Extreme anemia (Hb 33 g/L) in a 13-year-old girl: Is the transfusion always mandatory?

Iron-deficiency anemia is a frequent condition in women and adolescent girls often caused by heavy menstrual bleeding. Sometimes the level of chronic anemia, although well tolerated, can be very severe. The recently introduced Patient Blood Management guidelines and the availability of effective and safe intravenous iron preparations may question transfusion as the traditional option. We describe here the case of a 13 years old girl with extreme iron-deficiency chronic anemia (Hb 33 g/L) that was successfully treated with i.v. Ferric Carboxymaltose (FCM). After the administration of 2 g of FCM in three refracted doses, in association with folic acid 5 mg/day for two weeks, the hemoglobin raised to 79 g/L in 12 days and to 144 g/L after about 7 months without any undesired effect recorded. Intravenous FCM can be an effective and safe alternative to blood transfusion also in selected cases of severe iron-deficiency anemia in children.