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Consider IV iron if: Severe deficiency — ferritin under 15 ng/mL with anemia or significant symptoms, especially before surgery or pregnancy Failed oral iron — three months of compliant oral supplementation without ferritin response Intolerable side effects from oral iron despite trying multiple forms Malabsorption — celiac disease, inflammatory bowel disease, post–bariatric surgery, chronic H

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Because conditions like pernicious anemia are lifelong, prescription B12 therapy is often indefinite