This handout is for iron-deficiency anaemia (chronic — adult / pediatric / pregnancy). Your care team identified this based on: low haemoglobin on cbc (who 2024: <13 g/dl men, <12 g/dl non-pregnant women, <11 g/dl pregnancy).
Other reasons your team may use this plan: microcytic hypochromic indices (mcv <80 fl, ↑rdw) — iron studies reflex; ferritin <30 ng/ml — absolute iron deficiency (bsg 2021 pmid 34497146); fatigue / dyspnoea on exertion / pica / restless legs — iron-deficiency symptom cluster.
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| ferrous sulfate | 325 mg (≈65 mg elemental iron) | PO | once every other day, single morning dose | First-line oral repletion. Alternate-day SINGLE morning dosing maximises fractional absorption and roughly halves GI adverse effects vs split daily dosing — each dose transiently raises hepcidin and blunts the next-day dose (Stoffel Lancet Haematol 2017 PMID 29032957; Blood 2020 PMID 31413088). Expected Hb ↑ ~1 g/dL by 2 wk, ~2 g/dL by 3-4 wk; continue 3 mo after Hb normal to replete stores (target ferritin >100). BSG 2021 PMID 34497146. |
| ferrous fumarate | 210 mg (≈69 mg elemental iron) | PO | once every other day, single morning dose | Equivalent first-line oral salt; choice driven by formulary/tolerance. Same alternate-day single-dose physiology (Stoffel PMID 29032957). |
| ferrous gluconate | 324 mg (≈38 mg elemental iron) | PO | once every other day, single morning dose | Lower elemental content per tablet — used when ferrous sulfate is GI-intolerant before escalating to IV; tolerability favoured over potency (BSG 2021 PMID 34497146). |
| ascorbic acid | 250-500 mg | PO | with each iron dose | Reduces ferric to absorbable ferrous iron; modest absorption gain, of most value with achlorhydria/PPI use. Adjunct only — does not replace correct alternate-day timing. |
| ferric derisomaltose | Total replacement dose (≈20 mg/kg, up to 1000-1500 mg) single infusion | IV | single high-dose infusion, repeat per total-dose calculation | High single-dose IV iron with substantially lower hypophosphataemia than FCM (Wolf JAMA 2020: 8% vs 75%, PMID 32016310) and faster haematologic response than iron sucrose with low serious-hypersensitivity rate (FERWON-IDA PMID 31243803). Preferred IV agent when repeat dosing or phosphate-sensitive context. |
| ferric carboxymaltose | 750-1000 mg per infusion (max 1000 mg/wk; repeat ≥7 days later) | IV | one or two infusions per total-dose calculation | Effective high-dose IV iron; outcome benefit in HF with iron deficiency even without anaemia (AFFIRM-AHF PMID 33197395). CAUTION: strong hypophosphataemia signal — 75% incidence vs 8% FDI (Wolf JAMA 2020 PMID 32016310); monitor phosphate with repeat dosing or symptoms (fatigue/bone pain). |
| iron sucrose | 200 mg per infusion (≈100-200 mg sessions to total dose) | IV | multiple sessions to reach total dose | Well-established in CKD/dialysis (KDIGO 2026) and where a lower per-dose ceiling is preferred (e.g., some pregnancy protocols); requires multiple sessions to reach total dose. Slower repletion than single-dose FDI/FCM (FERWON-IDA PMID 31243803). |
| ferumoxytol | 510 mg per infusion x 2 (or 1020 mg single per label) | IV | two doses ≥3 days apart, or single per current label | High-dose IV iron alternative; rapid total-dose delivery. Note prior MRI-artefact and historical hypersensitivity considerations — administer with monitoring; reasonable where FDI/FCM unavailable. |
| packed red blood cell transfusion | — | — | — | Reserved for symptomatic/unstable anaemia only — restrictive threshold Hb 7 (8 with cardiac disease) per AABB 2023 (PMID 37824153). Transfusion does NOT treat iron deficiency — always pair with iron repletion + source workup. |
| treat underlying source (endoscopic/gynaecologic/dietary/eradication) | — | — | — | IDA is a symptom, not a disease. Definitive management = treat the source: endoscopic therapy of GI lesion, HMB management, gluten-free diet for coeliac, H. pylori eradication, dietary correction. Repletion without source control predicts recurrence (BSG 2021 PMID 34497146; AGA 2020 PMID 32810434). |
Plan: Iron repletion (oral alternate-day → IV) + cause-directed treatment
Use these zones to know what to do based on how you feel.
Call 911 or go to the nearest emergency room right away if you have:
Confirm source addressed (endoscopy result actioned, HMB managed, coeliac on gluten-free, H. pylori eradicated). Surveillance for recurrence (annual CBC ± ferritin in ongoing-risk patients), dietary counselling, vitamin-C co-administration tip, return precautions (recurrent fatigue, melaena, fresh PR bleeding). Pregnancy: confirm repletion before delivery and plan postpartum recheck. Pediatrics: re-screen at-risk infants/toddlers per schedule.
Guideline: BSG 2021 IDA in adults (Snook, Gut PMID 34497146) + AGA 2020 GI evaluation of IDA (Ko, Gastroenterology PMID 32810434) + Stoffel alternate-day iron physiology + KDIGO 2026 anaemia-in-CKD + AABB 2023 restrictive transfusion + WHO 2024 anaemia thresholds