A woman at 16 weeks has iron-deficiency anaemia with haemoglobin 7.4 g/dL. She cannot tolerate oral iron because of intractable vomiting, and her haemoglobin has fallen despite two weeks of parenteral correction attempts with oral formulations. What is the most appropriate route of iron therapy now?

• A Intramuscular iron dextran into the gluteal muscle
• B Intravenous iron sucrose or ferric carboxymaltose ✓
• C Continue oral iron with anti-emetics until delivery, then transfuse if needed
• D Immediate packed red cell transfusion as definitive therapy

Explanation

When oral iron is ineffective or not tolerated and anaemia is significant beyond the first trimester, intravenous iron sucrose or ferric carboxymaltose is the standard choice, restoring stores faster than oral therapy without the anaphylaxis risk of older high molecular weight dextran preparations. Transfusion is reserved for haemodynamic compromise, decompensation, or haemoglobin below about 7 g/dL near term, not as first-line repletion in a stable patient.

Reference: Williams Obstetrics, 26th ed.

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