The Use of Iron Sucrose Complex for Anemia in Pregnancy and the Postpartum Period

Intravenous iron sucrose v/s oral ferrous fumarate for treatment of anemia in pregnancy. A randomized controlled trial

Background

The objective of this study was to compare the efficacy, safety and tolerability of intravenous iron sucrose with that of oral ferrous fumarate in iron deficiency anemia during 14 to 34 weeks of pregnancy.

Methods

A randomized controlled trial was performed involving 112 patients attending the antenatal clinic at Shri B.M.Patil Medical college Hospital, Bijapur from October 2011 to August 2012,with hemoglobin levels between 70-110 g/L and serum ferritin of < 15 ng/ml.

In the intravenous group,200 mg of iron sucrose was administered in 100 ml 0.9% sodium chloride per day. Participants in the oral group were given 200 mg of ferrous fumarate per day. The primary outcome measures for the trial, haemoglobin and serum ferritin levels were measured after 4 weeks. Statistical significance was assessed using Student’s t-test.

Results

The change in haemoglobin in women receiving intravenous iron was higher than with oral ferrous fumarate 22 ± 11.5 g/L vs 12 ± 9 g/L (p < 0.0001).Similarly the change of serum ferritin was significantly higher in women receiving intravenous iron compared to oral iron.

55% participants in the intravenous group had an improvement in haemoglobin more than 20 g/L compared to only 11% of the oral therapy group.48% of patients in I.V group showed increase in ferritin level between 51 to 100 ng/ml in comparison to only 3.5% in oral group.

Intravenous iron sucrose is an effective in correction of anemia in pregnancy or iron store depletion.

Conclusion

Intravenous iron sucrose is more effective than 200 mg a day ferrous fumarate in increasing maternal iron stores.

Trial registration

The trial registration number is CTRI/2016/12/007552 registered in Clinical Trial Registry India on 8/12/2016. It is a retrospectively registered trial.

Blastocystis hominis as a contributing risk factor for development of iron deficiency anemia in pregnant women

Intestinal parasitic infection increases the risk of developing iron deficiency anemia (IDA) during pregnancy. The objective of this study was to assess Blastocystis hominis as a contributing risk factor for development of IDA in pregnant women. A total of 200 fecal specimens from 120 pregnant women with IDA (mean Hb = 9.6 g/dl), and 80 non-anemic controls were examined for Blastocystis. Fecal specimens were examined by the formalin/ethyl-acetate concentration technique, iron hematoxylin staining, modified Ziehl-Neelsen acid-fast staining, and by the in vitro cultivation technique for Blastocystis. Frequency of Blastocystis infection, detected microscopically and by the in vitro culture technique, was significantly higher in IDA study group (n = 48; 40%) compared to non-anemic controls (n = 5; 6.3%; P < 0.0001), and 26.5% (n = 53) in all study subjects. Among the 48 cases, Blastocystis without other intestinal parasitic infections was detected in 41 cases (34.2%), while seven cases (5.8%) with Blastocystis were coinfected with other intestinal parasites which included Giardia and Cryptosporidium (1.7% each), and Entamoeba sp., Ascaris, and Trichuris (0.8% each). The mean Hb level of the 48 Blastocystis-infected cases was 9.2 g/dl (mild anemia). While the other 72 IDA cases with no infection had mean Hb of 10.0 g/dl (mild anemia), with a significant difference in mean Hb level between Blastocystis-infected and the non-infected IDA cases (P < 0.0001). Furthermore, among the 48 Blastocystis-infected IDA cases, the mean Hb of the 41 Blastocystis-infected cases without other intestinal parasitic co-infection was 9.1 g/dl (mild anemia), while the mean Hb level of the 7 Blastocystis-infected cases with other intestinal parasitic co-infection was 8.7 g/dl (moderate anemia). Findings of the current study showed that B. hominis infection contributes to the development of IDA in pregnant women. Hence, parasitological diagnostic tests are recommended in routine examination at all antenatal clinics.

Intravenous Iron Therapy versus Oral Iron in Postpartum Patients in Rural Area

Objectives

The aim of this study is to evaluate the efficiency and safety of intravenous iron sucrose complex and comparison with oral iron therapy in postpartum period in rural area.

Materials and methods

It is a prospective, randomized, hospital-based clinical study carried out in over 150 patients, having Hb < 8 mg/dl after 24 hours of delivery. 600 to 800 mg iron sucrose has been given in divided doses, 200 mg on alternate day in 100 ml of normal saline to half of the patients whereas rest of the patients given 200 mg bd dose of ferrous sulphate by oral route for one month. Data was collected after 1st, 2nd, 3rd and 4th week for the hemoglobin estimation and assessment of the impact of intravenous iron sucrose treatment on the postpartum parameters.

Results

The mean Hb was significantly increased in the intravenous iron sucrose group in 7 days (7.42 ± 1.04 gm/dl to 9.8 ± 0.76 gm/dl) of treatment but there was no change observed in mean Hb in the patients treated with oral ferrous sulphate. Women treated with intravenous iron sucrose has shown significantly higher Hb on day 7, day 15 and day 30 as compared to the women those were treated with oral iron (p < 0.0001).

Conclusion

Overall intravenous iron sucrose appears to be an effective mode of treatment in postpartum patients with no serious side effects and associated with faster recovery in shorter duration of hospital stay than oral iron treatment.

Efficacy and safety of intravenous iron therapy as an alternative/adjunct to allogeneic blood transfusion

Anaemia is a common condition among patients admitted to hospital medicosurgical departments, as well as in critically ill patients. Anaemia is more frequently due to absolute iron deficiency (e.g. chronic blood loss) or functional iron deficiency (e.g. chronic inflammatory states), with other causes being less frequent. In addition, preoperative anaemia is one of the major predictive factors for perioperative blood transfusion. In surgical patients, postoperative anaemia is mainly caused by perioperative blood loss, and it might be aggravated by inflammation-induced inhibition of erythropoietin and functional iron deficiency (a condition that cannot be corrected by the administration of oral iron). All these mechanisms may be involved in the anaemia of the critically ill. Intravenous iron administration seems to be safe, as very few severe side-effects were observed, and may result in hastened recovery from anaemia and lower transfusion requirements. However, it is noteworthy that many of the recommendations given for intravenous iron treatment are not supported by a high level of evidence and this must be borne in mind when making decisions regarding its application to a particular patient. Nonetheless, this also indicates the need for further large, randomized controlled trials on the safety and efficacy of intravenous iron for the treatment of anaemia in different clinical settings.

Comparative efficacy and safety of intravenous ferric carboxymaltose in the treatment of postpartum iron deficiency anemia

OBJECTIVES

To compare the safety and efficacy of iron carboxymaltose with ferrous sulfate to treat iron deficiency anemia in the post partum.

METHODS

Patients were randomized (2:1 ratio) to receive iron carboxymaltose (up to 3 weekly doses of 1000 mg maximum, applied in 15 min; n=227) or ferrous sulfate (100 mg twice daily, 12 weeks; n=117). Changes in hemoglobin and iron stores up to week 12 were analyzed.

RESULTS

Iron carboxymaltose was as effective as oral iron sulfate in changing hemoglobin, despite the much shorter treatment period (2 weeks vs 12 weeks). Ferritin levels were significantly higher. Except for injection site burning, iron carboxymaltose was better tolerated than ferrous sulfate, mainly concerning gastrointestinal side effects. There were no safety concerns identified in breast-fed infants.

CONCLUSION

Parenteral iron carboxymaltose is a safe and effective treatment option for postpartum anemia, with advantages of a shorter treatment period, better compliance, rapid normalization of iron storages, and lower incidence of gastrointestinal side effects.