Iron Sucrose Dosing for Iron Deficiency Anemia
The most effective formula for calculating iron sucrose dosage in iron deficiency anemia (IDA) is the Ganzoni formula: Total iron deficit (mg) = body weight (kg) × [target hemoglobin - actual hemoglobin (g/dL)] × 0.24 + 500 mg for iron stores. 1
Dosing Approaches for Iron Sucrose
Ganzoni Formula Method
- Calculate total iron deficit using:
- Body weight (kg) × [target hemoglobin - actual hemoglobin (g/dL)] × 0.24 + 500 mg
- This formula accounts for both the iron needed to correct anemia and to replenish iron stores
- While considered the traditional gold standard, this formula can be inconvenient and may underestimate iron requirements 1
Simplified Dosing Based on Weight and Hemoglobin
For adult patients, a simplified approach based on hemoglobin and body weight can be used:
| Hemoglobin (g/dL) | Body weight <70 kg | Body weight ≥70 kg |
|---|---|---|
| 10-12 (women) | 1000 mg | 1500 mg |
| 10-13 (men) | 1000 mg | 1500 mg |
| 7-10 | 1500 mg | 2000 mg |
| <7 | 1500 mg + 500 mg | 2000 mg + 500 mg |
Administration Protocol
- Standard dose: 200 mg per injection 1, 2
- Administration time: Minimum 30 minutes 1
- Frequency: Can be given on alternate days, up to three times per week 3
- No dilution required: Can be administered as an IV push over 5 minutes 4
- Test dose: Required before administration 2
Clinical Considerations
Monitoring Response
- An acceptable response is an increase in hemoglobin of at least 2 g/dL within 4 weeks of treatment 1
- Monitor hemoglobin every 4 weeks until normalization 2
- Re-evaluate iron status 8-10 weeks after completion of therapy 2
- Target parameters: Hemoglobin ≥11-12 g/dL, ferritin >100 ng/mL, transferrin saturation >20% 2
Safety Profile
- Iron sucrose has a favorable safety profile with low risk of serious adverse reactions 2, 5
- Common side effects include:
Special Populations
- For children: Weight-based dosing is recommended:
- <10 kg: 25 mg per dose (total course 125 mg)
- 10-20 kg: 50 mg per dose (total course 250 mg)
20 kg: 100 mg per dose (total course 500 mg) 2
When to Consider IV Iron Sucrose as First-Line
- Clinically active inflammatory bowel disease
- Previous intolerance to oral iron
- Hemoglobin below 10 g/dL
- Patients requiring erythropoiesis-stimulating agents
- Ongoing blood loss
- Symptomatic iron deficiency despite normal hemoglobin 2
Pitfalls to Avoid
- Do not administer on the same day as anthracycline chemotherapy (increased cardiotoxicity risk) 2
- Avoid during periods of neutropenia (increased infection risk) 2
- The Ganzoni formula may underestimate iron requirements in some patients 1
- For patients with hemoglobin below 7.0 g/dL, consider an additional 500 mg beyond calculated dose 1
- Monitor patients for at least 30 minutes after infusion for hypersensitivity reactions 2
Iron sucrose is an effective treatment for IDA with a good safety profile when dosed appropriately, even at higher doses administered in a single session 6.