Ferritin

When low

Supplements (when low):

• Iron Bisglycinate -- 25-50mg elemental iron with Vitamin C 500mg for absorption; better tolerated than ferrous sulphate
• Alternate-day dosing -- iron 100mg every other day rather than daily increases fractional absorption (Stoffel et al. 2017) by reducing hepcidin-driven absorption block
• Heme Iron Polypeptide (Proferrin) -- 11mg elemental heme iron 1-3x/day; better absorbed and tolerated than non-heme iron when bisglycinate causes GI upset
• Lactoferrin -- 200mg/day; bypasses hepcidin regulation, maintains absorption even with elevated inflammation
• Take iron away from calcium, coffee, and tea (within 2h either side); these significantly inhibit absorption

Guidelines:

• Supplement between donations if ferritin drops below 30 ug/L
• Recheck ferritin 6-8 weeks after starting supplementation

Pharmacological options (severe deficiency, oral intolerance, or non-response):

• IV iron infusion (Ferinject / ferric carboxymaltose) -- 500-1000mg single dose IV; gold-standard for ferritin <15 ug/L or symptomatic deficiency; raises ferritin 50-100 ug/L within 2-4 weeks; physician-administered; monitor for hypophosphataemia
• Iron isomaltoside / ferric derisomaltose (Monoferric / Monofer) -- 1000mg single IV dose; lower hypersensitivity rate than older IV preparations; convenient for one-and-done dosing
• Iron sucrose (Venofer) -- 200mg per infusion; multiple sessions required to reach total iron deficit; useful where Ferinject/Monofer unavailable
• Indication: ferritin <30 ug/L with symptoms, or oral iron intolerance/non-response after 3 months
• For AAS users on regular phlebotomy, consider proactive IV iron every 6-12 months rather than chronic oral supplementation; physician oversight required