A 30-year-old primigravida at 35 weeks has iron deficiency anaemia with haemoglobin 6.4 g/dL despite four weeks of oral iron. She has fatigue, pallor, and mild dyspnoea on exertion. What is the most appropriate next step?

• A Continue oral iron and recheck haemoglobin after two weeks
• B Switch to parenteral iron sucrose alone
• C Add vitamin B12 and folic acid to oral iron
• D Transfuse packed red blood cells ✓

Explanation

In the third trimester with haemoglobin below 7 g/dL, especially close to term, transfusion is recommended because there is insufficient time for iron stores to rebuild and labour carries haemorrhage risk. Parenteral iron raises haemoglobin over two to three weeks, too slow at 35 weeks with symptomatic severe anaemia. Continuing oral iron after documented failure delays definitive correction. The deciding fact is the RCOG guidance that Hb below 7 g/dL in the third trimester warrants transfusion.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.