What management is recommended for a 72-year-old male with iron deficiency, diastolic dysfunction, and peripheral hypoperfusion, taking 65 mg of Carbonyl iron (Ferrous iron) with vitamin C, and having a normal hemoglobin level?

Management of Iron Deficiency Without Anemia in a 72-Year-Old Male

Your current approach of taking 65 mg carbonyl iron once daily in the morning before eating with vitamin C is appropriate, and you do NOT need emergent IV iron infusions given your normal hemoglobin (14.0 g/dL) and functional status. 1

Your Current Regimen is Correct

• Once-daily dosing is optimal because iron increases hepcidin levels for up to 48 hours, which blocks further absorption—taking iron more frequently will not improve absorption but will increase side effects 1
• Taking iron on an empty stomach with vitamin C (as you're doing) maximizes absorption, though the evidence for vitamin C enhancement is mixed 1
• Avoid tea and coffee within an hour after taking iron as they are powerful inhibitors of iron absorption 1
• Your 65 mg dose of carbonyl iron is reasonable—carbonyl iron has been shown to be effective and safe for treating iron deficiency, with tolerable side effects 2

When IV Iron Would Be Indicated (You Don't Meet These Criteria)

IV iron is reserved for specific situations that don't apply to you 1:

• Intolerance to oral iron (you're tolerating it well)
• Lack of response to oral iron (ferritin should increase within 1 month; hemoglobin should increase by 1 g/dL within 2 weeks in anemic patients) 1
• Impaired absorption (post-bariatric surgery, active inflammatory bowel disease, celiac disease) 1, 3
• Ongoing blood loss exceeding oral iron absorption 1
• Chronic inflammatory conditions where hepcidin is upregulated (CKD, heart failure, IBD, cancer) 1, 3

Special Consideration for Your Diastolic Dysfunction

• Iron deficiency in heart failure patients (even without anemia) is associated with increased mortality, hospitalizations, and decreased functional capacity 4
• However, most evidence for IV iron benefit in heart failure is in systolic dysfunction, not diastolic dysfunction 4
• Given your normal hemoglobin and good functional status, oral iron remains appropriate while you await cardiology evaluation 1, 4

Important Safety Note: Avoid Vitamin C Supplements Beyond What's in Your Iron Pill

• Do NOT take additional vitamin C supplements beyond what's included in your carbonyl iron formulation 1
• In patients with iron overload conditions (like hemochromatosis), pharmacological doses of vitamin C can accelerate iron mobilization to dangerous levels 1
• While you have iron deficiency (not overload), this is a general precaution, especially in older adults where undiagnosed conditions may exist 1

What to Monitor While You Wait

Check these parameters with your doctor:

• Ferritin level in 1 month to confirm response to oral iron 1
• Hemoglobin in 2-4 weeks if you develop any symptoms 1
• Identify the underlying cause of your iron deficiency—this is critical at age 72 and may require gastrointestinal evaluation if no obvious source (like dietary insufficiency) is identified 1, 3

Red Flags That Would Require Urgent Evaluation

Seek immediate medical attention if you develop:

• Worsening dyspnea, chest pain, or heart failure symptoms 3, 4
• Severe fatigue limiting daily activities 3
• Signs of ongoing bleeding (black tarry stools, blood in stool, significant bruising) 3
• Lightheadedness or syncope 3

Common Pitfalls to Avoid

• Don't take iron more than once daily—this won't improve absorption and will increase side effects 1
• Don't assume oral iron failure too early—give it at least 1 month before considering IV iron 1
• Don't ignore the need to find the underlying cause—iron deficiency in a 72-year-old male warrants investigation for occult GI bleeding or malabsorption 1, 3
• Don't take additional vitamin C supplements beyond what's in your iron preparation 1