How many 200 mg iron sucrose doses are needed to increase Hb from 6 g/dL to 12 g/dL in a patient with menorrhagia?

Iron Sucrose Dosing for Severe Iron Deficiency Anemia in Menorrhagia

For a 28-year-old female with menorrhagia and hemoglobin of 6 g/dL, approximately 5-6 doses of 200 mg iron sucrose (total 1000-1200 mg) are needed to reach a target hemoglobin of 12 g/dL.

Calculation of Iron Deficit

The iron deficit can be calculated using the following approach:

• Each 1 g/dL increase in hemoglobin requires approximately 150-200 mg of elemental iron
• Target increase: 6 g/dL (from 6 g/dL to 12 g/dL)
• Total iron needed: 6 g/dL × 150-200 mg = 900-1200 mg

Dosing Regimen

Based on FDA labeling and clinical guidelines for iron sucrose:

• Standard single dose: 200 mg per infusion 1
• Frequency: Can be administered 1-3 times weekly 2
• Total recommended dose: 1000-1200 mg for severe iron deficiency anemia 3, 1
• Expected hemoglobin response: 3-4 g/dL increase within 3-4 weeks 4

Evidence Supporting This Recommendation

Clinical studies demonstrate that iron sucrose is highly effective in treating iron deficiency anemia in women with menorrhagia:

• In patients with iron deficiency anemia, weekly doses of 200 mg iron sucrose produced a mean hemoglobin increase of 3.29 g/dL in women 4
• For severe anemia (Hb <9 g/dL), iron sucrose administration resulted in a 3.0 g/dL increase in hemoglobin levels within 3 weeks 5
• The FDA label for iron sucrose indicates that increases of 1.7 g/dL in hemoglobin can be achieved within 2-4 weeks of treatment 1

Administration Protocol

1. Administer 200 mg iron sucrose per dose
2. Infuse over 2-5 minutes or diluted in 100 mL normal saline over 15-30 minutes
3. Schedule infusions 2-3 times weekly until the total calculated dose is administered
4. Monitor hemoglobin levels after 2-4 weeks of therapy

Monitoring and Follow-up

• Check hemoglobin 2-4 weeks after initiating therapy 2
• Expected response: Increase of approximately 1 g/dL within 2 weeks and 2 g/dL within 4 weeks
• Monitor serum ferritin and transferrin saturation to ensure adequate iron stores (target ferritin >100 ng/mL and TSAT >20%) 3
• Avoid checking iron studies within 1-2 weeks of IV iron administration as ferritin levels can be artificially elevated 2

Potential Pitfalls and Considerations

• Ensure patient does not have infection or inflammation that could impair iron utilization
• Monitor for adverse reactions during infusion (uncommon with iron sucrose)
• Consider underlying cause of menorrhagia and implement appropriate management to prevent recurrence of anemia
• If hemoglobin fails to increase appropriately, evaluate for ongoing blood loss or other causes of anemia

Iron sucrose is generally well-tolerated with minimal adverse effects compared to other IV iron preparations, making it a safe option for rapid correction of severe anemia in this young patient with menorrhagia 4, 5.