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Iron deficiency anaemia (IDA) is a significant cause of morbidity worldwide.
The initial evaluation should contain a thorough history (including dietary habits, medication use, and menstrual cycles), identification of any concurrent disorders, and clinical examination.
To confirm IDA and rule out other potential causes, a relevant standardised laboratory workup such as iron studies, red cell indices, and haemoglobin electrophoresis (if relevant) should be performed.
An excellent response (Hb rise ≥10 g/L within a 2-week timeframe) to iron replacement therapy (IRT) in anaemic patients is highly suggestive of absolute iron deficiency, even if the results of iron studies are equivocal.
In cases of inexplicable IDA or IDA from high-prevalence areas, active screening for Helicobacter pylori (using non-invasive testing methods) and treatment initiation should be implemented.
As blood loss from the gastrointestinal tract is the commonest cause of IDA in adult men and post-menopausal females, bidirectional endoscopy must be conducted.
In pre-menopausal women with IDA, guidance about investigations varies.
In cases of persistent or recurrent IDA despite adequate IRT and negative bidirectional endoscopy, further evaluation of the small bowel (by capsule endoscopy, enteroscopy or CT/MR enterography) may be warranted.
Patient factors and the urgency of iron repletion must be considered when determining the appropriateness of the type of IRT.
IRT to replenish iron stores and improve haemoglobin levels can be done with iron therapy (oral/intravenous) or blood transfusions (reserved for severe, symptomatic patients).
Following the correction of anaemia, a clinical review according to standardised follow-up protocol focusing on symptom management, treatment compliance, and the presence of adverse events should be conducted.
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Mistakes in the management of iron deficiency anaemia: a narrative review
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