India · Paediatric mg/kg · Adult · Pregnancy · Treatment & Prophylaxis · Ferrous Sulphate · Fumarate · Fefol · Autrin
Normal Hb (adult ♀): ≥ 12 g/dL
Normal Hb (adult ♂): ≥ 13 g/dL
Mild anaemia: 10–11.9 g/dL
Moderate: 7–9.9 g/dL
Severe: < 7 g/dL
Pregnancy target: ≥ 11 g/dL
Children: age-dependent (use growth chart)
✅ Take on empty stomach (best absorption)
✅ Vitamin C (orange juice) doubles absorption
✅ Give 1h before or 2h after meals
❌ Avoid tea, coffee, calcium, antacids within 2h
❌ Don't take with milk or dairy
❌ Avoid with fluoroquinolones (chelation)
⚠️ Black stools are normal — warn patients/parents
| Patient / Indication | Elemental iron dose | Frequency | Duration | Guideline |
|---|---|---|---|---|
| Child — IDA treatment | 3–6 mg/kg/day | 2–3 divided doses | 3 months after Hb normal | IAP · WHO |
| Child — severe anaemia | 6 mg/kg/day (max 200mg/day) | 2–3 divided doses | Until Hb normalised | IAP |
| Child — prophylaxis (6m–5yr) | 1–2 mg/kg/day (max 15mg) | Once daily | Ongoing (high-risk areas) | WHO · IAP |
| Adolescent girl — prophylaxis | 60 mg elemental iron (1 tab) | Once weekly (WIFS) | Weekly year-round (GoI WIFS scheme) | MoHFW India |
| Adult — IDA treatment | 100–200 mg elemental/day | 2–3 divided doses | 3–6 months (3m after Hb normal) | BNF · WHO |
| Pregnancy — routine | 100 mg elem/day + folic acid 500mcg | Once daily | 14 wk → 6m postpartum | MoHFW India |
| Pregnancy — moderate anaemia | 120–200 mg elem/day | BD or TDS | Until Hb ≥11 g/dL then routine dose | WHO |
| IV iron sucrose — total deficit | Ganzoni formula: wt(kg) × (Hb target – actual Hb) × 0.24 + 500 | Single or divided infusions | Over 3–5 sessions | BNF |
India has the highest burden of iron deficiency anaemia (IDA) globally — the National Family Health Survey (NFHS-5, 2019–21) found that 67% of children under 5, 57% of women of reproductive age, and 25% of men are anaemic in India. IDA is the single most common nutritional deficiency disease in the country and a major contributor to maternal mortality, impaired child cognition, poor school performance, and reduced work productivity.
The most common prescribing error with iron is failing to distinguish between the weight of the iron salt and the elemental iron content. All iron dosing guidelines (IAP, WHO, BNF) are expressed in milligrams of elemental iron. Ferrous sulphate 200mg contains only 60mg elemental iron. Prescribing "200mg three times daily" (a common adult IDA prescription) actually delivers 180mg elemental iron per day — near the upper limit. Always state elemental iron in your prescription or counsel the dispensing pharmacist clearly.
Treatment of established IDA in children requires 3–6 mg elemental iron/kg/day in 2–3 divided doses. Feronia drops (30mg elemental iron/ml) are the most practical formulation for infants and young children — 1 ml = 30 mg elemental iron. For a 10 kg child at 3 mg/kg/day: 30 mg/day = 1 ml Feronia drops daily. Treatment must continue for 3 months after haemoglobin normalises to fully replenish body iron stores. Stopping at Hb normalisation is insufficient and leads to early relapse. For prophylaxis in high-risk areas (6 months–5 years): 1–2 mg/kg/day once daily as per IAP and WHO.
The MoHFW India's Anaemia Mukt Bharat programme recommends 100 mg elemental iron + 500 mcg folic acid daily from 14 weeks gestation until 6 months postpartum (a total of 180 tablets). For moderate anaemia in pregnancy (Hb 7–10 g/dL): increase to 120–200 mg elemental iron/day in divided doses until Hb reaches ≥11 g/dL, then continue 100 mg/day. For severe anaemia (Hb <7 g/dL) after 32 weeks, or if oral iron is not tolerated: IV iron (iron sucrose or ferric carboxymaltose) is recommended.
IV iron is indicated when: oral iron is not tolerated, not absorbed (IBD, post-gastrectomy), contraindicated, or when rapid Hb correction is needed (severe anaemia after 32 weeks pregnancy, pre-operative anaemia). Iron sucrose (Venofer) is the safest IV iron in India — maximum single dose 200mg, given over 30 minutes, maximum 3 times per week. Ferric carboxymaltose (Ferinject/Orofer-FCM) allows single large doses (1000mg in one infusion) and is increasingly used in India for moderate-severe IDA in pregnancy and postpartum haemorrhage. Total iron deficit is calculated using the Ganzoni formula: Total iron deficit (mg) = Body weight (kg) × (Target Hb – Actual Hb) g/dL × 0.24 + 500 mg (for stores).