What should be done with the iron supplementation (Ferrous sulfate) for an elderly female patient with a history of anemia, who has normal hemoglobin levels, elevated ferritin levels, and is currently taking Ferrous sulfate once daily?

Discontinue Ferrous Sulfate Immediately

This patient should stop taking ferrous sulfate immediately—her iron stores are already replete with a ferritin of 592 ng/mL, and continued supplementation risks iron overload without providing any benefit. 1

Laboratory Analysis

This patient's iron studies demonstrate replete iron stores, not iron deficiency:

• Ferritin 592 ng/mL: Well above the normal range and far exceeding the treatment target 2
• Iron saturation 43%: Normal to high (normal range ~20-45%)
• Hemoglobin 12.9 g/dL: Normal for an elderly female
• TIBC 186: Low-normal, consistent with adequate iron stores

These values indicate successful iron repletion or possibly iron overload, not ongoing deficiency requiring treatment.

Guideline-Based Rationale for Stopping Iron

Iron Supplementation Should Be Time-Limited

The British Society of Gastroenterology guidelines clearly state that iron supplementation should be continued for three months after correction of anemia to replenish body stores, then discontinued 1. This patient has:

• Normal hemoglobin (12.9 g/dL)
• Markedly elevated ferritin (592 ng/mL, well above the 15 ng/mL threshold for deficiency)
• Normal iron saturation (43%)

Continuing iron beyond store repletion is not recommended and potentially harmful. 3

Risk of Iron Overload

Multiple guidelines emphasize avoiding excessive iron accumulation:

• Monitor ferritin and avoid exceeding 500 ng/L to prevent iron overload risk 2
• This patient's ferritin of 592 ng/mL already exceeds this safety threshold
• Long-term daily oral iron supplementation in the presence of normal or high ferritin values is not recommended and is potentially harmful 3

Monitoring Plan After Discontinuation

Once iron is stopped, the British Society of Gastroenterology recommends: 1

• Check hemoglobin and red cell indices every 3 months for the first year
• Then check every 6 months for 2-3 years
• Restart iron only if hemoglobin or MCV falls below normal (with ferritin confirmation in doubtful cases)

For this patient specifically:

• Recheck CBC and ferritin in 3 months
• If hemoglobin remains stable and ferritin decreases toward normal range, continue monitoring
• Only reinitiate iron if true deficiency recurs (ferritin <30 ng/mL in elderly females) 3

Common Pitfall to Avoid

Do not continue iron supplementation simply because the patient has a "history of anemia." The goal of iron therapy is to correct anemia and replenish stores—both objectives have been achieved. 1 Continuing iron in the presence of elevated ferritin (592 ng/mL) exposes the patient to unnecessary risks including:

• Gastrointestinal side effects 1
• Potential tissue iron deposition
• Oxidative stress from excess iron 3

Investigation for Underlying Cause

Since this patient previously had anemia requiring treatment, consider whether the underlying cause was identified and addressed:

• If the original cause of iron deficiency was never determined, age-appropriate evaluation may be warranted (though this should not delay stopping iron supplementation) 1
• Common causes in elderly females include gastrointestinal blood loss, dietary insufficiency, or malabsorption
• However, most patients do not experience recurrent iron deficiency after successful treatment, even when no cause is found 1