More Effective Route of Treatment for Iron Deficiency Anemia in Pregnancy Intravenous Vs Oral Iron

Anemia and iron deficiency during pregnancy have been associated with preterm birth and neonatal complications. However, the evidence on whether intravenous or oral supplementation should be used has been conflicting. The aim was to assess the effectiveness of intravenous iron compared to oral iron supplementation on objective neonatal outcomes. We conducted a systematic review and meta-analysis of randomized controlled trials. Two databases were searched in November 2024 and the search was updated in February 2025. The main outcomes were the rate of preterm birth, stillbirths, and neonatal mortality. Random-effect meta-analysis was used to calculate risk ratios (RR) with 95% confidence intervals (CI). Evidence certainty was assessed according to GRADE. A total of 375 studies were screened and finally 15 were included. Seven studies with 8431 pregnancies analyzed the risk of preterm birth, and the risk appeared to be similar in both groups (RR 0.96, CI 0.86 to 1.07; moderate certainty evidence). Five studies with 8639 pregnancies analyzed the risk of stillbirth and found no difference (RR 0.85, CI 0.64 to 1.13; low certainty evidence). The neonatal mortality rate was 2.0% in the intravenous iron group, and 2.3% in the oral iron group (RR 0.90, CI 0.66 to 1.22; low certainty evidence). Cord hemoglobin levels were comparable between the study groups (mean difference 0.05 g/l, CI −0.33 to 0.24; low certainty evidence), and ferritin levels were slightly higher in the intravenous group (mean difference 19 µg/l, CI 0.5 to 38; low certainty evidence). Conclusions: Neonatal clinical outcomes did not differ between intravenous and oral iron supplementation treatment in pregnancy. A higher ferritin level in umbilical cord blood was found in the intravenous iron supplementation group, but the clinical relevance of this difference is unknown. Based on the results of this study, oral iron supplementation is a sufficient way to treat maternal iron deficiency, when focusing on objective neonatal outcomes.Trial registration: PROSPERO 2024 CRD42024615533 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024615533.What is Known:• Iron-deficiency anemia during pregnancy is associated with preterm birth and neonatal complications.• Intravenous iron increases maternal hemoglobin faster than oral iron, but benefits for neonatal outcomes have been unclear.What is New:• This systematic review and meta-analysis shows that neonatal outcomes—including preterm birth, stillbirth, and mortality—do not differ between intravenous and oral iron supplementation.• Intravenous iron yields higher cord ferritin, but its clinical relevance remains uncertain.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00431-025-06522-w.

Aim: The study aimed to compare the efficacy, safety, and tolerability of oral and intravenous (IV) iron supplementation in the management of anemia in chronic kidney disease (CKD) patients. Materials and Methods: This prospective, randomized, comparative clinical trial was conducted at a tertiary care hospital, enrolling 120 adult patients with CKD-associated anemia. Patients were randomly assigned to either the oral iron group (n=60), receiving ferrous sulfate 200 mg twice daily for 12 weeks, or the IV iron group (n=60), receiving IV iron sucrose 200 mg weekly for five doses. Hemoglobin (Hb), serum ferritin, and transferrin saturation (TSAT) levels were measured at baseline, week 4, week 8, and week 12. Adverse events, including gastrointestinal symptoms in the oral group and infusion reactions in the IV group, were recorded. Statistical analysis was performed using SPSS, with a significance level of p < 0.05. Results: At week 12, the IV iron group showed a significantly greater increase in Hb (11.35 ± 0.93 g/dL) compared to the oral iron group (10.75 ± 0.95 g/dL, p < 0.001). Ferritin levels also increased more in the IV iron group (480.75 ± 80.40 ng/mL vs. 225.40 ± 55.25 ng/mL, p < 0.001), along with TSAT (38.90 ± 6.50% vs. 24.50 ± 5.40%, p < 0.001). Gastrointestinal side effects were reported in 16 (26.67%) patients in the oral iron group, while infusion reactions were observed in 9 (15.00%) patients receiving IV iron (p < 0.001). Multiple regression analysis identified IV iron therapy as the strongest predictor of hemoglobin improvement (β = 0.40, p < 0.001), while diabetes mellitus negatively impacted hemoglobin response (β = -0.12, p = 0.038). Conclusion: IV iron supplementation was more effective than oral iron in improving hemoglobin levels, ferritin, and TSAT in CKD patients with anemia. While oral iron was associated with gastrointestinal side effects, IV iron therapy had a higher incidence of infusion-related reactions. Given its superior efficacy, IV iron should be the preferred treatment for patients requiring rapid and effective anemia correction, particularly in moderate to severe CKD cases.

目的评估静脉铁剂治疗复发性缺铁性贫血（IDA）的有效性和安全性。方法回顾性分析2012年5月至2021年12月期间90例复发性IDA患者的临床资料，比较静脉铁剂组与口服铁剂组的疗效及不良反应发生情况。结果90例复发性IDA患者中，男20例，女70例，中位年龄40（14，85）岁。60例接受静脉铁剂治疗，30例接受口服铁剂治疗。补铁治疗后第4、8周，静脉铁剂组血液学反应率分别为80.0％（48/60）、96.7％（58/60），显著高于口服铁剂组患者的3.3％（1/30）、46.7％（14/30）（Fisher，均P<0.001）；HGB较基线分别中位增高38（4，66）g/L和44.5（18，80）g/L，显著高于口服铁剂组的7（1，22）g/L和19（3，53）g/L（t＝10.720，P<0.001；t＝7.392，P<0.001）；HGB恢复正常患者分别为33例（55.0％）和54例（90.0％），显著高于口服铁剂组的0例和13例（43.3％）（Fisher，均P<0.001）。静脉铁剂组和口服铁剂组分别有26例和7例在治疗前以及治疗后8周检测了铁代谢指标。治疗后8周静脉铁剂组血清铁蛋白（SF）中位增高值113.7（49.7，413.5）µg/L，53.8％（14/26）的患者血清SF≥100 µg/L，显著高于口服铁剂组的14.0（5.8，84.2）µg/L（t＝4.760，P<0.001），而口服铁剂组则未有SF≥100 µg/L患者（Fisher，P＝0.013）。静脉铁剂组不良反应率为3.3％（2/60），远低于口服铁剂组20.0％（6/30）（Fisher，P＝0.015）。结论复发性IDA应用静脉补铁较口服补铁治疗血液学反应率更高，HGB上升更快，储存铁补足率更高，患者耐受良好。

While the prevalence and clinical characteristics of restless legs syndrome (RLS) are known to vary according to ethnicity, a detailed evaluation of this condition among patients with iron deficiency anemia (IDA) has not yet been reported in an Asian population. We investigated the prevalence and clinical characteristics of RLS in patients with IDA in Korea compared with age- and sex-matched patients diagnosed with idiopathic RLS. This prospective single-center study was performed at a regional university hospital. Consecutive patients with IDA were enrolled over a 4-year period. Clinical interviews and laboratory tests were conducted at the first visit. RLS diagnosis was confirmed through face-to-face interviews. We randomly selected patients with idiopathic RLS without comorbid medical disorders from our sleep center dataset as control patients. The clinical characteristics of both groups were compared. We enrolled 124 patients with IDA. Fifty (40.3%) patients were diagnosed with RLS, with 82% exhibiting severe to very severe symptoms. Patients with IDA and RLS were older and reported more sleep deterioration than patients with IDA without RLS. Patients with IDA and RLS also had a more depressed mood and higher periodic limb movement index scores than patients with idiopathic RLS. The prevalence of RLS among patients with IDA in Korea was high, with the majority having severe to very severe symptoms. Patients with IDA and RLS had poorer sleep quality and more emotional problems than patients with IDA without RLS. Therefore, patients with IDA should be screened for RLS to prevent adverse effects on the quality of sleep and life.

Background: Iron deficiency anemia (IDA) remains one of the most prevalent nutritional disorders globally, particularly affecting pregnant women in low- and middle-income countries. While oral iron is the standard first-line treatment, its gastrointestinal side effects and poor compliance often limit effectiveness. Intravenous (IV) iron offers a faster alternative but carries potential risks and higher costs. Objective: To systematically compare the efficacy and safety of intravenous iron therapy versus oral iron supplementation for treating iron deficiency anemia in pregnant women, based on randomized controlled trial (RCT) data. Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. Databases including PubMed, Cochrane CENTRAL, and Google Scholar were searched from inception to 15 March 2025 for RCTs comparing IV and oral iron in pregnant women with IDA. Outcomes included change in hemoglobin (Hb) levels, risk of postpartum hemorrhage (PPH), need for blood transfusion, and adverse events. Risk of bias was assessed using the Cochrane Risk of Bias Tool, and evidence certainty was graded using GRADE. A random-effects model was used to pool results. Results: Ten RCTs (n = 5954) were included. IV iron was associated with a significantly greater Hb increase at 3–6 weeks post-treatment (SMD: 0.25; 95% CI: 0.01–0.49; P = 0.04; I² = 85%). Sensitivity analysis excluding high-weight studies showed stronger results (WMD: 0.36 g/dL; 95% CI: 0.24–0.47; P &lt; 0.00001; I² = 27%). No significant difference was found in the risk of PPH (RR: 1.21; 95% CI: 0.77–1.89; P = 0.41) or need for transfusion (RR: 0.69; 95% CI: 0.46–1.03; P = 0.07). Adverse events were significantly lower in the IV iron group (RR: 0.51; 95% CI: 0.37–0.71; P &lt; 0.0001; I² = 0%). Conclusion: IV iron is more effective than oral iron for improving hemoglobin levels in pregnant women with IDA and has a better safety profile. However, it does not significantly reduce the risk of PPH or transfusion. These findings support the selective use of IV iron in clinical scenarios where oral iron is poorly tolerated or ineffective. Further research is needed to evaluate long-term maternal and neonatal outcomes and cost-effectiveness in resource-limited settings.

Postoperative Intravenous Iron Supplementation Does Not Improve Hemoglobin Level and Transfusion Rate Following Staged Bilateral Total Knee Arthroplasty

Anemia is a global health problem, and the most common cause is iron deficiency anemia (IDA). Although blood transfusion is considered for patients with hemoglobin (Hb) values below 7 g/dl, the optimal transfusion threshold for slowly developing anemia in ambulatory patients has not been clearly defined. IDA can progress slowly, allowing the hemodynamic system to compensate and prevent symptoms, even at very low hemoglobin levels, particularly in young, healthy individuals. Transfusion decisions should be individualized to the severity of symptoms rather than simply hemoglobin levels. The aim of this study is to retrospectively evaluate outpatients with iron deficiency anemia who refused blood transfusion and were treated with intravenous iron supplementation. This study is a retrospective study based on medical records. The patients with Hb level below 7 were found from medical records. The patients who did not undergo blood transfusion and were treated with IV iron were identified. The response to parenteral iron replacement therapy in severe IDA was evaluated in terms of improvement in hemoglobin, hematocrit, and ferritin levels and whether any complications developed. The study included 84 patients, with 89.3% being women and 10.7% men, and an average age of 35.1 years. The most common symptoms reported were fatigue, dizziness, and pallor. Hemoglobin levels significantly increased from 6.4 to 11.1 g/dl (p < 0.001) after IV iron treatment, as did ferritin levels, while total iron-binding capacity decreased. No complications, mortality, or morbidity were reported. Anemia such as IDA may develop without serious symptoms, even if Hb levels are below 7. It is important to manage these individuals with personalized care rather than relying solely on Hb levels for blood transfusion decisions. IV iron therapy can effectively raise Hb levels and reduce associated risks by reducing unnecessary blood transfusions. These findings highlight the need for individualized IV iron therapy as a first-line treatment in young healthy patients to improve outcomes and optimize healthcare resources.

INTRODUCTION: Intravenous (IV) iron supplementation for patients with iron deficiency anemia in pregnancy has been shown to improve hemoglobin (Hb) levels in the peripartum period and ultimately lead to a decrease in severe maternal morbidity (SMM), specifically blood transfusion. The objective of this study was to analyze the effects of IV iron supplementation on maternal pre-delivery Hb levels after the implementation of an institution-based protocol focused on maternal red blood cell transfusion reduction. METHODS: We performed a retrospective review of patients who received IVFe supplementation after the implementation of a maternal transfusion reduction bundle at our Level IV maternal care center in 2020. We reviewed changes in maternal Hb pre-infusion and pre-delivery over a 3-year period (2020–2023), along with rates of postpartum blood transfusion. Patients were excluded if they received an antepartum blood transfusion. Maternal demographics, ferritin and Hg levels were compared between the two groups using GraphPad Prism software. RESULTS: Two hundred ninety-five patients met inclusion criteria; most patients were Hispanic (71.9%), had Medicaid (51.9%), and underwent a vaginal delivery (76.9%). Mean gestational age at time of infusion was 34.2 weeks (95% CI, 33.7–34.7) The average Hb pre-infusion and pre-delivery were 8.9 (95% CI, 8.8–9.0) and 10.6 (95% CI, 10.4–10.8), respectively. The change in maternal Hb at time of delivery increased by 2 points (P&lt;.0001). Only two patients received a blood transfusion postpartum. CONCLUSION: Implementation of a standardized antenatal IV iron infusion protocol can improve maternal pre-delivery Hb levels and reduce morbidity associated with blood transfusion.

Background: Early-stage breast cancer patients frequently demonstrate iron deficiency with or without anemia because of recurrent menstrual losses during their premenopausal years. It is not uncommon to remain iron deficient after menopause due to failure to replete whole body iron stores with diet alone. Chemotherapy induces anemia through its suppressive effects on the bone marrow and hematologic recovery can be impeded by iron stores insufficient to manufacture new red blood cells. Available data suggests that intravenous (IV) iron supplementation is safe in cancer patients and that anemia in cancer patients is associated with an increase in all-cause mortality. We are conducting a retrospective study to understand the effect of IV iron supplementation on efficacy and toxicity in early-stage breast cancer patients receiving neoadjuvant chemotherapy. We hypothesize that IV iron supplementation can improve rates of pathologic complete response (pCR) and improve our ability to administer standard neoadjuvant chemotherapy regimens by maintaining patient quality of life and reducing need for dose modifications and treatment delays. Objective: To identify the effect of IV iron supplementation on the efficacy and toxicity of neoadjuvant chemotherapy in early-stage breast cancer patients. Methods: We are analyzing efficacy endpoints (pCR, 3 year invasive disease-free survival, etc.) and toxicity endpoints (dose reductions, dose delays, hemoglobin decreases, hemoglobin recovery, etc.) in a retrospective cohort of breast cancer patients receiving neoadjuvant chemotherapy. Patients will be divided into three major groups: (1) iron deficient (ferritin &amp;lt;100) receiving IV iron, (2) iron deficient not receiving IV iron and (3) not iron deficient (ferritin &amp;gt;100) not receiving IV iron. pCR rate will be evaluated across the entire cohort and subdivided by luminal (ER-positive), triple negative and HER2-positive subtypes. We will further analyze the absolute and relative changes in hemoglobin levels over time; the incidence of dose reductions and dose delays; and the effects on patient quality of life as evidenced in the medical record before, during and after the course of neoadjuvant chemotherapy. Results: We anticipate that iron deficient patients with or without IV iron supplementation will manifest a pCR rate no worse than non-iron deficient patients but that there will be better tolerability and fewer dose reductions or dose delays in patients receiving IV iron supplementation. At best, patients receiving IV iron will demonstrate a pCR rate superior to patients not receiving IV iron, possibly regardless of whether it is indicated (ferritin &amp;lt;100) or not (ferritin &amp;gt;100). Conclusions: Iron deficiency, with or without anemia, is common in women with early-stage breast cancer receiving neoadjuvant chemotherapy. Available data suggests that IV iron is safe during cancer chemotherapy and may improve efficacy and minimize side effects to these toxic drugs commonly known to cause myelosuppression. If we demonstrate that patients receiving IV iron have improved pCR rates and decreased dose reductions and dose delays, this could have a practice-changing effect on supportive care interventions administered during neoadjuvant chemotherapy for early-stage breast cancer. Citation Format: Jules Cohen, Meghana Rao. Intravenous Iron in Early-Stage Breast Cancer Patients Receiving Neoadjuvant Chemotherapy [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P1-06-11.

BackgroundApproximately 26% of patients undergoing major orthopedic elective procedures have preoperative anemia. This study aimed to investigate the effect of intravenous (IV) iron supplementation on the hemoglobin (Hb) level after staged bilateral total knee arthroplasty (TKA) in patients with or without preoperative anemia.MethodsWe retrospectively analyzed 418 patients who underwent staged bilateral TKA (1 week interval). The iron group (n = 220) received IV iron isomaltoside immediately after each TKA. The no-iron group (n = 198) was recommended to receive transfusion if postoperative anemia was diagnosed between the first and second TKA. Preoperative anemia was present in 42 (21.2%) and 50 (22.7%) patients in the no-iron and iron groups, respectively. Demographic data, preoperative and postoperative Hb levels, Hb level change (preoperative minus postoperative 6-week Hb level), and blood drainage amount were compared between groups.ResultsThe transfusion rate was lower in the iron group than in the no-iron group (96.5% vs. 58.6%, P < 0.001). Overall, the demographic data, preoperative and postoperative 6-week Hb levels, Hb level change, and blood drainage amount were not significantly different between the two groups. Among patients with preoperative anemia, the iron group showed lower Hb level change (0.6 ± 0.9 vs. 0.1 ± 1.1, P = 0.016).ConclusionPatients with preoperative anemia treated with IV iron showed lower Hb level change than did those without IV iron treatment. Despite the lower transfusion rate, the iron group showed similar postoperative 6-week Hb level and Hb level change to the no-iron group.

A Prospective Randomised Controlled Trial of a Single Intravenous Infusion of Ferric Carboxymaltose vs Single Intravenous Iron Polymaltose or Daily Oral Ferrous Sulphate in the Treatment of Iron Deficiency Anaemia in Pregnancy

Multidisciplinary Implementation of an Iron Deficiency Anemia in Pregnancy Treatment Protocol

Ferric carboxymaltose (Ferinject(R)), a novel iron complex that consists of a ferric hydroxide core stabilized by a carbohydrate shell, allows for controlled delivery of iron to target tissues. Administered intravenously, it is effective in the treatment of iron-deficiency anaemia, delivering a replenishment dose of up to 1000 mg of iron during a minimum administration time of </=15 minutes. Results of several randomized trials have shown that intravenously administered ferric carboxymaltose rapidly improves haemoglobin levels and replenishes depleted iron stores in various populations of patients with iron-deficiency anaemia, including those with inflammatory bowel disease, heavy uterine bleeding, postpartum iron-deficiency anaemia or chronic kidney disease. It was well tolerated in clinical trials. Ferric carboxymaltose is, therefore, an effective option in the treatment of iron-deficiency anaemia in patients for whom oral iron preparations are ineffective or cannot be administered. Ferric carboxymaltose is a macromolecular ferric hydroxide carbohydrate complex, which allows for controlled delivery of iron within the cells of the reticuloendothelial system and subsequent delivery to the iron-binding proteins ferritin and transferrin, with minimal risk of release of large amounts of ionic iron in the serum. Intravenous administration of ferric carboxymaltose results in transient elevations in serum iron, serum ferritin and transferrin saturation, and, ultimately, in the correction of haemoglobin levels and replenishment of depleted iron stores. The total iron concentration in the serum increased rapidly in a dose-dependent manner after intravenous administration of ferric carboxymaltose. Ferric carboxymaltose is rapidly cleared from the circulation and is distributed primarily to the bone marrow ( approximately 80%) and also to the liver and spleen. Repeated weekly administration of ferric carboxymaltose does not result in accumulation of transferrin iron in patients with iron-deficiency anaemia. Intravenously administered ferric carboxymaltose was effective in the treatment of iron-deficiency anaemia in several 6- to 12-week, randomized, open-label, controlled, multicentre trials in various patient populations, including those with inflammatory bowel disease, heavy uterine bleeding or postpartum iron-deficiency anaemia, and those with chronic kidney disease not undergoing or undergoing haemodialysis. In most trials, patients received either ferric carboxymaltose equivalent to an iron dose of </=1000 mg (or 15 mg/kg in those weighing <66 kg) administered over </=15 minutes (subsequent doses administered at 1-week intervals) or oral ferrous sulfate at a dose equivalent to 65 mg iron three times daily or 100 mg iron twice daily. In one trial, patients with chronic kidney disease undergoing haemodialysis received 200 mg of iron intravenously either as ferric carboxymaltose or iron sucrose administered into the haemodialysis line two to three times weekly. In all trials, ferric carboxymaltose was administered until each patient had received his or her calculated total iron replacement dose. Haemoglobin-related outcomes improved in patients with iron-deficiency anaemia receiving ferric carboxymaltose. Treatment with ferric carboxymaltose was associated with rapid and sustained increases from baseline in haemoglobin levels. Ferric carboxymaltose was considered to be as least as effective as ferrous sulfate with regard to changes from baseline in haemoglobin levels or the proportion of patients achieving a haematopoietic response at various timepoints. In general, improvements in haemoglobin levels were more rapid with ferric carboxymaltose than with ferrous sulfate. In patients with chronic kidney disease undergoing haemodialysis, ferric carboxymaltose was at least as effective as iron sucrose. Ferric carboxymaltose also replenished depleted iron stores and improved health-related quality-of-life (HR-QOL) in patients with iron-deficiency anaemia. Recipients of ferric carboxymaltose demonstrated improvements from baseline in serum ferritin levels and transferrin saturation, as well as improvements from baseline in HR-QOL assessment scores. Ferric carboxymaltose was at least as effective as ferrous sulfate with regard to endpoints related to serum ferritin levels, transferrin saturation and HR-QOL. Ferric carboxymaltose was well tolerated in clinical trials in patients with iron-deficiency anaemia, with most drug-related adverse events considered to be mild to moderate in severity. Commonly reported drug-related adverse events include headache, dizziness, nausea, abdominal pain, constipation, diarrhoea, rash and injection-site reactions. The incidence of drug-related adverse events in patients receiving intravenous ferric carboxymaltose was generally similar to that in patients receiving oral ferrous sulfate. In general, rash and local injection-site reactions were more common with ferric carboxymaltose, whereas gastrointestinal adverse events were more frequent with ferrous sulfate. In patients with chronic kidney disease undergoing haemodialysis, a lower proportion of ferric carboxymaltose than iron sucrose recipients experienced at least one drug-related adverse event.

Functional iron deficiency is one reason for lack of response to erythropoietin treatment. Concomitant intravenous (IV) iron supplementation has the potential to improve response to erythropoietin, allowing a decrease in erythropoietin dose requirements. In a recent study of anaemic, iron-replete patients with lymphoproliferative malignancies (Leukemia, 21, 2007, 627), the haemoglobin (Hb) increase and response rate were significantly greater in patients receiving epoetin beta with concomitant IV iron compared with patients receiving epoetin beta without IV iron (P < 0.05). The present analysis aimed to investigate whether a combination of epoetin beta and IV iron is cost-effective compared with epoetin beta without IV iron. This analysis was performed from a Swedish societal perspective as a within-trial evaluation of overall costs (based on differences in drug costs and resource use between groups) and effect (differences in Hb increases) during 16 weeks' treatment with epoetin beta with or without concomitant IV iron. There was an improved response to epoetin beta with IV iron therapy and an almost 2-fold greater increase in Hb levels. Overall mean cost per patient in the epoetin beta with IV iron group was euro5558 and in the epoetin beta without IV iron group was euro6228. Thus, treatment with epoetin beta with IV iron resulted in overall cost savings of about 11% compared with epoetin beta without iron, mainly due to reduced erythropoietin dosages. Epoetin beta with concomitant IV iron in anaemic patients with lymphoproliferative malignancies not receiving chemotherapy resulted in better outcomes at lower cost compared with epoetin beta without iron. This suggests that epoetin beta with IV iron is a dominant therapy from a Swedish perspective.

Presentation Date: 6/8/2024 Presentation Start Time: 6:00:00 PM Background Iron deficiency during pregnancy leads to increased maternal illness, low birth weight, prematurity, and intrauterine growth restriction. Pregnant women with sickle cell disease (SCD) are also at high risk for similar adverse outcomes. Although SCD is known for iron overload related to transfusion burden and ongoing hemolysis, a few patients with SCD do experience iron deficiency particularly the non-HbSS subtype group. Managing iron status in pregnant women with SCD is crucial. This case series aim is to examine the impact of intravenous (IV) iron supplement on pregnancy outcomes in four pregnant women with SCD. Methods Data was collected on four pregnant women with SCD anemia who received IV iron in a period of six months at a single institution. The data assessed included pre-and-post IV iron administration of hemoglobin levels, ferritin levels, transferrin saturation (TSAT), as well as gestational term, fetal birth weight, and APGAR scores. Results In our case series, three out of the four patients who received IV iron supplementation had HbSC. One patient has HbSS, this patient had short pregnancy intervals with three pregnancies in less than three years. All patients who received IV iron had a ferritin level of &amp;lt; 20ng/mL prior to infusion, and TSAT was &amp;lt; 20% prior to infusion. Two of the four patients delivered at full term (&amp;gt;38 weeks gestation). The patient with HbSS subtype has a miscarriage and one patient is currently pregnant in her 3rd trimester. Two patients completed a full course of IV iron, while two patients did not complete the full course due to medical noncompliance. Among the patients who completed the full course, one had a fetal birth weight of 4.0kg with APGAR scores of 9 and 9 at one- and five-minute intervals, respectively. The other patient who could not complete a full course due to medical noncompliance, had a fetal birth weight of 2.94kg and APGAR scores of 8 and 9 at one-and five-minute intervals, respectively. The patient with HbSS type SCD who did not complete the course experienced a miscarriage. Overall, hemoglobin levels improved for three of the four patients who received iron supplementation, except for one patient who received IV iron sucrose. This patient is currently pregnant and has noted an improvement in energy levels after receiving IV iron. Conclusions Our case series highlight that pregnant women with SCD can become iron deficient and require iron infusion. Traditionally, the Ganzoni equation for iron deficiency anemia is utilized to calculate the iron deficit for dosing iron. This equation is based on the baseline hemoglobin. However, in patients with hemoglobinopathies, the baseline hemoglobin is inherently low without a specific target hemoglobin. Consequently, this formula is not applicable for accurately determining iron deficit for dosing iron in this patient population. Further studies are needed to establish alternative methods for calculating iron deficit needs in the SCD patient population. Adequate iron stores improve fetal outcomes in the general population and most likely in the SCD patient population as evidenced by our case series. Therefore, it is necessary to adequately manage iron deficiency in this high-risk population.