Overview of management of iron deficiency

The management of iron deficiency involves the correction of iron deficiency using iron supplementation, and identification and treatment of the underlying cause of the iron deficiency (eg dietary insufficiency, heavy menstrual bleeding). Red blood cell transfusion may also be required for some patients.

Iron supplementation should be given to all patients with iron deficiency (ie low serum ferritin) anaemia (ie low haemoglobin concentration). Consider using iron supplementation in patients with iron deficiency without anaemia as there is some evidence that this improves symptomsSoppi, 2018.

Iron supplementation can be given either orally or intravenously. Oral and intravenous iron supplementation are equally effective in increasing haemoglobin concentration in patients with iron deficiencyBager, 2014. Oral iron therapy is safe (at the recommended dose) and cheap, but is often associated with gastrointestinal adverse effects, which reduce adherenceBager, 2014. Intravenous therapy allows rapid replacement of iron and is appropriate for patients with symptomatic anaemia, anaemia associated with malignancy, patients who do not tolerate or cannot absorb oral iron (eg after gastrectomy, or occasionally, after bariatric surgery), people with chronic kidney disease and for most iron-deficient patients with inflammatory bowel diseaseRichards, 2021.

Increasing dietary intake of iron is not sufficient to correct iron-deficiency anaemia. However, after iron stores are replenished, advise patients to increase their dietary intake (if low) of iron to prevent iron deficiency recurring if poor iron intake has been a contributing factor.

Generally, red blood cell transfusion alone is not an appropriate treatment for iron-deficiency anaemia. Blood transfusions may be used for decompensated patients (eg those with heart failure or angina) who are too unwell to wait for the predictable increase in haemoglobin from iron supplementation. When determining if a blood transfusion is indicated, it is important to consider the clinical situation, rather than making a decision based on haemoglobin and ferritin concentration alone. Severe anaemia caused by iron deficiency can be quite well tolerated, because it has developed slowly. In the very rare situation where a blood transfusion is indicated, iron supplementation is still necessary to prevent recurrence of iron-deficiency anaemiaNixon, 2018.