation is indicated if a patient cannot tolerate oral iron or if blood counts or iron stores do not improve with oral iron supplementation 1. Several different formulations of IV iron are available, and those that can replace iron deficits with 1 to 2 infusions are preferred 1. However, IV iron is substantially more expensive than oral formulations, and its use should be reserved for patients who meet specific criteria, such as those with impaired absorption or active inflammatory bowel disease (IBD) 1.

From the FDA Drug Label

Following intravenous administration, Venofer is dissociated into iron and sucrose and the iron is transported as a complex with transferrin to target cells including erythroid precursor cells. Increases in mean hemoglobin, hematocrit, serum ferritin and transferrin saturation were observed from baseline to end of treatment in patients with iron deficiency and Hemodialysis Dependent-Chronic Kidney Disease (HDD-CKD) who received Venofer.

Treatment of low ferritin with iron: Yes, iron supplementation is used to treat low ferritin levels. The provided drug label text indicates that Venofer, an intravenous iron formulation, increases serum ferritin levels in patients with iron deficiency and HDD-CKD.

• Key points:
  • Venofer is dissociated into iron and sucrose after administration.
  • Iron is transported to target cells, including erythroid precursor cells.
  • Increases in serum ferritin and other hematologic parameters are observed after treatment with Venofer. 2

From the Research

Diagnosis and Treatment of Low Ferritin

• Low ferritin levels are typically diagnosed by a serum ferritin concentration of less than 30 ng/mL in individuals without inflammatory conditions or by transferrin saturation less than 20% 3.
• The most common causes of iron deficiency are bleeding, impaired iron absorption, inadequate dietary iron intake, and pregnancy 3, 4.
• Oral iron supplementation is typically the first-line therapy for treating iron deficiency, with ferrous sulfate 325 mg/d or on alternate days being a common regimen 3.
• Intravenous iron is indicated for patients with oral iron intolerance, poor absorption, chronic inflammatory conditions, ongoing blood loss, and during the second and third trimesters of pregnancy 3, 5.

Guidelines for Iron Deficiency Treatment

• Guidelines on the diagnosis and treatment of iron deficiency vary widely across indications, but most recommend a serum ferritin concentration of 100 μg/L or higher as a target for treatment 6.
• The treatment targets for iron deficiency include an increase in hemoglobin concentrations to 10-12 g/dL or normalization, and serum ferritin greater than 100 μg/L or 200 μg/L 6.
• Transferrin saturation is also used as a target, with proposed thresholds ranging from 20% to 50% 6.

Ferritin Reference Intervals

• Ferritin reference intervals vary significantly between clinical laboratories, with some reporting lower limits well below 15 µg/L 7.
• A study found that the 90th percentile ferritin cutoff to identify iron deficiency anemia in adults was 24 µg/L in female patients and 25 µg/L in male patients 7.
• The study also found that menopausal status had a significant effect on median ferritin values, which increased 2- to 3-fold in the postmenopausal state 7.