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Refractory Iron Deficiency — RACP Adult Medicine MCQ

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EasyHaematologyRefractory Iron DeficiencyRACP Adult Medicine

A 35-year-old woman with iron deficiency anaemia (Hb 85 g/L, ferritin 5 µg/L) has not responded to 3 months of oral iron supplementation (ferrous sulfate 325 mg daily). She has no GI bleeding on investigation. She has coeliac disease on a gluten-free diet with negative tTG antibodies. What is the most appropriate next step?

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Correct answer: B — Switch to ferrous gluconate

Failure to respond to adequate oral iron therapy should prompt consideration of IV iron. In coeliac disease, even with serological remission, occult malabsorption of oral iron may persist. IV ferric carboxymaltose (typically 15 mg/kg up to 1000 mg) bypasses absorption issues and rapidly replenishes iron stores. It is well-tolerated with a low rate of anaphylaxis. Repeat dosing may be needed. TSAT and ferritin should be rechecked 4–6 weeks post-infusion.

Reference: eTG – 2025 – Haematology; Blood Service – 2024 – Iron Deficiency Guidelines