Management of iron deficiency in children, adults, and pregnant individuals: evidence-based and expert consensus recommendations

Ashley E Benson¹, Jamie O Lo², Maureen O Achebe³, Jorgeane S Aslan⁴, Michael Auerbach⁵, Bethany T Samuelson Bannow⁴, Marie J Boller¹, Thomas G Deloughery⁴, Jacquelin Dingman⁶, Layla Van Doren⁷, Geolani W Dy⁸, Patricia A Ford⁹, Jason A Freed¹⁰, Michael K Georgieff¹¹, Kristina M Haley¹², Chloe I Han¹³, Adam K Lewkowitz¹⁴, Kylee L Martens⁴, Robert T Means Jr¹⁵, Elizabeta Nemeth¹⁶, Sven R Olson⁶, Jacquelyn M Powers¹⁷, Kristin C Prewitt¹, Toby Richards¹⁸, Don C Rockey¹⁹, Eric J Roeland⁶, Kimberly S Ryan¹, Hanny Al-Samkari²⁰, Michelle Sholzberg²¹, Methodius G Tuuli¹⁴, Angela C Weyand²², Michelle P Zeller²³, Annette M Totten²⁴, Ilya Ivlev²⁴, Joseph J Shatzel⁴; Iron Consortium at Oregon Health & Science University

Affiliations

¹ Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA.
² Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA; Department of Urology, Oregon Health & Science University, Portland, OR, USA. Electronic address: loj@ohsu.edu.
³ Division of Hematology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁴ Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA.
⁵ Department of Medicine, Georgetown University School of Medicine, Washington, DC, USA.
⁶ Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA.
⁷ Section of Hematology, Department of Medicine, Yale School of Medicine, New Haven, CT, USA.
⁸ Department of Urology, Oregon Health & Science University, Portland, OR, USA.
⁹ Abramson Cancer Center, Pennsylvania Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
¹⁰ Division of Hematology and Hematologic Malignancies, Beth Israel Deaconess Medical Center, Boston, MA, USA.
¹¹ Division of Neonatology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
¹² Division of Pediatric Hematology and Oncology, Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA.
¹³ Division of Pediatric Critical Care, Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA.
¹⁴ Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Brown University Warren Alpert Medical School, Providence, RI, USA.
¹⁵ Departments of Internal Medicine, Medical Education, and Pathology, James H Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA.
¹⁶ Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
¹⁷ Division of Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
¹⁸ Institute of Clinical Trials and Methodology, University College London, London, UK.
¹⁹ Medical University of South Carolina Digestive Disease Research Center, Medical University of South Carolina, Charleston, SC, USA.
²⁰ Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
²¹ Departments of Medicine, and Laboratory Medicine & Pathobiology, St. Michael's Hospital, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, ON, Canada.
²² Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA.
²³ Michael G DeGroote Centre for Transfusion Research, Department of Medicine, McMaster University, Hamilton, ON Canada; Canadian Blood Services, Hamilton, ON, Canada.
²⁴ Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, OR, USA.

PMID: 40306833
DOI: 10.1016/S2352-3026(25)00038-9

Review

Management of iron deficiency in children, adults, and pregnant individuals: evidence-based and expert consensus recommendations

Ashley E Benson et al. Lancet Haematol. 2025 May.

. 2025 May;12(5):e376-e388.

doi: 10.1016/S2352-3026(25)00038-9.

Authors

Affiliations

¹ Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA.
² Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA; Department of Urology, Oregon Health & Science University, Portland, OR, USA. Electronic address: loj@ohsu.edu.
³ Division of Hematology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁴ Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA.
⁵ Department of Medicine, Georgetown University School of Medicine, Washington, DC, USA.
⁶ Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA.
⁷ Section of Hematology, Department of Medicine, Yale School of Medicine, New Haven, CT, USA.
⁸ Department of Urology, Oregon Health & Science University, Portland, OR, USA.
⁹ Abramson Cancer Center, Pennsylvania Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
¹⁰ Division of Hematology and Hematologic Malignancies, Beth Israel Deaconess Medical Center, Boston, MA, USA.
¹¹ Division of Neonatology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
¹² Division of Pediatric Hematology and Oncology, Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA.
¹³ Division of Pediatric Critical Care, Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA.
¹⁴ Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Brown University Warren Alpert Medical School, Providence, RI, USA.
¹⁵ Departments of Internal Medicine, Medical Education, and Pathology, James H Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA.
¹⁶ Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
¹⁷ Division of Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
¹⁸ Institute of Clinical Trials and Methodology, University College London, London, UK.
¹⁹ Medical University of South Carolina Digestive Disease Research Center, Medical University of South Carolina, Charleston, SC, USA.
²⁰ Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
²¹ Departments of Medicine, and Laboratory Medicine & Pathobiology, St. Michael's Hospital, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, ON, Canada.
²² Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA.
²³ Michael G DeGroote Centre for Transfusion Research, Department of Medicine, McMaster University, Hamilton, ON Canada; Canadian Blood Services, Hamilton, ON, Canada.
²⁴ Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, OR, USA.

PMID: 40306833
DOI: 10.1016/S2352-3026(25)00038-9

Abstract

Iron deficiency is the most common micronutrient deficiency worldwide. Oral iron is often recommended as first-line treatment, but there is no consensus on the optimal formulation, dosing strategy, or which patients should be treated preferentially with intravenous iron. To address these challenges, the Iron Consortium at Oregon Health & Science University (OHSU) convened an international panel of 26 experts in haematology, primary care, paediatrics, obstetrics, gastroenterology, cancer, and patient advocacy among its members. This panel was supplemented by insights from a four-person patient focus group to develop current recommendations using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. The panel developed clinically relevant questions in five priority topic areas, a systematic literature search was performed, and studies meeting a priori criteria were included to generate evidence tables for recommendation development. Evidence-based and expert opinion-based recommendations were made through a structured anonymous consensus voting process at an in-person meeting in Portland, OR, USA, hosted by OHSU on Feb 16-17, 2024. The expert panel made seven evidence-based recommendations for three demographic groups with iron deficiency: non-pregnant adults, pregnant individuals, and infants, children, and adolescents. Expert opinions supported the recommendations on 21 aspects of care for which there is insufficient evidence. This Review provides evidence-based recommendations and expert consensus on the diagnosis, treatment, and management of iron deficiency, detailing best practices for oral and intravenous iron repletion across diverse patient populations.

PubMed Disclaimer

Conflict of interest statement

Declaration of interests LVD reports speaking engagements and advisory board participation with Pharmacosmos and Daiichi Sankyo. AKL discloses receipt of honoraria for advisory boards and speaking engagements from Pharmacosmos, some of which were not directly related to the topic of the current guidelines. MPZ discloses receipt of honoraria for advisory boards and speaking engagements from the American Society of Hematology, McMaster University (ON, Canada), Pfizer, Transfusion Transmitted Injury Surveillance System, and Queen's University (ON, Canada), some of which were not directly related to the topic of the current guidelines. MGT reports direct payments, including honoraria and research funding, from Pharmacosmos. AEB, MKG, and HA-S report that their institutions received research funding from Pharmacosmos. HA-S reports consultancy fees and grants from several Agios, Amgen, Novartis, Pharmacosmos, Sobi, and Vaderis. All other authors declare no competing interests.

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Substances

Actions

LinkOut - more resources

Full Text Sources
- ClinicalKey
- Elsevier Science
Medical
- MedlinePlus Health Information

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Management of iron deficiency in children, adults, and pregnant individuals: evidence-based and expert consensus recommendations

Affiliations

Management of iron deficiency in children, adults, and pregnant individuals: evidence-based and expert consensus recommendations

Authors

Affiliations

Abstract

Conflict of interest statement

Publication types

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Medical