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How Would You Manage This Patient With Iron Deficiency Anemia? Grand Rounds Discussion From Beth Israel Deaconess
Joséphine A Cool1, Kylee L Martens2, Jason A Freed1
1Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (J.A.C., J.A.F., Z.K.).
Annals of Internal Medicine
|June 8, 2026
Summary
Iron deficiency anemia (IDA) is a common global health issue. This discussion highlights diagnostic challenges and treatment uncertainties for IDA, especially in women, referencing new guidelines.
Area of Science:
- Hematology
- Internal Medicine
- Clinical Guidelines
Background:
- Iron deficiency anemia (IDA) is the most prevalent cause of anemia globally, leading to significant disability.
- Women of reproductive age are particularly susceptible due to menstrual blood loss and gynecologic conditions.
- Iron deficiency (ID) can exist without anemia, and standard hemoglobin thresholds may miss diagnoses in menstruating women due to sex-specific reference ranges.
Purpose of the Study:
- To discuss areas of uncertainty in the diagnosis, evaluation, and treatment of IDA.
- To provide insights based on the 2025 Iron Consortium Guideline.
- To illustrate challenges with a case study of a young woman with ID.
Main Methods:
- Review of current guidelines and literature on IDA diagnosis and management.
- Discussion of diagnostic work-up including gynecologic evaluation, endoscopy, and specific disease testing.
- Consideration of oral versus intravenous iron therapy options.
Main Results:
- Guidelines for IDA diagnosis and management vary, influenced by population, clinical context, and evidence quality.
- Accurate diagnosis requires assessing both iron deficiency and anemia, considering potential limitations of hemoglobin thresholds.
- Identifying the underlying cause of ID/IDA is crucial for effective treatment.
Conclusions:
- Addressing diagnostic ambiguities and treatment variations in IDA is essential for improved patient outcomes.
- The 2025 Iron Consortium Guideline aims to clarify management strategies.
- Individualized patient assessment is key, particularly for women of reproductive age.
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