Treatment of Iron-Deficiency Anemia

Introduction to Treatment

Oral iron supplementation is the first-line treatment for slightly anemic patients with iron-deficiency anemia who have clinically inactive disease and no prior intolerance to oral iron 1, 2, 3

The American Gastroenterological Association recommends oral iron for patients with mild anemia (hemoglobin >100 g/L or >10 g/dL), clinically inactive disease, and no previous intolerance to oral preparations 1, 2, 4
The European Crohn’s and Colitis Organisation suggests switching to intravenous iron as first-line treatment when hemoglobin is below 100 g/L (10 g/dL), clinically active inflammatory disease is present, or previous intolerance to oral iron occurred 1, 2, 4, 5, 6, 7

An acceptable speed of response is ≥2 g/dL hemoglobin increase within 4 weeks, as recommended by the Journal of Crohn's and Colitis 5, 6, 7

For patients with hemoglobin 100-120 g/L (women) or 100-130 g/L (men), the recommended total dose is 1000 mg for body weight <70 kg and 1500 mg for body weight ≥70 kg, according to Clinical Nutrition 4, 8
For patients with hemoglobin 70-100 g/L, the recommended total dose is 1500 mg for body weight <70 kg and 2000 mg for body weight ≥70 kg, as suggested by Clinical Nutrition 4, 8

The goal of treatment is to normalize both hemoglobin levels and iron stores, not just correct anemia, as recommended by Clinical Nutrition 1, 2, 4
Re-treatment should be initiated when serum ferritin drops below 100 μg/L or hemoglobin falls below 12 g/dL (women) or 13 g/dL (men), according to Clinical Nutrition 4, 8

The European Crohn’s and Colitis Organisation recommends avoiding the use of oral iron in patients with active inflammation, as absorption is compromised and intravenous iron is more effective 5, 9, 7
The Journal of Crohn's and Colitis suggests not using iron dextran preparations without test dosing, as they carry a risk of serious anaphylactic reactions 5, 6, 7