22nd May 2023

Treatment of iron deficiency anaemia

It is important that a cause for the iron deficiency is investigated and that the underlying cause is treated, if identified.

Iron deficiency itself can be treated with oral or intravenous iron therapy. Blood transfusion may also be required in cases of severe anaemia (Hb <70g/L, or <80g/L in select patients) or in cases causing cardiovascular compromise.

Oral iron replacement with ferrous sulfate or ferrous gluconate is commonly used. Concomitant intake of calcium, tea, coffee, wine, or antacids reduces its absorption. Gastrointestinal intolerance to oral iron is common, and patients may experience nausea, constipation, and black discolouration of stool. If oral iron is tolerated, treatment is given for 3 months after the normalisation of blood tests, to ensure replacement of iron stores.

Intravenous iron can be considered if oral iron is not tolerated, failure to respond to oral iron, or in cases of intestinal malabsorption. Intravenous iron can cause anaphylaxis and therefore patients are closely monitored in an appropriate setting throughout the iron infusion.