Treatment of iron deficiency in nonpregnant adults

This algorithm applies to individuals with iron deficiency, with or without anemia. We treat all individuals who have iron deficiency anemia and most who have iron deficiency without anemia. For oral iron, alternate-day dosing facilitates absorption and reduces adverse effects; however, some patients may reasonably take their dose daily rather than every other day if preferred. Refer to UpToDate for efficacy and adverse effects of different oral and intravenous iron formulations and supporting evidence. There is a separate algorithm in UpToDate for managing iron deficiency in pregnancy.

RBC: red blood cell; IV: intravenous.

* Severe anemia generally refers to a hemoglobin level of <7 to 8 g/dL or anemia with symptoms of hemodynamic compromise or cardiac ischemia. RBC transfusion is the fastest way to raise the hemoglobin level in these individuals, although some people may tolerate lower hemoglobin levels without transfusion and may reasonably decline transfusions for asymptomatic or mildly symptomatic anemia with a hemoglobin in this range. One unit of RBCs contains approximately 200 mg of iron, which is unlikely to completely replete body iron stores.

¶ Some experts will give a trial of oral iron first before using IV iron, especially if resources or facilities for administering IV iron are limiting. IV iron provides full replacement much more rapidly than oral iron and does not cause gastrointestinal side effects. IV iron can be given in the second and third trimesters of pregnancy but not the first trimester (due to lack of safety data in the first trimester). Concerns about anaphylaxis with IV iron mainly apply to a formulation that is no longer available. Minor infusion reactions such as flushing and myalgias occur in <1% of individuals and are generally treated by pausing the infusion.

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Treatment of iron deficiency in nonpregnant adults