What is the recommended dose and frequency of iron sucrose (iron supplement) for a 28-year-old female with severe anemia (hemoglobin 6g/dL) and symptoms of giddiness and presyncope?

Iron Sucrose Dosing for Severe Anemia in a 28-Year-Old Female

For a 28-year-old female with severe anemia (hemoglobin 6g/dL) and symptoms of giddiness and presyncope, intravenous iron sucrose should be administered at a dose of 200mg per session, 2-3 times weekly, until reaching a total calculated iron deficit of approximately 1000-1500mg.

Assessment and Indication for IV Iron

Severe anemia (Hb 6g/dL) with symptomatic presentation (giddiness and presyncope) represents an urgent clinical scenario requiring prompt intervention. This patient's presentation warrants intravenous iron rather than oral supplementation for several reasons:

• Hemoglobin <10g/dL (specifically 6g/dL) is a clear indication for IV iron therapy 1
• Symptomatic presentation (giddiness and presyncope) indicates clinical instability
• Need for rapid correction to prevent potential complications

Dosing Calculation and Administration

Total Iron Deficit Calculation

The total iron deficit can be estimated based on the patient's weight and hemoglobin deficit:

For a patient with Hb 6g/dL (target Hb 12g/dL for women):

• For body weight <70kg: 1500mg total iron deficit 1
• For body weight ≥70kg: 2000mg total iron deficit 1

Administration Schedule

• Dose per session: 200mg iron sucrose per infusion 1
• Frequency: 2-3 times weekly 2, 3
• Administration method: Slow IV infusion over 15-30 minutes
• Total duration: Approximately 2-3 weeks until total calculated dose is reached

Monitoring and Follow-up

• Check hemoglobin levels after 1-2 weeks of therapy to assess response
• Monitor serum ferritin and transferrin saturation after completing the iron course
• Continue therapy until target hemoglobin is achieved (≥12g/dL) and iron stores are replenished (ferritin >100 ng/mL) 1
• Consider maintenance therapy if underlying cause of anemia persists

Safety Considerations

• Iron sucrose has a better safety profile compared to iron dextran with fewer serious adverse events 1
• No test dose is required for iron sucrose (unlike iron dextran) 1
• Common side effects include nausea, hypotension, and injection site reactions
• Resuscitation facilities should be available during administration 1

Evidence of Efficacy

Multiple studies have demonstrated the efficacy of IV iron sucrose in severe anemia:

• In women with preoperative anemia, IV iron sucrose achieved a mean hemoglobin increase of 3.0g/dL compared to 0.8g/dL with oral iron 4
• In pregnant women with moderate-to-severe anemia, IV iron sucrose increased hemoglobin from 7.63g/dL to 11.20g/dL after 8 weeks 2
• Another study showed a 5.1g/dL increase in hemoglobin with IV iron sucrose compared to 3.1g/dL with oral iron 3

Clinical Pearls and Pitfalls

• Pearl: Iron sucrose can be given in doses up to 200mg per session, making it more convenient than iron dextran which requires more frequent dosing 1
• Pitfall: Avoid exceeding the recommended maximum single dose of 200mg to prevent potential toxicity
• Pearl: Intravenous iron is preferred over oral iron in severe anemia as it bypasses intestinal absorption issues and provides faster correction
• Pitfall: Always rule out ongoing blood loss as a cause of severe anemia before initiating therapy

This dosing regimen should rapidly improve the patient's hemoglobin levels and alleviate symptoms of giddiness and presyncope, while minimizing the risk of adverse effects.