Microcytic hypochromic; fatigue, pica, koilonychia
Order: Iron, TIBC, ferritin + peripheral smear → ↓iron, ↑TIBC, ↓ferritin (ferritin = most accurate)
Treat: Ferrous sulfate 325 mg PO (65 mg elemental) daily/QOD w/ vitamin C; continue 3–6 mo after normalizing
Adult (esp. male / postmenopausal) → find source: Colonoscopy / endoscopy (GI malignancy until proven otherwise)
Order set
- FBC, film
- Iron studies (ferritin, TSAT)
- Reticulocytes
- Coeliac serology
- FOB/endoscopy if adult
Criteria
AdmitSymptomatic severe anaemia / active bleeding
TransfuseHb <70 g/L (or symptomatic/cardiac)
DischargeHaemodynamically stable, oral iron started, source workup arranged
Clinical detail — differentials, red flags, pitfalls, disposition
Red flags
- GI bleeding
- Weight loss
- Postmenopausal/male → exclude malignancy
Differentials
- Thalassaemia trait
- Anaemia of chronic disease
- Sideroblastic
Common mistakes
- Treating without finding the source
- Missing coeliac
Disposition & follow-up
Oral iron + source workup; recheck FBC 2–4 wk.
Discharge package
MedicationsOral iron 3–6 months after normalisation
Follow-upRecheck FBC 2–4 wk; complete source workup
LifestyleIron-rich diet, vitamin C with iron
Warning symptomsOngoing bleeding, fatigue, melaena
💊 Treatment detail — doses & preparation
Ferrous sulfateoral iron
Dose325 mg (65 mg elemental) OD or alternate days on empty stomach + vitamin C
Preparation325 mg tablets/elixir; alternate-day dosing absorbs better (hepcidin)
MonitorHb in 2–4 wk (reticulocytes by day 7); GI upset, black stools — counsel
Ferric carboxymaltoseIV iron
Dose500–1000 mg IV over 15–30 min (intolerance/non-response to oral; preferred in IBD/CKD/bariatric surgery or ongoing blood loss)
PreparationDilute 1000 mg in 250 mL NS, infuse with observation
MonitorPhosphate (transient ↓), hypersensitivity; Hb at 4–8 wk
Transfusion thresholdsupportive
DoseTransfuse only if Hb very low + symptomatic/cardiac — iron repletion is the fix
PreparationCrossmatch, give 1 unit then reassess
MonitorHb increment ~10 g/L per unit
📖 BSH Iron DeficiencyReviewed July 2026