Optimal parenteral nutritional support, provided concomitantly with extraordinarily large replacement doses of intravenous iron dextran can be safe, effective, and life-saving for severely anemic patients who cannot or will not accept erythrocyte transfusion. Five patients who had sustained massive acute blood loss and two who had severe chronic anemia received as much as 140 ml of iron dextran intravenously. The average initial hemoglobin value in the patients with acute blood loss was 4.7 gm/dl (range 2.6 to 8.4 gm/dl), increasing to an average of 9.8 gm/dl (range 7.5 to 12.8) in 23.4 days (range 17 to 30 days), a 166% increase. The average initial hemoglobin value in the patients with chronic anemia was 3.7 gm/dl, increasing to 10.5 gm/dl over an average period of 121 days, a 182% increase. Total abdominal colectomy, pyloroplasty with truncal vagotomy, and highly selective vagotomy were accomplished without complications in four of the patients. There were no adverse reactions to the therapeutic regimen, and all patients were discharged in good condition.