What is the appropriate iron supplementation regimen for a 14‑year‑old female, 5 ft 5 in tall, weighing 120 lb, with hemoglobin 107 g/L and mean corpuscular volume 70 fL?

Iron Supplementation for Adolescent Female with Microcytic Anemia

This 14-year-old female should receive oral iron supplementation at a dose of 60-120 mg of elemental iron daily, taken between meals, with dietary counseling to address underlying iron deficiency. 1

Clinical Context

This patient presents with:

• Hemoglobin 107 g/L (10.7 g/dL) – mild anemia by WHO criteria (anemia in females ≥15 years is Hb <12 g/dL, but for adolescent girls 12-15 years, <11.5 g/dL is often used) 1
• MCV 70 fL – significant microcytosis indicating iron deficiency anemia 1
• Age 14 years – high-risk period due to menstruation, growth demands, and potentially inadequate dietary iron intake 1

The combination of low hemoglobin with marked microcytosis (MCV 70 fL) strongly suggests iron deficiency anemia as the presumptive diagnosis. 1

Recommended Treatment Regimen

Initial Therapy

• Prescribe 60-120 mg elemental iron daily as oral supplementation 1
• Administer between meals to optimize absorption 1
• Consider adding vitamin C (ascorbic acid) to enhance iron absorption if response is suboptimal 1
• Provide dietary counseling emphasizing iron-rich foods (heme iron from meat is better absorbed than non-heme iron from plants) 1

Practical Dosing Options

Standard ferrous sulfate tablets contain approximately 60 mg elemental iron per 325 mg tablet. 2 Ferrous gluconate (324 mg tablet = 38 mg elemental iron) is an alternative if ferrous sulfate is not tolerated. 2 For this patient, one to two 60-mg iron tablets daily represents the appropriate range. 1

Follow-Up Protocol

4-Week Reassessment

• Repeat hemoglobin measurement at 4 weeks 1
• Expected response: Hemoglobin increase ≥1 g/dL (≥10 g/L) confirms iron deficiency anemia diagnosis 1
• If adequate response: Continue iron therapy for 2-3 additional months to replenish iron stores 1
• If inadequate response despite compliance: Obtain additional testing including MCV, RDW, and serum ferritin to evaluate for alternative causes or malabsorption 1

Long-Term Management

• Recheck hemoglobin after completing the full treatment course 1
• Reassess approximately 6 months after successful treatment completion 1
• Annual screening is reasonable given her risk factors (adolescent female with history of iron deficiency) 1

Important Considerations

Dietary Optimization

The USDA recommends 15 mg/day dietary iron for girls aged 14-18 years, though adolescent females with menstruation or athletic activity may require higher intake (up to 22 mg/day for highly active females). 1 Emphasize:

• Heme iron sources (red meat, poultry, fish) for better absorption 1
• Iron absorption enhancers (vitamin C-rich foods) 1
• Avoiding iron inhibitors (excessive dairy, tea, coffee with meals) 1

When to Investigate Further

If after 4 weeks there is no response to oral iron despite documented compliance and absence of acute illness, further evaluation is warranted including: 1

• Serum ferritin (<15 μg/L confirms iron deficiency) 1
• Complete iron panel (serum iron, transferrin saturation, TIBC) 1
• Consider celiac disease screening in refractory cases 1
• Evaluate for ongoing blood loss (particularly menorrhagia) 1

Common Pitfalls to Avoid

• Do not delay treatment waiting for ferritin results when clinical presentation strongly suggests iron deficiency anemia 1
• Do not use intravenous iron as first-line therapy unless oral iron is not tolerated or absorbed 1
• Do not stop iron supplementation once hemoglobin normalizes; continue for 2-3 months to replenish stores 1
• Do not assume treatment failure without confirming compliance, as adherence is a common issue with oral iron 1

Alternative Formulations

If gastrointestinal side effects occur with standard ferrous sulfate:

• Try alternate oral preparations (ferrous gluconate, ferrous fumarate) 1
• Consider liquid preparations if tablets are not tolerated 1
• Recent evidence suggests intermittent dosing (every other day) may be as effective with fewer side effects, though this is primarily studied in pregnancy 3