What is the dose and frequency of iron sucrose (iron sucrose) for a 28-year-old female with severe iron deficiency anemia (hemoglobin 6 grams per deciliter), menorrhagia, and symptoms of giddiness, weighing 60 kilograms?

Iron Sucrose Dosing for Severe Iron Deficiency Anemia with Menorrhagia

For a 28-year-old female with severe iron deficiency anemia (hemoglobin 6 g/dL) due to menorrhagia, weighing 60 kg, the recommended dosing is 200 mg IV iron sucrose administered once weekly until the calculated iron deficit is corrected, with total dose not exceeding 1000 mg. 1

Dosing Calculation and Administration

The treatment approach should follow these steps:

1. Initial dosing: 200 mg IV iron sucrose administered over 30-60 minutes
2. Frequency: Once weekly administration
3. Duration: Continue until calculated iron deficit is corrected or maximum total dose of 1000 mg is reached
4. Administration method: Slow IV infusion over 30-60 minutes

Iron Deficit Calculation

For a patient with hemoglobin of 6 g/dL and weight of 60 kg, the iron deficit can be calculated using the formula:

Iron deficit (mg) = [Target Hb - Actual Hb] × Weight × 0.24 + 500

Assuming a target hemoglobin of 12 g/dL:

• Iron deficit = [12 - 6] × 60 × 0.24 + 500 = 6 × 60 × 0.24 + 500 = 86.4 + 500 = 986.4 mg

Therefore, approximately 5 weekly doses of 200 mg would be required (total 1000 mg).

Monitoring and Follow-up

• Immediate monitoring: Observe patient for at least 30 minutes following each IV injection to monitor for adverse reactions 1
• Short-term follow-up: Check hemoglobin levels after 2 weeks of therapy to assess initial response
• Long-term monitoring: Monitor hemoglobin every 4 weeks until normalization, then every 3 months for the first year 1
• Target levels: Aim for hemoglobin >12 g/dL and ferritin >100 μg/L 1

Safety Considerations

• No test dose is required for iron sucrose, unlike iron dextran 1
• Common adverse effects include dizziness, headache, hypertension, injection-site reactions, and nausea (occurring in 1-10% of patients) 1
• Iron sucrose has a favorable safety profile compared to other IV iron preparations 1

Clinical Efficacy

• Studies show that iron sucrose therapy is effective in achieving target hemoglobin levels in approximately 80% of patients with iron deficiency anemia 1
• Most patients show significant improvement in hemoglobin levels within 2 weeks of therapy 1, 2
• In one study, the average increase in hemoglobin levels was 3.29 g/dL for women after completing iron sucrose therapy 2

Important Considerations for This Patient

• Given the severe anemia (Hb 6 g/dL) with symptoms (giddiness), IV iron is preferred over oral iron for rapid correction 1
• The patient's menorrhagia should be addressed concurrently to prevent recurrence of iron deficiency
• If the patient experiences any adverse reactions during administration, consider slowing the infusion rate 1
• Ensure proper hydration before administration to minimize risk of hypotension

This approach provides rapid correction of severe anemia while maintaining a good safety profile, which is particularly important for this symptomatic young patient with ongoing blood loss from menorrhagia.