Table 4.
Guideline recommendations on the use of iron therapy
| Citation | First-line oral iron therapy? | Patient group/circumstance | IV iron therapy? | Patient group/circumstance/first or second line | Threshold Hb level for IV iron therapy |
|---|---|---|---|---|---|
| Munro MG et al. [5] | Y |
In confirmed IDA (Hb < 12 g/dL and MCV low or normal < 100) Prior to surgery if time interval allows |
Y |
First line: if there is a relatively short interval to surgery and SF < 30 ng/mL and/or TSAT < 20% Second line: if Hb does not increase > 1 g/dL with oral iron therapy, and SF < 30 ng/mL and/or TSAT is < 20% |
N/S |
|
ACOG Opinion #785 [51] |
Y | If Hb ≥ 8 g/dL or hematocrit ≥ 25% | Y | Second line: in patients with poor compliance to oral iron therapy | N/S |
| Health Quality Ontario [57] | Y | In ID or any confirmed anemia (with Hb > 9 g/dL), including prior to surgery | Y |
First line: to correct severe anemia, including before and after surgery First line: prior to surgery, particularly if in need of rapid correction, to increase Hb > 12 g/dL Second line: if unresponsive or intolerant to oral iron therapy |
Hb ≤ 9 g/dL |
|
Arab HA et al. [62] |
Y |
In confirmed ID or IDA In women who are asymptomatic but at high risk of ID or IDA |
Y |
First line: prior to surgery/after GI or bariatric surgery First line: in those who express a preference for IV iron therapy, at the treating physician’s discretion Second line: in poor/non-respondersa or those intolerant to oral iron therapy Second line: if Hb does not increase by 2 g/dL and/or SF remains < 30 ng/mL after 3 months of oral iron therapy |
Hb < 8 g/dL |
|
ACOG Opinion #136 [63] |
Y | In confirmed ID or IDA | Y | Second line: in non-responders to oral iron therapy | N/S |
|
American College of Nurse-Midwives [53] |
N/Sb | In anemia | |||
|
Demers C et al. [55] |
N/Sb | In confirmed ID or anemia | |||
|
Vilos GA et al. [64] |
N/Sb | Preoperatively in patients with anemia undergoing surgery for uterine fibroids | |||
Eight out of 22 guidelines provided recommendations on the use of iron therapy in women presenting with HMB. Oral iron therapy is recommended as first-line treatment if patient health and circumstances permit. Intravenous iron therapy is recommended in preference to, or subsequent to, oral iron therapy depending on circumstances
ACOG American College of Obstetricians and Gynecologists, GI gastrointestinal, Hb hemoglobin, HMB heavy menstrual bleeding, ID iron deficiency, IDA iron-deficiency anemia, IV intravenous, MCV mean corpuscular volume, N/S not stated, SF serum ferritin, TSAT transferrin saturation
aWomen with a 1% increase in reticulocyte count and an improvement in Hb by 0.5 g/dL after 30 days are considered responders and should continue on oral iron therapy for 2 further months
bGuidelines do not specify whether iron therapy should be oral or intravenous