Iron Deficiency with or without Anemia Clinical Pathway – Primary Care, Emergency Department, and Inpatient

Team Assessment

History and Physical
Mild disease may be asymptomatic, without physical exam findings

Recommended Labs

CBC, reticulocyte count
Iron panel
- Serum iron, TIBC, transferrin, transferrin saturation
Ferritin
Additional Testing Considerations

Interpretation of Iron Studies

H&P, labs not consistent with IDA
Differential of Microcytic Anemia

Labs consistent with IDA with/without anemia

Hematology consult not routinely indicated

IDA always secondary—identify cause

Review common causes of iron deficiency

Mild
Iron Deficiency with or without Anemia

Hgb > 9 g/dL

Moderate IDA
Hgb 7–9 g/dL

Severe IDA
Hgb < 7 g/dL

No/mild
hemodynamic symptoms

Significant
hemodynamic symptoms
or Hgb < 4 g/dL

Iron Therapy

Enteral Iron
Considerations for IV Iron
- Failed or concern for poor adherence to oral regimen, poor absorption
Note: IV iron can be given in ED prior to discharge

Refer to ED, Admit to Med/Surg

Considerations for ICU Admission

Administer supplemental oxygen

Consider cardiac POCUS

Transfuse PRBCs

Stable hemodynamics

Iron Therapy

Enteral Iron
Considerations for IV Iron
- Failed or concern for poor adherence to oral regimen, poor absorption

Continued Outpatient Management

Address common causes of iron deficiency
Treatment Follow-Up Lab Guidance
Review hematologic response to iron therapy
Hematology Consult Indications

Posted: March 2026
Authors:
- C. Witmer, MD
- A. Moore, PharmD
- A. Cohen, MD
- B. Nfonoyim Bernhard, MD
- S. Rose, MD
- J. Jacobson, CRNP
- P. Parthasarathy, MD
- A. Mummery, CRNP
- S. Muthusami, MD
- M. Eng, MD
- D. Cascher, MD
- J. Varghese, CRNP
- R. Green, MD
- J. Sperling, MD
- A. Brennan, MD
Editors: Clinical Pathways Team

Evidence

CHOP Programs

Division of Hematology

Podcast

Primary Care Perspectives: Iron Deficiency Anemia

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

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Primary Care, Emergency Department, and Inpatient Clinical Pathway for Diagnosis and Treatment of Iron Deficiency with or without Anemia

Evidence

CHOP Programs

Podcast