Iron Sucrose Dosing for Severe Anemia in a 22-Year-Old Female
For a 22-year-old female with severe anemia (hemoglobin 4.5 g/dL), intravenous iron sucrose should be administered at a maximum single dose of 200 mg over 10 minutes, with multiple doses required to achieve full iron repletion. 1
Assessment of Severe Anemia
- Hemoglobin of 4.5 g/dL represents severe anemia requiring urgent intervention 2
- This level of anemia is significantly below the WHO threshold for anemia in women (<12.0 g/dL) and indicates a critical situation 2
- Symptoms like giddiness (dizziness) are consistent with severe anemia and suggest compromised tissue oxygenation 3
Iron Sucrose Dosing Considerations
- Iron sucrose (Venofer) has a maximum single infusion dose of 200 mg 1, 4
- Each dose should be administered over a minimum of 10 minutes 1
- For severe anemia, multiple doses will be required to achieve full iron repletion 1
Calculating Total Iron Deficit
The total iron deficit can be calculated using the following formula:
- Total iron deficit (mg) = [Target Hb - Actual Hb] × Weight (kg) × 2.4 + 500 mg (for iron stores) 1
- For a standard 60 kg female:
- Iron deficit = [12 g/dL - 4.5 g/dL] × 60 kg × 2.4 + 500 mg
- Iron deficit = 7.5 × 60 × 2.4 + 500 = 1,080 + 500 = 1,580 mg 1
Administration Protocol
- Administer 200 mg iron sucrose per session (maximum single dose) 1, 4
- Multiple sessions will be required to deliver the total calculated iron deficit 1
- Typically, sessions can be scheduled 2-3 times weekly until the total iron requirement is met 4
- Monitor for adverse reactions during administration, as anaphylaxis can occur (though less common with iron sucrose than with iron dextran) 1
Monitoring Response
- Check hemoglobin levels after 2-4 weeks to assess initial response 1
- Target hemoglobin should be 11-12 g/dL 1
- Continue iron therapy until both hemoglobin normalization and iron store repletion are achieved 1
- Monitor ferritin and transferrin saturation to ensure adequate iron stores (target ferritin >100 ng/mL and TSAT >20%) 1
Important Considerations and Precautions
- Resuscitation facilities should be available during IV iron administration due to potential for anaphylactic reactions 1
- At this critically low hemoglobin level (4.5 g/dL), red blood cell transfusion may also be indicated alongside iron therapy 5
- Investigate underlying cause of severe iron deficiency anemia (e.g., gastrointestinal bleeding, malabsorption, heavy menstrual bleeding) 1
- Once hemoglobin normalizes, continue monitoring every 3 months for the first year to detect recurrence 1
Follow-up Care
- After initial treatment, monitor hemoglobin levels every 3-4 weeks until normalized 1
- Once normalized, check hemoglobin every 3 months for 1 year, then after a further year 1
- If hemoglobin or red cell indices fall below normal during follow-up, additional iron supplementation should be given 1
- Investigate for underlying causes if anemia recurs despite adequate iron replacement 1