Management of non anaemic iron deficiency in adolecents

Management of non-anaemic iron deficiency in adolescents involves identifying and treating the underlying cause of iron deficiency and considering iron supplementation to replenish iron stores even in the absence of anaemia.

Although most guidelines focus on iron deficiency anaemia, the principles for non-anaemic iron deficiency include oral iron supplementation to restore iron stores and prevent progression to anaemia.

Oral iron therapy is typically started with a once-daily dose of 50-100 mg elemental iron (e.g., one ferrous sulfate 200 mg tablet daily) taken on an empty stomach to optimize absorption, but it can be taken with food if gastrointestinal side effects occur.

Lower doses and less frequent dosing may improve tolerability and adherence without compromising efficacy.

Monitoring should include rechecking haemoglobin and iron indices within 4 weeks to assess response, although haemoglobin may be normal initially; ferritin and transferrin saturation can guide iron store repletion.

Iron supplementation should be continued for about 3 months after normalization of iron parameters to replenish stores fully.

In adolescents, especially those with risk factors such as menorrhagia, dietary insufficiency, or malabsorption, ongoing prophylactic iron supplementation may be considered.

If oral iron is not tolerated or ineffective, intravenous iron therapy may be considered, although this is less common in primary care and usually reserved for specific indications.

Education on adherence, potential side effects, and safe storage of iron supplements is important.

Further investigation is warranted if iron deficiency persists despite supplementation or if there are signs of underlying pathology.

Summary: For adolescents with non-anaemic iron deficiency, initiate oral iron supplementation (50-100 mg elemental iron daily), monitor response and iron status, continue treatment for 3 months after repletion, consider prophylaxis in at-risk individuals, and investigate persistent deficiency.

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