A 29-year-old primigravida at 28 weeks has iron deficiency anaemia with haemoglobin 8.4 g/dL despite six weeks of oral ferrous sulfate, and she cannot tolerate further oral iron because of persistent vomiting. She is haemodynamically stable and asymptomatic. The MOST appropriate management is:

• A Parenteral iron, such as iron sucrose or ferric carboxymaltose ✓
• B Switch to a different oral salt and reassess in four weeks
• C Continue the same oral preparation with vitamin C supplementation
• D Blood transfusion

Explanation

Failure of or intolerance to oral iron in the second or third trimester with moderate anaemia is the accepted indication for parenteral iron, which corrects haemoglobin faster than oral therapy. Transfusion is reserved for haemoglobin below about 7 g/dL, decompensation, or anaemia within a few weeks of delivery, none of which apply here. Switching oral salts merely repeats a strategy that has already failed over six weeks.

Reference: DC Dutta's Textbook of Obstetrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.