Iron Deficiency Anemia Diagnosis and Management

Diagnostic Criteria

The American Gastroenterological Association recommends that a ferritin level of 37 μg/L falls below the 45 μg/L threshold, providing optimal sensitivity and specificity for iron deficiency in clinical practice 1, 2
A mean corpuscular volume (MCV) of 73.5 fL and mean corpuscular hemoglobin (MCH) of 24.2 pg are characteristic of iron deficiency, with MCH being a more reliable marker than MCV 1
Hemoglobin levels of 12.4 g/dL with hematocrit 37.6% represent mild anemia that warrants investigation when accompanied by confirmed iron deficiency 1

The American College of Gastroenterology recommends that men with hemoglobin <110 g/L or non-menstruating women with hemoglobin <100 g/L should be referred for gastrointestinal evaluation 1, 2
Investigation for gastrointestinal blood loss should be considered in patients with confirmed iron deficiency, especially with more severe degrees of anemia 1

The American Gastroenterological Association recommends oral ferrous sulfate 200 mg three times daily for at least three months after correction of anemia to replenish iron stores 2
Alternative formulations include ferrous gluconate or ferrous fumarate if ferrous sulfate is not tolerated, and adding ascorbic acid can enhance iron absorption 2
A good response to iron therapy is defined as a hemoglobin rise ≥10 g/L within 2 weeks, which confirms iron deficiency 2, 3

The American College of Gastroenterology recommends monitoring hemoglobin concentration and red cell indices at three-monthly intervals for one year, then after a further year 2
Serum ferritin and transferrin saturation should be checked to assess iron store repletion, and additional oral iron should be provided if hemoglobin or MCV falls below normal 2