What is the recommended dosage and frequency of iron sucrose (iron sucrose) for a 28-year-old female patient with severe anemia (hemoglobin 6 gm/dL) and symptoms of lightheadedness and presyncope?

Iron Sucrose Dosage for Severe Iron Deficiency Anemia

For a 28-year-old female with severe anemia (hemoglobin 6 g/dL) presenting with giddiness and presyncope, administer iron sucrose 200 mg intravenously once weekly for 5 weeks, for a total dose of 1000 mg. 1

Dosing Regimen Details

• Dose per infusion: 200 mg iron sucrose
• Frequency: Once weekly
• Duration: 5 weeks (total of 5 infusions)
• Total dose: 1000 mg elemental iron
• Administration: Slow intravenous infusion

This dosing regimen is supported by clinical guidelines and has been shown to effectively replenish iron stores and correct severe anemia in young adults 1, 2.

Rationale for This Regimen

1. Severity of anemia: With hemoglobin of 6 g/dL and symptomatic presentation (giddiness and presyncope), this patient has severe anemia requiring prompt correction 3.

2. Efficacy: Studies have demonstrated that this regimen results in significant hemoglobin increases, with mean increases of 3.29 g/dL in women 2. In one study, 84% of female patients showed an increase of at least 2 g/dL with this protocol 2.

3. Safety profile: Iron sucrose has fewer adverse effects compared to other parenteral iron preparations such as iron dextran 1. The 200 mg weekly dose is within safety parameters, as the maximum recommended single dose should not exceed 200 mg 1.

Expected Response

• Early response: Expect hemoglobin increase of approximately 1 g/dL within 2 weeks
• Complete response: Target increase of at least 2 g/dL within 4 weeks
• Target hemoglobin: 10-12 g/dL
• Target ferritin: >100 ng/mL

Monitoring Recommendations

• Check hemoglobin levels 2-4 weeks after initiating therapy to assess response 1
• Monitor for adverse reactions during infusion (though true anaphylaxis is rare at <1:200,000 administrations) 1
• Do not check iron parameters (ferritin, transferrin saturation) within 4 weeks of administration as results will be artificially elevated 1

Important Considerations and Potential Pitfalls

• Infusion rate: Administer as a slow IV infusion to minimize risk of adverse reactions
• Continuation of therapy: If hemoglobin response is inadequate after the initial 5-week course, consider additional evaluation for other causes of anemia
• Oral iron transition: After completing IV iron course, consider transitioning to oral iron for 3 months to maintain iron stores 3
• Adverse effects: While generally well-tolerated, monitor for potential side effects including hypotension, nausea, and infusion site reactions

This regimen provides a standardized approach for correcting severe iron deficiency anemia in this young female patient while minimizing the risk of adverse effects associated with parenteral iron therapy.