A pregnant woman at 30 weeks is found to have hemoglobin of 7.2 g/dL with a peripheral smear showing microcytosis, hypochromia, and target cells. Serum ferritin is 6 ng/mL. She is at high altitude. The most appropriate treatment is:
- A Oral ferrous sulfate alone
- B Blood transfusion
- C IV iron sucrose ✓
- D Erythropoietin injections
Correct answer: C. IV iron sucrose
Explanation
Hemoglobin below 7 g/dL in the second half of pregnancy with confirmed iron deficiency (ferritin <12 ng/mL) and inadequate time for oral iron response (30 weeks gestation) warrants IV iron therapy. IV iron sucrose or ferric carboxymaltose provides rapid iron repletion. Oral iron at this hemoglobin level and gestation is too slow. Transfusion is reserved for Hb <6 g/dL or hemodynamic instability.
Reference: Williams Obstetrics, 26th ed.
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