Aim: This trial was undertaken to evaluate the efficacy and safety of intravenous infusion of iron sucrose (ISC) with adjuvant recombinant human erythropoietin (rhEPO) versus ISC alone, in correction of moderate and severe iron deficiency anemia (IDA) during late third trimester. Patients and methods: Forty two pregnant women with gestational age > 32 weeks with IDA resistant to oral iron therapy alone were randomly assigned to intravenously ISC plus rhEPO or ISC alone 72-96 hour a part. Target hemoglobin value was 11 g/dl. Primary outcome were hematological respond to treatment by increase in hematocrit and reticulocyte count while the secondary outcomes were other hematological parameters, serum ferritin, patient's symptoms. Result: Both regimens was safe and effective but in ISC + rhEPO group the reticulocyte count were higher from day 8 (P< 0.0001), rising in hematocrit were greater from day 8 and continued (P
0.01 — 0.0001) and at end of study (day 29) more women in ISC + rhEPO group reach the target hemoglobin of 11 g/dl than in ISC alone group (no = 20 vs no = 16). Both groups did not differ in respect the maternal and fetal safety outcomes parametes. Conclusion: Intravenous ISC at 300 mg in 300m1NaC10.9% infused over 30 minutes is safe and effective, adding rhEPO subcutaneously at low dose 4000 u/ 72-96 safely synergistic the efficacy of ISC in correction of gestational IDA resistant to oral iron therapy.