How would you treat a pregnant woman with iron deficiency who has undergone bariatric surgery?

Here’s how readers responded to a You Make the Call question about a pregnant woman with iron deficiency who has undergone bariatric surgery.

Disclaimer: ASH does not recommend or endorse any specific tests, physicians, products, procedures, or opinions, and disclaims any representation, warranty, or guaranty as to the same. Reliance on any information provided in this article is solely at your own risk.

We use iron dextran 1,000 mg IV over 3- to 4-hour infusions routinely in pregnant women. We only give acetaminophen 650 mg for pre-medication. We do not like making patients return for multiple infusions of small doses of IV iron, which is what occurs with iron sucrose or citrate. The copay for ferric carboxymaltose has been prohibitive for many of our patients, so we use it rarely.

Sally Stabler, MD
Aurora, CO

The patient would certainly benefit from other new parenteral iron formulations.

At our hospital, we routinely treat iron deficient pregnant patients with one to two doses of ferric carboxymaltose 500 mg. Since the introduction of this formulation to the hospital pharmacy, we have treated over 50 patients with good results and minimal side effects.

Up to 1,000 mg of elemental iron can be injected at each session and the iron profile can be re-evaluated at least seven days after injection. We use the usual formula for iron repletion for both non-pregnant and pregnant women.

Ebrahim Osfouri, MD
Bushehr University of Medical Sciences
Bushehr, Iran

For a young pregnant woman in second trimester or beyond, ferric carboxymaltose would be appropriate. It can be administered weekly up to 1,000 mg/dose, depending on degree of deficiency and any anemia.

Andrew Shearer, MBBS
Cairns, Australia

Two doses of ferric carboxymaltose
injection 750 mg.

Maurice Schwarz, MD
Mechanicsville, VA  

Iron carboxymaltose 1 mg IV.

Riton Das, MD
Port Macquarie, Australia

We have in our country iron polymaltose 500 mg for IV use. Not knowing the hemoglobin and ferritin levels, I would prescribe two 500 mg doses in 15 days.

Jorge David Korin, MD
Buenos Aires, Argentina

I would treat with iron carboxymaltose 1 g. It is safe in second and third trimesters. One could also give iron polymaltose 1 g. It is safe; however, the infusion time is much longer.

William Renwick, MBBS
St Albans, Australia

I treat many pregnant women with significant iron deficiency. Iron sucrose is not the safest IV iron preparation. My experience over the last three years is with iron carboxymaltose, which has a low side effect profile and is safe. In Australia, we can give 1,000 mg in one infusion over one hour in second trimester of pregnancy. In my practice, we believe it is as safe as an IV infusion over one hour.

Richard Herrmann, MBBS
Osborne Park, Australia

 We routinely use ferric carboxymaltose, which is safe. The amount of iron that can be administered is also higher, leading to fewer injections.

Aniruddha Dayama, MD
Ghaziabad, India

Carboxymaltose iron preparation would be my choice.

Evan Slater, MD
Ventura, CA

Use ferric carboxymaltose. It has the lowest side effect profile. It can be given as an IV push dose of 500 mg in an outpatient setting or consulting room.

Michael Pidcock, MBBS
Canberra, Australia

Carboxymaltose 1,000 mg IV and, depending on her hemoglobin, another dose of 500 or 1,000 mg.

Rodolfo Cançado, MD, PhD
São Paulo, Brazil

Iron dextran.

Ali Alain Madani, MD PhD
Tucson, AZ