From the Guidelines
Oral iron supplementation with ferrous sulfate 200 mg (containing 65 mg elemental iron) once daily is the recommended initial treatment for a hemoglobin (Hgb) of 10.4 g/dL with iron saturation of 11%. This recommendation is based on the British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults 1. The guidelines suggest that a once daily dose of 50–100 mg of elemental iron may be the best compromise option for initial treatment.
Key Considerations
- The optimal drug, dosage, and timing of oral iron replacement therapy (IRT) for adults with iron deficiency anaemia (IDA) are not clearly defined, but ferrous sulfate is a commonly used and effective option 1.
- It is essential to monitor the initial haematological response and modify the treatment as appropriate in case of apparent therapeutic failure 1.
- The absence of an Hb rise of at least 10 g/L after 2 weeks of daily oral IRT is strongly predictive of subsequent failure to achieve a sustained haematological response 1.
- Regular Hb monitoring is recommended to ensure an ultimately satisfactory response, with the optimal interval being every 4 weeks until the Hb is in the normal range 1.
Treatment Duration and Iron Repletion
- Treatment typically continues for 3-6 months to replenish iron stores even after hemoglobin normalizes 1.
- The duration required for iron repletion and the appropriate measure of true iron repletion are both unclear, but 2 months of continued iron may be sufficient in healthy, almost iron-replete subjects 1.
Alternative Options
- For patients with significant intolerance to oral IRT, oral ferric maltol, alternate day oral iron, and parenteral iron are alternative options 1.
- Parenteral iron is more effective than continuing traditional oral therapy in patients with chronic disease, continuing blood loss, impaired absorption, or GI inflammatory pathology 1.
From the FDA Drug Label
2 DOSAGE & ADMINISTRATION Venofer must only be administered intravenously either by slow injection or by infusion. The dosage of Venofer is expressed in mg of elemental iron. Each mL contains 20 mg of elemental iron.
- 3 Adult Patients with Non-Dialysis Dependent-Chronic Kidney Disease (NDD-CKD) Administer Venofer 200 mg undiluted as a slow intravenous injection over 2 to 5 minutes or as an infusion of 200 mg in a maximum of 100 mL of 0. 9% NaCl over a period of 15 minutes. Administer on 5 different occasions over a 14 day period.
The patient has a hemoglobin (Hgb) level of 10.4 with an iron saturation of 11, indicating iron deficiency anemia.
- The treatment for iron deficiency anemia with Venofer (iron sucrose) is intravenous iron supplementation.
- For adult patients with Non-Dialysis Dependent-Chronic Kidney Disease (NDD-CKD), the recommended dose is 200 mg administered on 5 different occasions over a 14 day period.
- The treatment may be repeated if iron deficiency reoccurs 2.
From the Research
Treatment for Hgb of 10.4 with Iron Saturation of 11
- The patient's hemoglobin (Hgb) level is 10.4, which is below the normal range, indicating anemia 3.
- The iron saturation level is 11, which is low, suggesting iron deficiency anemia.
- According to a study published in TheScientificWorldJournal, oral iron supplementation is a cheap, safe, and effective means of increasing Hgb levels and restoring iron stores 4.
- Ferrous sulfate is a commonly used iron supplement for the correction of iron-deficiency anemia, but it can have gastrointestinal side effects 5.
- Lactoferrin supplementation has been shown to have better effects on serum iron, ferritin, and Hgb concentration compared to ferrous sulfate, with fewer side effects 5.
- A study published in the Nutrition journal found that supplementing with 30 mg/day of elemental iron, either as ferrous sulfate or iron bis-glycinate chelate, showed positive effects on increasing ferritin concentration in schoolchildren with low iron stores 6.
Treatment Options
- Oral iron supplementation with ferrous sulfate or lactoferrin can be considered to increase Hgb levels and restore iron stores 4, 5.
- Recombinant erythropoietin may also be an option to raise Hgb levels, especially for patients who decline blood transfusion 7, 3.
- It is essential to monitor the patient's response to treatment and adjust the therapy as needed to achieve optimal Hgb levels and improve quality of life 3.