Medically reviewed by Uri Gedalia, MD, FACS
Chief Medical Officer, TrufaMED Urgent Care & Concierge Medicine
Board-Certified, General Surgery
Last reviewed: August 2026
Iron deficiency anemia is one of the most under-diagnosed conditions we see. Patients present with fatigue, brain fog, exercise intolerance, hair loss, or pica, and have often been told for years that nothing is wrong. The most reliable test — ferritin — is often not part of a routine physical.
This is the iron deficiency workup, the indication for IV iron, the protocol we use, and what it costs in Miami.
How To Tell If You Are Iron-Deficient
Symptoms are nonspecific but common:
- Persistent fatigue, especially not improved by sleep
- Brain fog, difficulty concentrating
- Hair loss or hair thinning
- Cold extremities
- Restless legs, especially at night
- Pica (unusual cravings for ice, dirt, starch)
- Reduced exercise tolerance
- Pale skin, pale lower eyelid conjunctiva
- Shortness of breath with mild exertion
The labs:
- Ferritin — the most sensitive marker. Levels under 30 ng/mL in women and under 50 in men suggest iron deficiency even if hemoglobin is still normal. Functional iron deficiency can present with ferritin in the 30 to 100 range with symptoms.
- Serum iron, TIBC, transferrin saturation
- Complete blood count (look for hemoglobin, hematocrit, MCV, MCH)
- If borderline: reticulocyte hemoglobin, soluble transferrin receptor
Who Is At Risk
- Menstruating women, particularly with heavy periods
- Pregnant and postpartum women
- Endurance athletes
- Vegetarians and vegans (without active supplementation)
- Patients with GI conditions: celiac, inflammatory bowel disease, gastric bypass, chronic NSAID use
- Frequent blood donors
- Patients with chronic kidney disease
- Patients with chronic inflammation, certain cancers, or hereditary blood disorders
Oral Iron First
First-line treatment is oral iron supplementation. Multiple formulations are available; the differences matter for tolerability:
- Ferrous sulfate — cheapest, most-studied, GI side effects common
- Ferrous bisglycinate — gentler on GI, well-absorbed
- Carbonyl iron — gentler, more expensive
- Heme iron polypeptide — very gentle, expensive
Standard dose is 60 to 120 mg elemental iron daily, taken with vitamin C and away from coffee/tea/dairy. Alternate-day dosing has emerging evidence as equally effective with better absorption per dose.
Recheck labs at 8 to 12 weeks. Hemoglobin should rise; ferritin will lag. Full repletion typically takes 3 to 6 months.
When IV Iron Makes Sense
We move to IV iron when:
- Oral iron is not tolerated (severe GI side effects despite multiple formulations tried)
- Oral iron has not raised ferritin meaningfully after 3 months
- Severe deficiency requiring rapid repletion
- Active GI bleeding or absorption disorder where oral iron will not work
- Postpartum severe deficiency
- Patients with chronic kidney disease
- Pre-surgical optimization where time is short
IV Iron Protocol At TrufaMED
We use ferric carboxymaltose (Injectafer) or low-molecular-weight iron dextran depending on indication and patient profile. Both are FDA-approved and well-tolerated.
Standard protocol:
- Initial physician visit with full iron panel and assessment
- First infusion 15 to 30 minutes, observed for 15 minutes after
- Second infusion 7 days later if total dose requires it
- Recheck labs 4 to 8 weeks after final infusion
Side effects are uncommon. Transient mild flushing, headache, or nausea in some patients. Anaphylaxis is rare but the risk is the reason we observe in clinic. Skin discoloration at the IV site (siderosis) can occur if there is extravasation; we use careful technique to minimize.
Cost And Insurance
IV iron is often covered by insurance when the clinical indication is documented (severe deficiency, oral failure, malabsorption, postpartum). Coverage requires documentation of the trial-and-failure with oral iron or the clinical indication for IV first-line.
Out-of-pocket: $300 to $700 per infusion depending on the agent and total dose required. We provide itemized invoices for insurance reimbursement when applicable.
Frequently Asked Questions
How fast will I feel better?
Most patients notice a meaningful change in fatigue and brain fog within 2 to 4 weeks of completing IV iron repletion. Hair regrowth, restless legs improvement, and exercise capacity often take 8 to 12 weeks.
Is it safe in pregnancy?
Yes, after the first trimester. We coordinate with OB-GYN for pregnant patients.
How long does the IV take?
15 to 30 minutes for the infusion itself, plus 15 minutes of post-infusion observation.
Will my hemoglobin stay up forever?
It depends on the cause of the deficiency. If you have ongoing blood loss (heavy periods, GI bleeding) you may need maintenance therapy or treatment of the underlying cause.