9.1.1 Iron-deficiency anaemias

General Guidance

• Treatment is appropriate only in cases of demonstrable iron-deficiency state. It is important to exclude any serious underlying cause of the anaemia e.g. GI erosions, colonic carcinoma.
• Routine prophylaxis in pregnancy is not appropriate. Prophylaxis in pregnancy is only justified if there is demonstrable iron-deficiency or in women who have additional risk factors for iron deficiency (e.g. poor diet), mennorrhagia, after subtotal or total gastrectomy, and in the management of low birth-weight infants, and in infants delivered by caesarean section.
• Iron supplementation should be given by mouth unless there are compelling reasons for using another route.
• There is little difference between any of the ferrous salts in terms of efficacy. The incidence of adverse effects due to ferrous sulphate is no greater than with other iron salts when compared on the basis of equivalent amounts of elevated iron.
• Compound iron preparations offer no significant advantages over plain ferrous sulphate.
• Modified release iron preparations are likely to carry the iron past the area of the gut from which iron is absorbed, therefore such preparations should not be used.
• The use of preparations with combined vitamin is not justifiable except in the case of folic acid in pregnant women the first trimester of pregnancy. It is important to ensure that such women receive the recommended daily dose of folic acid as some preparations contain suboptimal amounts of folic acid. It may be better to give such women plain ferrous sulphate and separate folic acid supplementation. Iron deficiency anaemia is uncommon in early pregnancy.

Recommended drugs

Ferrous Sulphate tablets £

Combined iron and folic acid: Pregaday £

Ferrous Fumarate £

Drug Traffic Light Key:

Green – On Formulary

Amber – Restricted use, see local guidelines      

Purple – Specialist use/initiation

Red – Non Formulary

Relative Costs Key (where indicated):

£££££ - high

£££ - moderate

£ - low