If the Hgb level fails to rise after 1 month of oral therapy, it is important to assess for persistent bleeding, iron malabsorption, noncompliance, improper iron administration, or other causes for the anemia. Parenteral (IV or intramuscular [IM]) iron administration is safe and effective, but painful, expensive, and occasionally associated with regional lymphadenopathy or allergic reaction (Andrew, 2003; Mckenzie, 2004). Therefore parenteral iron is reserved for children who have iron malabsorption or chronic hemoglobinuria. Transfusions are indicated for the most severe anemia and in cases of serious infection, cardiac dysfunction, or surgical emergency when anesthesia is required. Packed RBCs (2 to 3 ml/kg), not whole blood, are used to minimize the chance of circulatory overload. Supplemental oxygen is administered when tissue hypoxia is severe.