A 28-year-old woman has haemoglobin 7.2 g/dL, MCV 68 fL, serum ferritin 8 ng/mL, TIBC 450 µg/dL. She is prescribed oral ferrous sulphate 325 mg TDS. After 4 weeks, haemoglobin rises to 8.8 g/dL (increase of 1.6 g/dL). For how long should iron therapy be continued after haemoglobin normalises?

• A Stop immediately when Hb normalises
• B Continue for 3–6 months after Hb normalisation to replenish stores ✓
• C Continue indefinitely without monitoring
• D Switch to IV iron once Hb normalises for faster store replenishment

Explanation

In iron deficiency anaemia, oral iron should be continued for 3–6 months after haemoglobin normalises to replenish depleted tissue and reticuloendothelial iron stores. Treatment adequacy is monitored by serum ferritin (target >50 ng/mL). Stopping at haemoglobin normalisation leads to early relapse. IV iron is reserved for malabsorption, intolerance, or failure to respond to oral therapy.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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