A 30-year-old at 32 weeks has iron-deficiency anaemia with haemoglobin 7.2 g/dL, MCV 68 fL, serum ferritin 4 ng/mL, and transferrin saturation 8%. She reports intolerance to oral ferrous sulphate (nausea, constipation). What is the most appropriate management?
- A IV iron sucrose or ferric carboxymaltose infusion ✓
- B Switch to ferrous bisglycinate (organic iron) — better tolerated with equivalent absorption
- C Blood transfusion as haemoglobin < 8 g/dL
- D Folic acid supplementation and dietary modification
Explanation
IV iron is indicated in pregnancy when: (1) oral iron is not tolerated or absorbed, (2) there is a need for rapid correction (late gestation, < 32 weeks with severe deficiency), or (3) haemoglobin fails to respond to 4 weeks of adequate oral supplementation. Ferric carboxymaltose (FCM) allows high doses (up to 1000 mg) in a single infusion with low adverse effect profile and is preferred in the second/third trimester. Iron sucrose (200–300 mg per session) is also safe in pregnancy. Blood transfusion is reserved for haemoglobin < 7 g/dL with symptoms or < 8 g/dL peripartum — not first-line at 7.2 g/dL at 32 weeks without acute haemorrhage. Ferrous bisglycinate may reduce GI side effects but does not overcome established intolerance necessitating parenteral route.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.