(P-TS-61) Intravenous Iron May Be an Alternative to Red Blood Cell Transfusion in Severely Iron-Deficient Anemic Patients with Menorrhagia

Background/Case Studies: Menorrhagia can result in iron deficiency in females of reproductive age. Some of these women may become severely anemic with hemoglobin < 7 g/dL, symptomatic with fatigue, and cardiorespiratory symptoms, and are sent to emergency room (ER) by primary care physicians (PCP) with a request for red blood cell (RBC) transfusion. The most common approach is to transfuse RBC and discharge from the ER.

Study

Design/Methods: A review of the outcome in a female patient with severe iron deficiency presenting to the ER and alternatively managed by RBC transfusion and intravenous iron replacement.

Results/Findings: A 38-year-old female with menorrhagia and iron deficiency anemia was seen in the ER for severe fatigue in November 2020. The patient’s hemoglobin was 6.9 g/dL and she received two units of RBC transfusion per request by her PCP. Her hemoglobin on the following day was 9.1 g/dL. Approximately one year later, she presented to the ER again with severe fatigue and lightheadedness, referred by her PCP for RBC transfusion. Her hemoglobin was 7.0 g/dL on outpatient labs. In the ER, her vital signs were stable and her physical examination was remarkable for moderate pallor. Laboratory studies in the ER revealed microcytic anemia with Hb 7.5 g/dL, MCV 69 fL, and serum ferritin 3 ng/mL. Blood type and screen showed Group O , RHD positive, negative antibody screen. Due to Group O blood shortage, the ER physician was contacted and she was given intravenous iron sucrose (Venofer) 100 mg and was advised to take oral ferrous sulfate 325 mg once daily. The patient “felt better “ after receiving IV iron and was discharged from the ER. One week later, repeat hemoglobin was 7.9 g/dL. Importantly, the patient’s hemoglobin six months later was 13.1 g/dL (as shown in Figure A) and she has not been seen in the ER since.

Conclusions: In severely anemic, iron-deficient females of reproductive age, intravenous iron repletion may be considered as a viable alternative to RBC transfusion, even in symptomatic cases.