25/06/2026
Rapid reminder for doctors
Dealing with anemia in paeds
Before intravenous iron,
1.Confirm iron deficiency (low ferritin,CBC- low MCV/MCH, high RDW, compatible blood film)
2. Hemodynamically stable ?. If the child has heart failure, shock, altered consciousness, or severe symptoms- breathlessness, tachycardia, a packed red blood cell transfusion may be needed first rather than IV iron alone.
3. *Total iron dose (mg) dose = Body weight (kg) × (Target Hb − Actual Hb) × 2.4 + Iron stores*
Target Hb = 12 g/dL
Iron stores =15 mg/kg (or about 500 mg in adults;
4. *Ferric carboxymaltose* ( inj elinjec smai,ferinject searle-500 -1000 mg/10 ml)
- *15 mg/kg per dose*
Total iron requirement is *divided into multiple doses* of 15 mg/kg, given every 3–7 days until the total iron deficit is replaced.
5. Recheck Hb and reticulocyte count in 2–4 weeks and ferritin after iron repletion.
6. Investigate the cause of iron deficiency (dietary deficiency, occult blood loss, malabsorption, etc.).
7. A 500/1000 mg ferric *carboxymaltose vial is a single-dose vial. Once opened, the remaining drug should be discarded*
If a second dose is needed after ≥7 days, use fresh vial and withdraw required ml again. Discard unused portion.
8. *iron sucrose* (Venofer -100 mg/vial ®) – when oral iron not tolerable, Rapid iron replacement required, Ferric carboxymaltose unaffordable.
Iron sucrose dose *-7 mg/kg per infusion*
Maximum 100–300 mg per infusion.
Total iron requirement is divided into multiple doses of 7 mg/kg, given every 3–7 days until the total iron deficit is replaced.
Advantage- each vial 100 mg-so convenient in pediatrics:
Observe for hypersensitivity during and for at least 30 minutes after infusion.
Recheck Hb after 2–4 weeks and ferritin after iron repletion.
Lastly- ferric carboxymaltose = 15 mg/kg in 1–2 large doses, whereas iron sucrose = 5–7 mg/kg in multiple smaller doses. This is the key difference.
Dr Ayaz Ahmed
