Executive summary
- Confirm iron deficiency (microcytosis helps but is not mandatory): ferritin is key, interpreted alongside inflammation (CRP) and chronic disease context.
- Don’t just treat — find the cause: GI blood loss, malignancy risk, coeliac disease, menorrhagia, dietary issues, medications (NSAIDs).
- Oral iron works best when tolerable: once-daily or alternate-day strategies can improve adherence; recheck Hb response early.
Investigations (high-yield primary care pattern)
- Bloods: FBC, ferritin, CRP (or ESR), B12/folate if mixed picture; consider TFTs if relevant.
- Coeliac screen if unexplained or in at-risk groups.
- GI evaluation: threshold for GI referral is lower in men, post-menopausal women, older adults, or those with GI symptoms/red flags.
- Gyn causes: assess menstrual loss, fibroids, contraception, pregnancy status.
Oral iron (practical prescribing + monitoring)
- Typical option: ferrous sulfate 200 mg (≈65 mg elemental iron) once daily; if side effects, consider alternate-day dosing or a different salt/preparation.
- Advice: take on an empty stomach if tolerated; avoid co-administration with calcium/tea/coffee; vitamin C-containing drink may help absorption.
- Response check: recheck Hb in ~2–4 weeks (expect a rise if adherent and correct diagnosis).
- Continue for ~3 months after Hb normalises to replenish stores (individualise to ferritin/clinical context).
Transparency
This page is an educational, clinician-written summary of publicly available NICE guidance intended for trained healthcare professionals. It uses original wording (not copied text) and should be used alongside the full NICE source, local pathways, and clinical judgement. Doses provided are for general reference; always check the BNF/SPC.