What is the significance of a patient's iron level of 37-145 mcg/dL, Total Iron-Binding Capacity (TIBC) of 228-428 mcg/dL, and iron saturation of 20-55% while on iron supplements?

From the Guidelines

The patient should continue their current iron supplementation regimen as their iron studies show normal values, with an iron level of 72 mcg/dL, total iron binding capacity (TIBC) of 349 mcg/dL, and iron saturation of 21%. Based on the most recent and highest quality study 1, oral iron supplementation is generally effective, available, inexpensive, and safe, and there is no strong evidence that any of the available oral formulations is more effective or better tolerated than the others. The patient's iron saturation, while at the lower end of normal, is still adequate, and regular monitoring of iron studies every 3-6 months would be appropriate to ensure continued effectiveness of the supplementation.

• Key points to consider:
  • Iron supplements are best absorbed when taken on an empty stomach, but if gastrointestinal side effects occur, taking them with food is acceptable 1.
  • Vitamin C co-administration is commonly recommended to improve oral absorption, although the evidence supporting this practice is limited 1.
  • The patient should be aware that iron supplements may cause dark stools and constipation, which can be managed with increased fluid intake and dietary fiber.
  • If the patient experiences gastrointestinal intolerance, consideration can be given to lower dosing or every-other-day dosing, as suggested by some studies 1.
  • It is also important to note that the patient's current iron level, TIBC, and iron saturation are within normal limits, indicating that the body has adequate iron available for essential functions like oxygen transport, energy production, and immune system support.
• Monitoring and follow-up:
  • Regular monitoring of iron studies every 3-6 months would be appropriate to ensure continued effectiveness of the supplementation.
  • Assessment for nonadherence, malabsorption, or ongoing blood loss exceeding iron intake is needed if a response to oral iron supplementation is not seen within 1 month of treatment 1.

From the FDA Drug Label

Purpose Iron Supplement Therapy Ferrous Sulphate is an iron supplement for iron deficiency and iron deficiency anemia when the need for such therapy has been determined by a physician. The patient's iron level is 37 - 145 mcg/dL, TIBC is 228 - 428 mcg/dL, and iron saturation is 20 - 55 %. Given the patient's low iron saturation of 21%, it appears that the patient may have iron deficiency. The patient is on an iron supplement, which is indicated for iron deficiency and iron deficiency anemia 2. Continuation of iron supplement therapy may be necessary to address the patient's iron deficiency.

From the Research

Iron Supplement Component Ref Range & Units

• The patient's iron level is 72 mcg/dL, which is below the reference range of 37 - 145 mcg/dL [(3,4,5,6,7)].
• The patient's TIBC (Total Iron Binding Capacity) level is 349 mcg/dL, which is above the reference range of 228 - 428 mcg/dL [(3,4,5,6,7)].
• The patient's iron saturation level is 21%, which is below the reference range of 20 - 55% [(3,4,5,6,7)].

Treatment Options

• Intravenous iron preparations can facilitate rapid iron repletion in one or two doses, both for absolute iron deficiency and functional iron deficiency [(3,5)].
• Oral iron therapy is often recommended as first-line treatment, but there is no consensus on the optimal formulation, dosing strategy, or which patients should be treated preferentially with intravenous iron [(4,7)].
• The use of intravenous iron may be preferred when rapid correction of the iron deficit is required, or in patients with intolerance or unresponsiveness to oral iron [(5,6)].

Considerations for Treatment

• Iron deficiency treatment selection is driven by several factors, including the presence of inflammation, the time available for iron replenishment, and the anticipated risk of side-effects or intolerance [(3,5,6)].
• Adverse events occurring with intravenous iron can be anticipated according to when they typically occur, which provides a basis for educating and preparing staff and patients on how iron infusions can be administered safely and efficiently [(3,5)].
• The main treatment target for intravenous iron is an improvement of the quality of life, for which hemoglobin is a surrogate marker 5.