When should iron therapy start per the protocol for new patients?

When should iron therapy start per the protocol for new patients?

• A. Ferritin <500 and TSAT <30%
• B. Ferritin >800 and TSAT >40%
• C. Ferritin <100 and TSAT <10%
• D. TSAT >50% regardless of ferritin

Answer: (A)

Iron therapy is started when there is both depleted iron stores and low circulating iron. Ferritin reflects stored iron, while TSAT shows how much iron is readily available for making red blood cells. The protocol uses a combined threshold of ferritin below 500 and TSAT below 30% to begin treatment because this indicates true iron deficiency needing replenishment, despite the inflammatory common in CKD that can complicate lone ferritin readings. If ferritin is high (e.g., above 800) and TSAT is high (above 40%), there’s sufficient iron and therapy could cause overload. If ferritin and TSAT are extremely low (e.g., ferritin <100 and TSAT <10%), some systems might consider treatment, but the standard protocol here specifically targets the 500/30 cutoff. A high TSAT (over 50%) with any ferritin level suggests ample circulating iron, so iron therapy would not be appropriate.

Iron therapy is started when there is both depleted iron stores and low circulating iron. Ferritin reflects stored iron, while TSAT shows how much iron is readily available for making red blood cells. The protocol uses a combined threshold of ferritin below 500 and TSAT below 30% to begin treatment because this indicates true iron deficiency needing replenishment, despite the inflammatory common in CKD that can complicate lone ferritin readings. If ferritin is high (e.g., above 800) and TSAT is high (above 40%), there’s sufficient iron and therapy could cause overload. If ferritin and TSAT are extremely low (e.g., ferritin <100 and TSAT <10%), some systems might consider treatment, but the standard protocol here specifically targets the 500/30 cutoff. A high TSAT (over 50%) with any ferritin level suggests ample circulating iron, so iron therapy would not be appropriate.