Iron Deficiency Anemia

• Hemoglobin: Men <13 g/dL · Women <12 g/dL.
• MCV: <80 fL → microcytic picture.

• Ferritin <30 ng/mL → diagnostic of IDA (if no inflammation).
• Ferritin 30–100 ng/mL with chronic disease/inflammation → check iron studies (↓ serum iron, ↑ TIBC, ↓ transferrin saturation).
• Ferritin >100 ng/mL → IDA unlikely; consider other causes.

• First-line if stable: Oral ferrous sulfate 190 mg (60 mg elemental Fe) BID.
• Elemental Fe dose should be 100–200 mg daily.
• Children: 3–6 mg/kg/day elemental iron (max 200 mg/day).
• Start once daily; counsel on adherence and side effects.
  • Tolerated → may increase to BID for better response.
  • Significant side effects → reduce to every-other-day.
• Continue for 3 months after correction of Hb to replete stores.

• Hb rise ≥1 g/dL per month = adequate response.
• Recheck CBC + ferritin after 8–12 weeks until Hb normalizes.

Indications for IV iron (routine referral):

• Intolerance or failure of oral iron after 4–6 weeks of adherence.
• Malabsorption (IBD, celiac, bariatric surgery).
• CKD on dialysis.
• Ongoing blood loss not manageable orally.
• Severe deficiency needing rapid repletion (e.g., late pregnancy).

Red flags needing ER referral:

• Hb <7 g/dL (or <8 g/dL if symptomatic/elderly/CAD).
• Severe anemia symptoms: angina, syncope, heart failure, tachycardia.
• Hemodynamic instability.
• Ongoing severe bleeding (GI, uterine, etc.).

Urgent OPD referral for severe anemia (Hb <8 g/dL) hemodynamically stable, rapidly worsening Hb (>2 g/dL drop in <3 months without clear cause), or suspicious systemic features.