Initial Management of Iron Deficiency Anemia in Adult Males

Diagnosis and Immediate Actions

• The European Society of Gastrointestinal Endoscopy recommends verifying iron deficiency with serum ferritin, as it is the single most useful marker, and transferrin saturation can help if false-normal ferritin is suspected due to inflammation 1, 2
• A hemoglobin rise ≥10 g/L within 2 weeks of starting iron therapy confirms absolute iron deficiency, even if initial iron studies were equivocal 1, 2, 3

Iron Replacement Therapy

• The American Gastroenterological Association suggests beginning ferrous sulfate, fumarate, or gluconate one tablet daily, typically 325 mg ferrous sulfate = 65 mg elemental iron 2, 4
• The British Society of Gastroenterology recommends not deferring iron therapy while awaiting investigations unless colonoscopy is imminent 2, 4, 5

Mandatory Urgent Investigation

• The European Society of Gastrointestinal Endoscopy states that GI pathologies, including cancer, cause IDA in approximately one-third of men, making urgent investigation essential 1, 2
• A detailed history focusing on chronic blood loss, NSAID use, PPI therapy, dietary intake, previous GI surgery, family history of GI disease, and symptoms suggesting celiac disease is crucial 1, 6

First-Line GI Investigation

• The American College of Gastroenterology recommends that gastroscopy and colonoscopy should be the first-line investigations in men with newly diagnosed IDA 2, 5, 7
• The European Society of Gastrointestinal Endoscopy suggests performing small bowel biopsy during gastroscopy if celiac serology wasn't done 1, 5

Long-Term Management

• The British Society of Gastroenterology states that hemoglobin levels normalize with iron therapy in most cases, but IDA recurs in a minority on long-term follow-up 2, 5, 7
• The American Gastroenterological Association recommends considering parenteral (intravenous) iron if oral preparations are not tolerated, malabsorption is present, or there is inadequate response 4, 5