Iron Deficiency Anemia

Iron Deficiency Anemia

 Evaluation & Management of Iron Deficiency Anemia (IDA)

Step 1. Confirm Anemia

  • Hemoglobin (Hb):
    • Men <13 g/dL
    • Women <12 g/dL
  • MCV: <80 fL → microcytic picture.

Step 2. Assess Iron Status

  • Ferritin <30 ng/mL → diagnostic of IDA (if no inflammation present).
  • Ferritin 30–100 ng/mL if chronic disease/inflammation present → check iron studies (↓serum iron, ↑TIBC, ↓transferrin saturation).
  • Ferritin >100 ng/mL → IDA unlikely → consider other causes of anemia

Step 3. Initial Management (Oral Iron)

  • First-line treatment if stable:
    • Oral ferrous sulfate 190 mg (60 mg elemental Fe) twice daily.
    • Elemental Fe dose should be between 100-200 mg daily.
    • Children: 3–6 mg/kg/day elemental iron (max 200 mg/day)
  • Start once daily, and counsel about adherence and dealing with side effects.
    • if tolerated → may increase to BID for a better response.
    • if significant side effects → reduce to once every other day.
  • Continue for 3 months after correction of Hb to replete iron stores.

Step 4. Monitor Response

  • Hb rise ≥ 1 g/dL per month = adequate response.
  • Recheck CBC + ferritin after 8–12 weeks of treatment until Hb normalize.

If Poor Response / Oral Iron Not Suitable → IV Iron Referral

  • Indications for IV iron (routine referral):
    • Intolerance or failure of oral iron after 4-6 weeks of adherence.
    • Malabsorption (IBD, celiac, bariatric surgery).
    • Chronic kidney disease on dialysis.
    • Ongoing blood loss not manageable orally.
    • Severe deficiency needing rapid repletion (e.g., late pregnancy).

Urgent Referral / Admission (for transfusion & workup)

  • Red flags needing ER referral:
    • Hb <7 g/dL (or <8 g/dL if symptomatic/elderly/with CAD).
    • Severe anemia symptoms: angina, syncope, heart failure, tachycardia.
    • Hemodynamic instability.
    • Ongoing severe bleeding (GI, uterine, etc.).
  • Urgent OPD referral is otherwise indicated for patients with severe anemia (Hb <8 g/dL) who are hemodynamically stable without severe symptoms, or with rapidly worsening Hb (> 2 g/dL drop in < 3 months without clear explanation) or if suspicious systemic features are present.

 

  

 

Prepared & reviewed by: Dr. Fahad Saad Almutairi, Dr. Bader Thuwaini Alanazi