---
title: Iron Deficiency Anemia Workup
description: A comprehensive guide to the clinical evaluation and management of iron deficiency anemia.
keywords: [iron deficiency, anemia, hemoglobin, ferritin, transferrin, treatment]
category: clinical
---

## Definition and Epidemiology

Iron deficiency anemia (IDA) is a common condition characterized by a reduction in the body's iron stores, leading to decreased hemoglobin production and subsequent anemia. IDA is the most prevalent form of anemia worldwide, affecting an estimated 1.62 billion people globally, with the highest burden in developing countries and among women and children.

## Diagnostic Criteria

The diagnosis of IDA is based on a combination of clinical history, physical examination, and laboratory testing. The key diagnostic criteria are:

1. Decreased hemoglobin (Hb) levels:
   - Hb < 13 g/dL in adult males
   - Hb < 12 g/dL in adult non-pregnant females
   - Hb < 11 g/dL in pregnant females

2. Decreased serum ferritin levels:
   - Ferritin < 30 ng/mL (adults)
   - Ferritin < 12 ng/mL (children)

3. Decreased transferrin saturation (TSAT):
   - TSAT < 20%

4. Microcytic, hypochromic red blood cell morphology on peripheral blood smear.

## Etiology and Workup

The underlying causes of IDA are diverse and may include:

1. Gastrointestinal blood loss:
   - Peptic ulcer disease, inflammatory bowel disease, colorectal cancer, hemorrhoids
2. Menstrual blood loss
3. Malabsorption:
   - Celiac disease, atrophic gastritis, bariatric surgery
4. Dietary deficiency:
   - Vegetarian or vegan diet, poverty, malnutrition
5. Increased iron requirements:
   - Pregnancy, lactation, growth spurts in children

A comprehensive workup should include:

1. Complete blood count (CBC) with red cell indices
2. Serum ferritin, iron, total iron-binding capacity (TIBC), and TSAT
3. Occult blood testing (fecal occult blood test or fecal immunochemical test)
4. Endoscopic evaluation (esophagogastroduodenoscopy and/or colonoscopy) in the presence of gastrointestinal symptoms or positive occult blood testing

## Treatment

The primary goal of treatment is to replenish the body's iron stores and restore normal hemoglobin levels. The treatment approach is based on the underlying cause and severity of IDA.

1. Oral iron supplementation:
   - First-line treatment for mild to moderate IDA
   - Ferrous sulfate, ferrous gluconate, or ferrous fumarate
   - Recommended daily dose: 100-200 mg of elemental iron
   - Adverse effects: gastrointestinal discomfort, constipation, nausea

2. Intravenous (IV) iron therapy:
   - Indicated for severe IDA, poor response to oral iron, or intolerance to oral iron
   - Options include iron sucrose, ferric carboxymaltose, or ferric derisomaltose
   - Administered in a healthcare setting under medical supervision
   - Adverse effects: hypersensitivity reactions, hypophosphatemia

3. Blood transfusion:
   - Reserved for acute, severe, or life-threatening IDA
   - Indicated for symptomatic anemia with Hb < 7 g/dL or in the presence of comorbidities

4. Treatment of underlying causes:
   - Address the root cause of IDA, such as gastrointestinal bleeding, malabsorption, or dietary deficiency

## Monitoring and Follow-up

Patients with IDA should be monitored closely to assess the response to treatment and ensure resolution of anemia. Recommended monitoring parameters include:

1. Hemoglobin and hematocrit levels:
   - Measured at baseline, 4 weeks, and 12 weeks after initiation of treatment
   - Target Hb: 12-15 g/dL (adults), 11-14 g/dL (children)

2. Serum ferritin and TSAT:
   - Measured at baseline and every 3-6 months during treatment
   - Target ferritin: 30-100 ng/mL, TSAT: 20-50%

3. Adverse effects of iron therapy:
   - Monitor for gastrointestinal side effects, hypersensitivity reactions, and other complications

Patients with IDA should be followed up regularly to ensure adequate response to treatment and to address any underlying causes. Referral to a gastroenterologist or hematologist may be warranted in cases of refractory or recurrent IDA.

## Contraindications and Precautions

Certain conditions and situations require special consideration when managing IDA:

1. Hemochromatosis or other iron overload disorders:
   - Avoid oral or IV iron supplementation

2. Acute or chronic infection:
   - Serum ferritin may be elevated, masking true iron deficiency
   - Defer iron therapy until infection is controlled

3. Pregnancy:
   - Oral iron supplementation is recommended during pregnancy
   - Intravenous iron may be used in cases of severe anemia or intolerance to oral iron

4. Chronic kidney disease:
   - Increased risk of iron overload and complications
   - Careful monitoring and dose adjustment of iron therapy is required

In summary, the comprehensive workup and management of iron deficiency anemia involves a systematic approach, including diagnostic testing, identification of the underlying cause, and appropriate treatment with oral or intravenous iron supplementation, as well as close monitoring and follow-up to ensure resolution of anemia and replenishment of iron stores.