In iron deficiency anemia in pregnancy, when should parenteral iron be preferred over oral supplementation?
- A When GI intolerance to oral iron, non-compliance, malabsorption (IBD/bariatric surgery), or Hb <8 g/dL after 28 weeks exists ✓
- B When hemoglobin is <7 g/dL at any gestational age
- C After 34 weeks gestation when insufficient time remains for oral iron to correct Hb before delivery
- D Only when ferritin is <5 mcg/L regardless of hemoglobin level
Correct answer: A. When GI intolerance to oral iron, non-compliance, malabsorption (IBD/bariatric surgery), or Hb <8 g/dL after 28 weeks exists
Explanation
Parenteral (IV) iron is preferred when: (1) oral iron is not tolerated (GI side effects), (2) non-compliance is documented, (3) malabsorption syndromes exist (IBD, celiac, post-bariatric surgery), (4) Hb <8 g/dL after 28 weeks (insufficient time for adequate oral response before third-trimester demands), or (5) rapid correction is needed. A Hb <7 g/dL is an indication for packed red cell transfusion (not just IV iron). IV iron sucrose and ferric carboxymaltose are commonly used after the first trimester.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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