How many 200mg doses of IV Venofer (iron sucrose) are needed for a 30-week pregnant woman with severe iron deficiency anemia?

IV Iron Sucrose (Venofer) Dosing for Severe Iron Deficiency in Pregnancy

For a 30-week pregnant woman with ferritin of 8 and iron saturation of 17%, a total of 5 doses of 200mg IV Venofer (iron sucrose) is recommended to correct severe iron deficiency anemia and replenish iron stores.

Assessment of Iron Status

The patient presents with clear evidence of severe iron deficiency:

• Ferritin of 8 ng/mL (significantly below the threshold of 30 μg/L for iron deficiency in pregnancy) 1
• Iron saturation of 17% (below target of 20%)
• At 30 weeks gestation (third trimester)

These values indicate severe iron deficiency anemia requiring prompt intervention to improve maternal and fetal outcomes.

IV Iron Sucrose Dosing Calculation

Iron sucrose (Venofer) is administered in the following manner:

• Maximum single dose: 200mg 2
• Administration time: 10 minutes per dose 2
• Typical dosing schedule: 200mg on alternate days 1, 3

Total Dose Calculation:

1. For severe iron deficiency in pregnancy, a total dose of 1000mg is typically required to:

   • Correct the existing anemia
   • Provide adequate iron stores for the remainder of pregnancy
   • Support increased iron demands of the third trimester

2. This translates to 5 doses of 200mg IV iron sucrose administered on alternate days 3, 4

Expected Response to Treatment

With this dosing regimen, you can expect:

• Hemoglobin increase of approximately 2-3 g/dL within 3-4 weeks 5, 3
• Significant improvement in ferritin levels (from baseline of 8 to >50 ng/mL) 3
• Improved iron saturation to >20% 2
• Better maternal and fetal outcomes compared to oral iron therapy 5, 4

Advantages of IV Iron Sucrose Over Alternatives

IV iron sucrose is superior to oral iron in this scenario because:

• More rapid correction of severe anemia (5.1 g/dL vs 3.1 g/dL increase in hemoglobin) 5
• Better compliance due to fewer gastrointestinal side effects 4
• Higher likelihood of achieving target hemoglobin (>11 g/dL) before delivery 6
• Avoids the need for blood transfusion 6

Monitoring Recommendations

After initiating IV iron therapy:

• Check hemoglobin and reticulocyte count after 1-2 weeks to confirm appropriate response 3, 4
• Reassess complete iron studies (ferritin, iron saturation) 2-4 weeks after completion of therapy 7
• Continue monitoring hemoglobin monthly until delivery 7

Safety Considerations

While administering IV iron sucrose:

• Ensure resuscitation facilities are available (though anaphylaxis is rare with iron sucrose) 2, 1
• Monitor for minor side effects like transient abdominal pain, weakness, or phlebitis at infusion site 6
• Administer as a slow IV infusion over 10 minutes per dose 2

Key Pitfalls to Avoid

1. Underdosing: Insufficient total dose may fail to replenish iron stores and lead to recurrence of anemia before delivery
2. Delayed treatment: Postponing IV iron therapy may result in worsened maternal anemia and adverse fetal outcomes
3. Inadequate monitoring: Failure to follow up on hemoglobin response could miss non-responders
4. Relying on oral iron: In severe deficiency at 30 weeks, oral iron alone is unlikely to correct anemia before delivery 5, 4

By following this 5-dose regimen of 200mg IV iron sucrose, you can effectively correct the patient's severe iron deficiency anemia and improve both maternal and fetal outcomes.