Iron deficiency is the most common micronutrient deficiency worldwide and the predominant cause of anaemia, which affects one‐quarter of the global population.

In Australia, 22.3% of women have depleted iron stores (serum ferritin level < 30 μg/L), with pre‐menopausal women disproportionately affected. In contrast, 3.5% of men are iron deficient.

Australian guidelines have been published to guide the investigation and management of iron deficiency in 2014 and updated more recently in 2024(1). Cases of iron deficiency do not require assessment in a specialist haematology department and can be managed in the community.

Definition

Anaemia is a haemoglobin below the reference range for a given age, gender and pregnancy-status. In contrast, to other forms of anaemia, patients with iron deficiency generally have a low mean corpuscular volume (MCV) and a low serum ferritin.

Common causes of iron deficiency

Increased physiological requirements for iron

  • Childhood and adolescence
  • Pregnancy and breastfeeding

Inadequate dietary intake of iron

  • Malnutrition
  • Restrictive diets (poor quality, vegetarian, vegan)

Malabsorption

  • Coeliac disease
  • Previous gastric/intestinal surgery
  • Inflammatory bowel disease
  • Impaired gastric acid secretion (proton pump inhibitors)

Most cases are due to chronic blood loss

  • Menstrual loss in pre-menopausal women
  • Gastrointestinal blood loss (from benign and malignant GIT disease)
  • Chronic intravascular haemolysis

Investigations

  • FBC
  • Blood film
  • Iron studies
  • Coeliac screen
  • FOBT and upper and lower endoscopies if the cause of the iron deficiency is unknown (especially in men and post-menopausal women).

Management

  • Oral iron replacement is appropriate initial therapy for most patients. It is essential that a formulation with an adequate dose of oral iron is prescribed (eg Ferrogradumet or Ferrograd C) and that replacement be continued until the patient is iron replete and the cause of the iron deficiency has been addressed. A FBC and iron studies should be performed 3 months after commencing oral iron to ensure the patient has had an adequate response to therapy.
  • Parenteral iron supplementation may be required for patients who are unresponsive to or intolerant of oral iron. Iron carboxymaltose (Ferinject) may be safely given in the community or by most general medical unit.
  • If appropriate, please send a referral to your nearest General Medical Department.
  • In the absence of severe bleeding or serious/ life-threatening end-organ ischaemia, blood transfusion is not required.