In a 40-year-old woman with serum ferritin 8 ng/mL and hemoglobin 10.8 g/dL presenting with fatigue, what total dose of intravenous iron sucrose (Venofer) should be administered and what is the recommended dosing interval?

IV Iron Sucrose Dosing for Iron Deficiency Anemia

For this 40-year-old woman with severe iron deficiency (ferritin 8 ng/mL, Hb 10.8 g/dL), administer 200 mg of intravenous iron sucrose twice weekly for a total of 1000-1200 mg, given over 5-6 weeks.

Total Dose Calculation

• Target total dose: 1000-1200 mg of elemental iron 1, 2
• This patient has profound iron deficiency with ferritin of only 8 ng/mL (normal >30 ng/mL) and mild anemia
• Studies demonstrate that 200 mg doses given twice weekly effectively correct both hemoglobin and ferritin levels in iron deficiency anemia 1, 3

Dosing Interval and Schedule

Recommended regimen:

• 200 mg iron sucrose per infusion 4
• Twice weekly administration 1, 3
• Duration: 5-6 weeks (total of 10-12 infusions) 1, 2
• Each infusion should be given over 10 minutes as a bolus dose 4

Alternative Acceptable Schedule

• 200 mg weekly for 10 weeks is also effective, though slower 2
• The twice-weekly regimen achieves faster correction of anemia and is better tolerated than oral iron 3

Expected Response

Hemoglobin improvement:

• Mean increase of 3.3-4.6 g/dL after completing therapy 2
• Significant improvement visible by day 14-21 3
• 84-94% of patients achieve at least 2 g/dL increase in hemoglobin 2

Ferritin restoration:

• Target ferritin >100 ng/mL for adequate iron stores 4
• Mean post-treatment ferritin reaches 99-224 ng/mL 1, 2
• Ferritin correction occurs by day 30 of treatment 1, 3

Safety Considerations

This regimen is safe with minimal adverse effects:

• No serious or life-threatening reactions reported with 200 mg bolus dosing 1, 2
• Mild side effects occur in <5% of patients (vs 20% discontinuation rate with oral iron) 5
• Resuscitation facilities must be available during infusion despite low risk 4
• No test dose required for iron sucrose (unlike iron dextran) 4

Monitoring

Follow-up laboratory testing:

• Recheck hemoglobin and ferritin at 4 weeks 1, 3
• If hemoglobin remains <11 g/dL or ferritin <100 ng/mL after completing the course, consider additional doses 4
• Monitor every 3 months for 1 year after correction to detect recurrence 4

Important Caveats

Do not exceed these limits:

• Maximum single dose: 200 mg per infusion 4
• Stop therapy if ferritin exceeds 800 ng/mL or transferrin saturation >50% 4
• Unlike iron dextran, iron sucrose cannot be given as a single large infusion 4

Oral iron is inadequate for this patient:

• With ferritin this low (8 ng/mL), oral iron absorption is insufficient to correct deficiency rapidly 4
• IV iron achieves faster correction and better tolerability than oral supplementation 5, 3