A woman at 32 weeks gestation has iron deficiency anemia with Hb 7.2 g/dL and ferritin 6 µg/L. She is intolerant to oral iron due to severe GI side effects. The PREFERRED management is:

• A Blood transfusion immediately
• B Intramuscular iron sorbitol (Jectofer)
• C Continue oral iron with dose reduction and antacid co-administration
• D Intravenous iron sucrose or ferric carboxymaltose infusion ✓

Explanation

For iron deficiency anemia in pregnancy with oral iron intolerance, intravenous iron (ferric carboxymaltose or iron sucrose) is the appropriate management. IV iron sucrose and ferric carboxymaltose are safe in the second and third trimesters, rapidly replenish iron stores, and improve Hb more quickly than oral iron. Blood transfusion is reserved for hemodynamic compromise or Hb <6 g/dL with symptoms. IM iron sorbitol has largely been abandoned due to pain, pigmentation, and risk of sarcoma. Antacid co-administration reduces oral iron absorption.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.