## Iron Deficiency Anemia — First-Line Treatment ### Clinical Diagnosis The patient presents with classic features of iron deficiency anemia: - **Microcytic, hypochromic RBCs** (MCV 58 fL, normal 80–100 fL) - **Low serum ferritin** (8 ng/mL; normal >30 ng/mL in women) - **Low serum iron** (35 μg/dL; normal 50–150 μg/dL) - **Symptoms**: fatigue, dyspnea on exertion ### First-Line Iron Replacement **Key Point:** Ferrous sulfate 325 mg once daily (equivalent to ~65 mg elemental iron) is the standard first-line oral iron replacement therapy for iron deficiency anemia. **High-Yield:** Ferrous salts are preferred over ferric salts because they are better absorbed in the acidic environment of the proximal small intestine. Ferrous sulfate is the most cost-effective and widely used formulation. ### Dosing & Administration | Parameter | Detail | |-----------|--------| | **Standard dose** | 325 mg ferrous sulfate once daily (or divided BID if GI intolerance) | | **Elemental iron content** | ~65 mg per 325 mg tablet | | **Expected Hb rise** | 1–2 g/dL per week if compliant | | **Duration of therapy** | 3–6 months (until Hb normalizes + 3 months to replete iron stores) | | **Best absorption** | On empty stomach, 1 hour before food; vitamin C enhances absorption | ### Common Side Effects & Management **Clinical Pearl:** GI side effects (nausea, constipation, abdominal discomfort) occur in 10–20% of patients. If intolerant: - Reduce dose to 325 mg alternate days or BID with meals - Switch to ferrous gluconate (milder GI profile) - Consider parenteral iron if severe intolerance or malabsorption ### Monitoring Response **Tip:** Assess response at 2–4 weeks: - Reticulocyte count should rise (peak at 5–7 days) - Hemoglobin should increase by 1–2 g/dL per week - If no response → investigate compliance, ongoing blood loss, or malabsorption [cite:Harrison 21e Ch 97]
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