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Van Doren L, Steinheiser M, Boykin K, Taylor KJ, Menendez M, Auerbach M. Expert consensus guidelines: Intravenous iron uses, formulations, administration, and management of reactions. Am J Hematol 2024; 99:1338-1348. [PMID: 38282557 DOI: 10.1002/ajh.27220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 01/01/2024] [Accepted: 01/08/2024] [Indexed: 01/30/2024]
Abstract
Intravenous iron has become an essential component for the treatment of iron deficiency and iron deficiency anemia. Individuals administering Intravenous iron should have knowledge in intravenous iron administration, including a pre-infusion assessment to evaluate infusion reaction risks, pre- and post-infusion monitoring, identification of and management of infusion reactions, accurate documentation of these reactions, laboratory monitoring and recognition and management of treatment-emergent hypophosphatemia. This comprehensive consensus provides step-by-step guidance and tools for practitioners to promote safe delivery of intravenous iron, recognition, and management of infusion reactions and treatment-emergent hypophosphatemia.
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Affiliation(s)
- Layla Van Doren
- Section of Hematology, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Kristen Boykin
- Florida Cancer Specialists and Research Institute, Florida, USA
| | | | - Monica Menendez
- FEM Iron Infusion Centers by Heme Onc Call, Miami, Florida, USA
| | - Michael Auerbach
- Department of Medicine, Georgetown University School of Medicine, Washington, District of Columbia, USA
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2
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Li M, Wright A, Rahim AM, Tan KH, Tagore S. Retrospective Study Comparing Treatment Outcomes in Obstetric Patients With Iron Deficiency Anemia Treated With and Without Intravenous Ferric Carboxymaltose. Cureus 2024; 16:e55713. [PMID: 38586790 PMCID: PMC10998652 DOI: 10.7759/cureus.55713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2024] [Indexed: 04/09/2024] Open
Abstract
Introduction Iron deficiency anemia is associated with an increased risk of adverse maternal and perinatal outcomes. Intravenous iron preparation containing ferric carboxymaltose has been shown to be a safe and effective way of increasing hemoglobin (Hb) and mean corpuscular volume (MCV) levels and reducing the need for blood transfusion. In our center, it used to be given as an inpatient procedure because of the risks of potential drug reactions. In 2021, we initiated the administration of intravenous ferric carboxymaltose as an outpatient procedure. We compared the outcomes of patients between 2021 and 2023 after the initiation of outpatient administration of intravenous ferric carboxymaltose in 127 obstetric patients with iron deficiency anemia in the second and third trimesters. Methods In this study conducted in a large maternity unit in Singapore between 2021 to 2023, we compared the changes in maternal hematological parameters among obstetric patients with iron deficiency anemia presenting to the day care unit in the second or third trimester with a Hb level of <8 g/dl treated with a single dose of ferric carboxymaltose injection (Ferinject) against a control group who were referred for treatment but defaulted on and declined treatment. Results Ferric carboxymaltose significantly increased the Hb and MCV levels at delivery in obstetric patients with iron deficiency. The mean Hb at delivery was 10.8 g/dL in the case group compared to 8.8 g/dL in the control group. The percentage of patients with Hb ≥10.0 g/dL was 73.4% in the case group compared to 27.8% in the control group. The incidence of adverse side effects was low and mild (2/127; 1.6%). None of the patients received were hospitalized because of ferric carboxymaltose. Conclusion A single injection dose of ferric carboxymaltose as an outpatient antenatal procedure was easily administered and well tolerated. Obstetric patients with iron deficiency anemia who received intravenous ferric carboxymaltose had a significantly higher level of Hb than those who did not.
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Affiliation(s)
- Mingyue Li
- Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore, SGP
| | - Ann Wright
- Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, SGP
| | - Asmira M Rahim
- Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore, SGP
| | - Kok Hian Tan
- Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore, SGP
| | - Shephali Tagore
- Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, SGP
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Park JKH, Lee S, Heo CY, Jeong JH, Myung Y. The effect of immediate postoperative intravenous administration of ferric carboxymaltose after autologous free-flap breast reconstruction. Sci Rep 2022; 12:19125. [PMID: 36352090 PMCID: PMC9645745 DOI: 10.1038/s41598-022-23976-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 11/08/2022] [Indexed: 11/10/2022] Open
Abstract
Intravenous ferric carboxymaltose (IV-FCM) can effectively correct perioperative anemia in patients undergoing major surgeries. However, its efficacy and side effects in patients undergoing free flap-based breast reconstruction are yet to be investigated. At our institution, from year 2020, patients with breast cancer undergoing abdominal free flap-based breast reconstruction were injected 500 mg of IV-FCM immediately post-operation. Propensity-matched 82 IV-FCM injected (study group) and 164 historical control group patients were retrospectively analyzed for transfusion rates, changes in hematological parameters, and flap or donor-site related complications. The major and minor complication rates related to the operation site were similar between the two groups. There was no significant difference in the transfusion rate between the two groups (control 29.9% vs. study 32.9%, p = 0.71). However, the total amount of transfusion required was significantly higher in the historical control group (control-53.2% 1 pack, 42.6% 2 packs, 4.3% 3 packs of RBC vs. Study-66.7% 1 pack, 33.3% 2 packs, p = 0.02) than in the study group. Additionally, the historical control group showed a significantly higher drop in red blood cell count, hemoglobin, and hematocrit levels from postoperative days 1-2 and 2-3 compared to the study group. Immediate postoperative use of IV-FCM in free flap-based breast reconstruction was well tolerated by patients and reduced overall transfusion volume.
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Affiliation(s)
- Joseph Kyu-hyung Park
- grid.412480.b0000 0004 0647 3378Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-Dong, Bundang-Gu, Seongnam-Si, 463-707 Gyeonggi-Do Korea
| | - Seungjun Lee
- grid.412480.b0000 0004 0647 3378Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-Dong, Bundang-Gu, Seongnam-Si, 463-707 Gyeonggi-Do Korea
| | - Chan Yeong Heo
- grid.412480.b0000 0004 0647 3378Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-Dong, Bundang-Gu, Seongnam-Si, 463-707 Gyeonggi-Do Korea
| | - Jae Hoon Jeong
- grid.412480.b0000 0004 0647 3378Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-Dong, Bundang-Gu, Seongnam-Si, 463-707 Gyeonggi-Do Korea
| | - Yujin Myung
- grid.412480.b0000 0004 0647 3378Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-Dong, Bundang-Gu, Seongnam-Si, 463-707 Gyeonggi-Do Korea
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Gupte SA, Venkataraman G, Shah AS, Mudholkar AS, Jangam SM. Clinical effects and safety of ferric carboxymaltose in pregnancy: An Indian real-life experience. J Obstet Gynaecol Res 2021; 47:3464-3470. [PMID: 34342089 DOI: 10.1111/jog.14956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/26/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND There is limited clinical evidence of ferric carboxymaltose injection (FCM) usage in Indian pregnant women. We assessed the efficacy and safety of FCM in Indian pregnant women with moderate-to-severe anemia. METHODS Single-center, retrospective, observational data collection was conducted at a tertiary care research institute. Data of pregnant women with anemia who received FCM in their second and third trimester was retrieved and analyzed for hematological parameters at baseline and at 4 ± 2 weeks. Neonatal outcomes were also assessed. Adverse events and other safety parameters were noted. RESULTS Data of 271 patients was retrieved and analyzed for safety and data for 168 patients analyzed for efficacy. A significant increase in hemoglobin was noted with FCM in 4 weeks (1.25 g/dL; p < 0.001). Patients with severe anemia reported an increase in hemoglobin of 4.23 g/dL (p = 0.01). Patients receiving FCM in the second trimester noted a significant increase in hemoglobin of 1.74 g/dL (p < 0.001). A significant increase in hemoglobin was noted as early as 20 days (p < 0.001) and also in patients receiving FCM after 34 weeks (p = 0.002). No adverse fetal or neonatal outcomes were observed. Adverse events noted in 4% of patients with itching and rash being most common. Continuous monitoring of blood pressure, heart rate, and oxygen saturation for 40 min during and after FCM administration reported no deterioration or negative safety signal. CONCLUSION FCM corrects anemia in all subsets of Indian pregnant women and supports evidence of efficacy and safety. Continuous monitoring of vital parameters during FCM infusions supports its excellent safety.
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Affiliation(s)
- Sanjay A Gupte
- Department of Obstetrics and Gynecology, Gupte Hospital and Centre for Research in Reproduction, Pune, India
| | - Gayatri Venkataraman
- Department of Obstetrics and Gynecology, Gupte Hospital and Centre for Research in Reproduction, Pune, India
| | | | - Aparna S Mudholkar
- Department of Obstetrics and Gynecology, Gupte Hospital and Centre for Research in Reproduction, Pune, India
| | - Shweta M Jangam
- Department of Clinical Research, Gupte Hospital and Centre for Research in Reproduction, Pune, India
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Benson CS, Shah A, Frise MC, Frise CJ. Iron deficiency anaemia in pregnancy: A contemporary review. Obstet Med 2021; 14:67-76. [PMID: 34394714 PMCID: PMC8358243 DOI: 10.1177/1753495x20932426] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 05/13/2020] [Indexed: 01/01/2023] Open
Abstract
Iron deficiency anaemia is a global health problem, which particularly affects pregnant women. Iron deficiency anaemia during pregnancy is associated with increased maternal and perinatal morbidity and mortality. Maternal iron deficiency may also be associated with neurocognitive deficits in infants. Iron requirements increase during pregnancy and are influenced by hepcidin, the master regulator of iron homeostasis. The enduring global burden of maternal anaemia suggests that currently employed iron supplementation strategies are suboptimal. Recent developments in our understanding of systemic and placental iron homeostasis may improve therapeutic effectiveness by altering the dose and frequency of oral iron. Intravenous iron appears to be a safe treatment to correct maternal anaemia rapidly but research on patient-centred outcomes and cost-effectiveness is needed. Future trials should be adequately powered to assess outcomes relevant to pregnant women.
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Affiliation(s)
- Charlotte S Benson
- Department of Obstetrics, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Akshay Shah
- Department of Medicine, University of Oxford, Oxford, UK
- Nuffield Department of Anaesthesia, John Radcliffe Hospital, Oxford, UK
| | - Matthew C Frise
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
- Intensive Care Unit, Royal Berkshire Hospital, NHS Foundation Trust, Reading, UK
| | - Charlotte J Frise
- Fetal Maternal Medicine Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Queen Charlotte’s and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
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Assouline B, Benoliel A, Zamberg I, Legouis D, Delhumeau C, Favre M, Andrès A, Toso C, Samii K, Schiffer E. Intravenous iron supplementation after liver surgery: Impact on anemia, iron, and hepcidin levels-a randomized controlled trial. Surgery 2021; 170:813-821. [PMID: 33888314 DOI: 10.1016/j.surg.2021.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/11/2021] [Accepted: 03/06/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND Anemia is a recognized risk factor for perioperative related morbidity and mortality and is frequently reported in liver surgeries with an estimated incidence of 32%. We aim to assess the impact of intravenous iron administration in the immediate postoperative period on anemia and iron status as well as to determine the kinetics of hepcidin after liver surgery. METHODS The HepciFer trial, a randomized controlled trial, included 50 patients undergoing liver surgery. In accordance with the randomization process, patients received either ferric carboxymaltose (15 mg/kg, maximum 1 g) or placebo 4 hours after surgery. RESULTS The mean hemoglobin level, 7 days after surgery, did not differ significantly between the intervention and control group (11.1 ± 1.8 g/dL and 10.4 ± 1.6 g/dL, respectively) with a mean difference of +0.7 g/dL ([95% confidence interval, -0.3 to +1.7], P = .173). Within patients receiving intravenous iron supplementation, none presented biological signs of functional iron deficiency. Hepcidin levels remained significantly higher during the observation period in the intervention group. Inflammatory biomarkers, red blood cells transfusion rate and hospital duration of stay were similar between groups. CONCLUSION Intravenous ferric carboxymaltose administration did not result in a significant increase of hemoglobin levels 7 days after surgery. However, this study suggests that intravenous iron supplementation in the immediate postoperative settings prevents functional iron deficiency. Intravenous iron supplementation overcame the hepcidin-mediated blockade of iron absorption and should be considered as the preferred route of administration in the postoperative period.
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Affiliation(s)
- Benjamin Assouline
- Division of Anesthesiology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland.
| | - Alan Benoliel
- Division of Anesthesiology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Ido Zamberg
- Division of Anesthesiology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland. https://twitter.com/IdoZamberg
| | - David Legouis
- Division of Anesthesiology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Cecile Delhumeau
- Division of Anesthesiology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Mathieu Favre
- Division of Anesthesiology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Axel Andrès
- Division of Digestive Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Christian Toso
- Division of Digestive Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Kaveh Samii
- Division of Hematology, Department of Oncology, Geneva University Hospitals, Geneva, Switzerland
| | - Eduardo Schiffer
- Division of Anesthesiology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
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Auerbach M, Gafter-Gvili A, Macdougall IC. Intravenous iron: a framework for changing the management of iron deficiency. LANCET HAEMATOLOGY 2020; 7:e342-e350. [PMID: 32220343 DOI: 10.1016/s2352-3026(19)30264-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 11/25/2019] [Accepted: 12/02/2019] [Indexed: 12/21/2022]
Abstract
For decades intravenous iron was considered dangerous. Newer formulations with carbohydrate cores binding elemental iron more tightly allow complete iron replacement within 15-60 min in one visit. Meta-analyses and prospective comparisons of different formulations support equivalent safety to placebo with less toxicity than oral iron. Of the available formulations, the preponderance of published evidence supports equal safety and efficacy. In this Viewpoint, we report evidence supporting repositioning of intravenous iron to the frontline in multiple disorders with iron deficiency, which include heart failure, chronic kidney disease, inflammatory bowel disease, patient blood management in the perioperative period, and obstetrics and gynaecology. We have also highlighted neonatal evidence supporting the inadequacy of oral iron in late pregnancy, a critical period of iron need for normal foetal brain development. Physicians should consider prioritising the use of intravenous iron rather than oral iron as a treatment for iron deficiency in some of these clinical scenarios.
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Durup D, Schaffalitzky de Muckadell P, Strom CC. Evaluation of the reported rates of hypersensitivity reactions associated with iron dextran and ferric carboxymaltose based on global data from VigiBase™ and IQVIA™ MIDAS® over a ten-year period from 2008 to 2017. Expert Rev Hematol 2020; 13:557-564. [PMID: 32129113 DOI: 10.1080/17474086.2020.1738215] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objectives: It is hypothesized that the risk of hypersensitivity reactions (HSRs) may be lower with ferric carboxymaltose than iron dextran because of its non-dextran carbohydrate moiety. This study compares the risk of HSRs between iron dextran and ferric carboxymaltose.Methods: This was a retrospective pharmacoepidemiological study with a case-population design covering 2008-2017. Global exposure data were estimated using IQVIA™ sales data. Spontaneously reported HSR data were retrieved from the World Health Organization database (VigiBase™) using different search criteria including: the Standardized MedDRA® Query (SMQ) 'Anaphylactic reaction'; type I-IV HSR terms; narrow terms for anaphylactic/anaphylactoid reactions; and cases with a fatal outcome.Results: Total exposure in 100 mg doses was 117.3 million for iron dextran and 84.2 million for ferric carboxymaltose. The relative risk (with 95% confidence interval) for ferric carboxymaltose versus iron dextran was 4.18 (3.88-4.50) for SMQ Anaphylactic reaction; 12.9 (9.90-16.7) for type I-IV HSRs; 1.72 (1.45-2.04) for anaphylactic/anaphylactoid reactions; and 1.92 (1.24-2.99) for death.Conclusion: The risk of spontaneously reported HSRs was consistently higher with ferric carboxy-maltose than with iron dextran over the period 2008-2017. Thus, this study does not support that dextran-free intravenous irons are associated with fewer HSRs than iron dextran.
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Elstrott B, Khan L, Olson S, Raghunathan V, DeLoughery T, Shatzel JJ. The role of iron repletion in adult iron deficiency anemia and other diseases. Eur J Haematol 2020; 104:153-161. [PMID: 31715055 PMCID: PMC7031048 DOI: 10.1111/ejh.13345] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/26/2019] [Accepted: 10/29/2019] [Indexed: 12/21/2022]
Abstract
Iron deficiency anemia (IDA) is the most prevalent and treatable form of anemia worldwide. The clinical management of patients with IDA requires a comprehensive understanding of the many etiologies that can lead to iron deficiency including pregnancy, blood loss, renal disease, heavy menstrual bleeding, inflammatory bowel disease, bariatric surgery, or extremely rare genetic disorders. The treatment landscape for many causes of IDA is currently shifting toward more abundant use of intravenous (IV) iron due to its effectiveness and improved formulations that decrease the likelihood of adverse effects. IV iron has found applications beyond treatment of IDA, and there is accruing data about its efficacy in patients with heart failure, restless leg syndrome, fatigue, and prevention of acute mountain sickness. This review provides a framework to diagnose, manage, and treat patients presenting with IDA and discusses other conditions that benefit from iron supplementation.
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Affiliation(s)
- Benjamin Elstrott
- Division of Hematology-Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Lubna Khan
- Division of Hematology-Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Sven Olson
- Division of Hematology-Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
| | - Vikram Raghunathan
- Division of Hematology-Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Thomas DeLoughery
- Division of Hematology-Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Joseph J. Shatzel
- Division of Hematology-Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
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REGAIN STUDY: Retrospective Study to Assess the Effectiveness, Tolerability, and Safety of Ferric Carboxymaltose in the Management of Iron Deficiency Anemia in Pregnant Women. Anemia 2019; 2019:4640635. [PMID: 31781389 PMCID: PMC6875230 DOI: 10.1155/2019/4640635] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/08/2019] [Accepted: 08/20/2019] [Indexed: 11/23/2022] Open
Abstract
Iron deficiency anemia (IDA) during pregnancy arises because of preexisting inadequate stores or complex physiological changes and can lead to serious maternal and fetal complications. Oral iron, either as iron sulfate or fumarate, with or without folic acid, is the most commonly used treatment for IDA in pregnancy. Intravenous (IV) iron has a role in the treatment of IDA in pregnancy, particularly in women who present late, display severe anemia (Hb ≤ 9 g/dL), or risk factors, and are intolerant/noncompliant of oral iron. Previously, administration of IV iron was minimal, owing to potentially serious anaphylactic reactions. Recently, new IV iron products have been developed, offering better compliance, tolerability, efficacy, and a good safety profile. Our study aimed to assess the effectiveness, safety, and tolerability of IV ferric carboxymaltose (FCM) in the treatment of IDA in pregnant women in the UAE. Data from 1001 pregnant women who received at least one administration of FCM (500, 1000, or 1500 mg) during their second or third trimester of pregnancy (2 years backward from study initiation) were collected retrospectively from electronic medical records at Corniche Hospital, Abu Dhabi, UAE. Results showed that 41.4% of the women were able to achieve an increase of ≥2 g/dL in blood hemoglobin overall. A change of ≥2 g/dL was achieved by 27.5% of women administered a dose of 500 mg, 39.2% of women administered a dose of 1000 mg, and 63.9% of women administered a dose of 1500 mg of IV FCM. This indicates a directly proportional relationship between increasing IV FCM dose and the increase of ≥2 g/dL in blood hemoglobin. A total of 7 (0.7%) women reported mild, nonserious adverse events during the study. Within the limits of this retrospective study, IV FCM therapy was safe and effective in increasing the mean hemoglobin of pregnant women with IDA.
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Juul SE, Derman RJ, Auerbach M. Perinatal Iron Deficiency: Implications for Mothers and Infants. Neonatology 2019; 115:269-274. [PMID: 30759449 DOI: 10.1159/000495978] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 12/04/2018] [Indexed: 11/19/2022]
Abstract
Iron deficiency, with or without anemia, is common in pregnant women. In fact, nearly 30% of reproductive-age women are anemic worldwide, and anemia in pregnancy has an estimated global prevalence of 38%. Severe anemia can substantially increase the risk of maternal mortality, and can adversely affect fetal development. In this review, we examine the available data regarding epidemiology and consequences of iron deficiency in mothers and infants, current treatment strategies, and make recommendations for screening and treatment of iron deficiency anemia in gravidas and neonates.
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Affiliation(s)
- Sandra E Juul
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Richard J Derman
- Global Affairs, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Michael Auerbach
- Georgetown University School of Medicine, Washington, District of Columbia, USA,
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12
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Abstract
Iron deficiency anemia of pregnancy is common, especially in South Asia, and is associated with adverse maternal and fetal outcomes including increased incidences of maternal mortality, preterm labor and low birth weight. Screening for anemia alone is not sufficient to diagnose iron deficiency. Iron deficiency in neonates is associated with a statistically significant increment in cognitive and behavioral abnormalities which persist after iron repletion. Oral iron is the frontline standard but is associated with an unacceptably high incidence of gastrointestinal adverse events leading to poor adherence. Prospective evidence reports an incidence of neonatal iron deficiency up to 45% even with oral iron supplementation. New evidence reports oral iron ingestion increases serum hepcidin leading to decreased absorption suggesting further decreasing efficacy. Published evidence reports that intravenous iron is safe and effective in the second and third trimesters of pregnancy. Intravenous iron is the preferred route when there is oral iron intolerance or in those situations where oral iron is ineffective or harmful. Intravenous iron is also preferred if the anemia is severe (< 8 g/dL) in the second trimester or at any time in the third trimester when there is little expectation that adequate quantities of iron will be delivered to the fetus as iron requirements increase in each trimester. Guidelines for maternal and neonatal screening and treatment lack consistency and differ between the United States and Europe. New formulations of intravenous iron with complex carbohydrate cores that bind elemental iron more tightly mitigating the release of large quantities of labile free iron allow the administration of complete replacement doses in 15-60 min. The preponderance of published evidence suggests that intravenous iron is underutilized in pregnancy and guidelines suggesting there is insufficient evidence to recommend the routine screening and treatment of iron deficiency in gravidas should be revisited. The major recommendation from this commentary is that in low-income countries, a trial or demonstration project to test the efficacy, safety, cost and feasibility of the administration of intravenous iron to anemic and/or iron-deficient women be undertaken.
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Affiliation(s)
- Michael Auerbach
- Auerbach Hematology and Oncology, Baltimore, MD, USA.
- Georgetown University, Washington DC, USA.
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13
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Tandon R, Jain A, Malhotra P. Management of Iron Deficiency Anemia in Pregnancy in India. Indian J Hematol Blood Transfus 2018; 34:204-215. [PMID: 29622861 PMCID: PMC5885006 DOI: 10.1007/s12288-018-0949-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/08/2018] [Indexed: 01/28/2023] Open
Abstract
Iron deficiency anemia (IDA) continues to be the commonest etiology of anemia in pregnancy. The prevalence of iron deficiency (ID) in pregnant Indian women is amongst the highest in the world. Untreated iron deficiency (ID) has significant adverse feto-maternal consequences. Plethora of investigations are available for diagnosis of IDA, each having specific advantages and disadvantages when used in the pregnancy setting. Therapy for ID includes dietary modification, oral iron supplementation, intravenous iron and blood transfusion. Newer parenteral iron preparations are safe and there is mounting evidence to suggest their use in frontline settings for pregnancy associated IDA in the second and third trimester. Through this review, we suggest an algorithm for diagnosis and treatment of IDA in pregnancy depending on the severity of anemia and period of gestation suited for widespread use in resource limited settings. Also, we recommend ways for increasing public awareness and tackling this health issue including the observance of "National Anemia Awareness and Treatment Day."
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Affiliation(s)
- Rimpy Tandon
- Department of Obstetrics and Gynaecology, Government Medical College and Hospital-32, Chandigarh, India
| | - Arihant Jain
- Department of Internal Medicine (Clinical Hematology Division), PGIMER, Chandigarh, India
| | - Pankaj Malhotra
- Department of Internal Medicine (Clinical Hematology Division), PGIMER, Chandigarh, India
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Gilmartin CE, Hoang T, Cutts BA, Leung L. Retrospective cohort study comparing the adverse reactions and efficacy of intravenous iron polymaltose with ferric carboxymaltose for iron deficiency anemia. Int J Gynaecol Obstet 2018; 141:315-320. [PMID: 29498039 DOI: 10.1002/ijgo.12476] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 12/21/2017] [Accepted: 02/27/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To examine the adverse drug reactions (ADRs) and the efficacy of intravenous iron polymaltose and ferric carboxymaltose (FCM) among gynecology/obstetric patients with anemia. METHODS The present retrospective observational study examined data from anemic obstetrics and gynecology patients who received either iron polymaltose or FCM between January 1, 2011, and April 30, 2015, at The Royal Women's Hospital, Victoria, Australia. Patient demographic data, dosage, ADR documentation, and hemoglobin levels were collected from medical records and compared. RESULTS The study included 221 patients; 111 and 110 received iron polymaltose and FCM, respectively. ADRs were documented for 18 (16.2%) patients in the iron polymaltose group and 2 (1.8%) in the FCM group (P<0.001), with no incidences of anaphylaxis. Both formulations achieved increased hemoglobin levels within 12 weeks (P<0.001 for both). Mean hemoglobin level increases were similar in both groups among non-pregnant patients (P=0.186), but were greater in the iron polymaltose cohort among pregnant patients (P=0.005). FCM dose compliance was suboptimal, with 8 of 57 (14%) patients who required second visits for doses greater than 1000 mg returning for the infusion. CONCLUSION FCM was associated with a lower incidence of ADRs than iron polymaltose. Patients receiving FCM infusions were less likely to receive their total required iron dose. Further randomized prospective studies are required to compare clinical efficacy of iron polymaltose versus FCM.
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Affiliation(s)
| | - Thu Hoang
- Pharmacy Department, The Royal Women's Hospital, Parkville, Vic., Australia.,Drug Delivery, Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Vic., Australia
| | - Briony A Cutts
- Department of Obstetrics, The Royal Women's Hospital, Parkville, Vic., Australia.,Department of Hematology, The Royal Children's Hospital, Parkville, Vic., Australia
| | - Laura Leung
- Pharmacy Department, The Royal Women's Hospital, Parkville, Vic., Australia
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15
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Breymann C, Auerbach M. Iron deficiency in gynecology and obstetrics: clinical implications and management. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2017; 2017:152-159. [PMID: 29222250 PMCID: PMC6142528 DOI: 10.1182/asheducation-2017.1.152] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Iron deficiency is the commonest cause of anemia during pregnancy; however, its prevalence is highly determined by nutritional and socioeconomic status. Oral iron is the frontline therapy, but is often poorly tolerated. Awareness of the available intravenous formulations is essential for management. Before delivery, risk factors such as multiparity and heavy uterine bleeding increase the prevalence of iron deficiency and should be motivation for early diagnosis and treatment. Neonates born with iron deficiency have a statistically significant increment in both cognitive and behavioral abnormalities that persist after repletion, highlighting the need for heightened awareness of the diagnosis. A smartphone application providing information on nutrition and treatment is provided. New formulations of intravenous iron with carbohydrate cores, which bind elemental iron more tightly, minimize the release of labile free iron to allow complete replacement doses of intravenous iron in 15 to 60 minutes, facilitating and simplifying care.
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Affiliation(s)
- Christian Breymann
- Obstetric Research–Feto Maternal Hematology Unit, University Hospital Zurich, Zurich, Switzerland
| | - Michael Auerbach
- Department of Medicine, Georgetown University School of Medicine, Washington, DC; and
- Auerbach Hematology and Oncology, Baltimore, MD
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16
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Auerbach M, James SE, Nicoletti M, Lenowitz S, London N, Bahrain HF, Derman R, Smith S. Results of the First American Prospective Study of Intravenous Iron in Oral Iron-Intolerant Iron-Deficient Gravidas. Am J Med 2017; 130:1402-1407. [PMID: 28739199 DOI: 10.1016/j.amjmed.2017.06.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 06/22/2017] [Accepted: 06/26/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Anemia affects up to 42% of gravidas. Neonatal iron deficiency is associated with low birth weight, delayed growth and development, and increased cognitive and behavioral abnormalities. While oral iron is convenient, up to 70% report significant gastrointestinal toxicity. Intravenous iron formulations allowing replacement in one visit with favorable side-effect profiles decrease rates of anemia with improved hemoglobin responses and maternal fetal outcomes. METHODS Seventy-four oral iron-intolerant, second- and third-trimester iron-deficient gravidas were questioned for oral iron intolerance and treated with intravenous iron. All received 1000 mg of low-molecular-weight iron dextran in 250 mL normal saline. Fifteen minutes after a test dose, the remainder was infused over the balance of 1 hour. Subjects were called at 1, 2, and 7 days to assess delayed reactions. Four weeks postinfusion or postpartum, hemoglobin levels and iron parameters were measured. Paired t test was used for hemoglobin and iron; 58/73 women were questioned about interval growth and development of their babies. RESULTS Seventy-three of 74 enrolled subjects completed treatment. Sixty had paired pre- and posttreatment data. The mean pre- and posthemoglobin concentrations were 9.7 and 10.8 g/dL (P < .00001), transferrin saturations 11.7% and 22.6% (P = .0003), and ferritins 14.5 and 126.3 ng/mL, respectively (P < .000001). Six experienced minor infusion reactions. All resolved. Data for 58 infants were available; one was low on its growth charts for 11 months. The remaining 57 were normal. None were diagnosed with iron deficiency anemia. CONCLUSION Intravenous iron has less toxicity and is more effective, supporting moving it closer to frontline therapy.
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Affiliation(s)
- Michael Auerbach
- Clinical Professor of Medicine, Georgetown University School of Medicine, Washington, DC; Auerbach Hematology and Oncology, Baltimore, Md.
| | | | - Melissa Nicoletti
- Department of Family Medicine, MedStar Franklin Square Hospital Center, Baltimore, Md
| | - Steven Lenowitz
- Department of OB/GYN, MedStar Franklin Square Hospital Center, Baltimore, Md
| | - Nicola London
- Department of OB/GYN, MedStar Franklin Square Hospital Center, Baltimore, Md
| | | | - Richard Derman
- Global Affairs, Thomas Jefferson University School of Medicine, Philadelphia, Pa
| | - Samuel Smith
- Department of OB/GYN, MedStar Franklin Square Hospital Center, Baltimore, Md
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17
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Qassim A, Mol BW, Grivell RM, Grzeskowiak LE. Safety and efficacy of intravenous iron polymaltose, iron sucrose and ferric carboxymaltose in pregnancy: A systematic review. Aust N Z J Obstet Gynaecol 2017; 58:22-39. [PMID: 28921558 DOI: 10.1111/ajo.12695] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 08/02/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Intravenous (IV) iron in pregnancy is useful where oral iron is not tolerated or a rapid replenishment of iron is required. AIMS To review the literature on the efficacy and safety of different IV iron preparations in the management of antenatal iron-deficiency anaemia (IDA). MATERIALS AND METHODS We searched MEDLINE, Embase and Scopus from inception to June 2016. Eligible studies were randomised controlled trials (RCTs) and observational studies, involving administration of IV iron (ferric carboxymaltose (FCM), iron polymaltose (IPM) or iron sucrose (IS)), regardless of comparator, to manage antenatal IDA. Two independent reviewers selected studies, extracted data and assessed quality. RESULTS A total of 47 studies were eligible (21 RCTs and 26 observational studies), investigating IS (n = 2635; 41 studies), FCM (n = 276; four studies) and IPM (n = 164; three studies). All IV preparations resulted in significant improvements in haematological parameters, with a median increase of 21.8 g/L at 3-4 weeks and 30.1 g/L by delivery, but there was no evidence of any associated improvements in clinical outcomes. A greater median increase in Hb was observed with a high (25 g/L; range: 20-39.6 g/L) compared with low dose (20 g/L; range: 6.2-50.3 g/L). The median prevalence of adverse drug reactions for IPM (2.2%; range: 0-4.5%) was lower than FCM (5.0%; range: 0-20%) and IS (6.7%; range: 0-19.5%). CONCLUSION While IV iron in pregnancy improves haematological parameters, there is an absence of evidence for improvements in important maternal or perinatal outcomes. No single preparation of IV iron appeared to be superior, with the current IV iron preparation of choice largely determined by cost and convenience around administration.
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Affiliation(s)
- Alaa Qassim
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia
| | - Ben W Mol
- The Robinson Research Institute, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Rosalie M Grivell
- The Robinson Research Institute, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia.,Department of Obstetrics and Gynaecology, Flinders Medical Centre, Bedford Park, SA, Australia.,Department of Obstetrics and Gynaecology, School of Medicine, Flinders University, Bedford Park, SA, Australia
| | - Luke E Grzeskowiak
- The Robinson Research Institute, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia.,SA Pharmacy, SA Health, Flinders Medical Centre, Bedford Park, SA, Australia
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18
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Muñoz M, Peña-Rosas JP, Robinson S, Milman N, Holzgreve W, Breymann C, Goffinet F, Nizard J, Christory F, Samama CM, Hardy JF. Patient blood management in obstetrics: management of anaemia and haematinic deficiencies in pregnancy and in the post-partum period: NATA consensus statement. Transfus Med 2017; 28:22-39. [DOI: 10.1111/tme.12443] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 05/30/2017] [Accepted: 06/18/2017] [Indexed: 01/06/2023]
Affiliation(s)
- M. Muñoz
- Perioperative Transfusion Medicine, Department of Surgical Specialties, Biochemisty and Inmunology; University of Málaga; Málaga Spain
| | - J. P. Peña-Rosas
- Evidence and Programme Guidance, Department of Nutrition for Health and Development; World Health Organization; Geneva Switzerland
| | - S. Robinson
- Guy's and St Thomas' NHS Foundation Trust; Clinical Lead for Transfusion and Obstetric Haematology; London UK
| | - N. Milman
- Departments of Clinical Biochemistry and Obstetrics, Naestved Hospital; University of Copenhagen; Naestved Denmark
| | - W. Holzgreve
- FIGO Representative, Professor of Gynaecology and Obstetrics; Medical Director and CEO, University Hospital Bonn; Bonn Germany
| | - C. Breymann
- Obstetric Research - Feto Maternal Haematology Research Unit; University Hospital Zurich; Zurich Switzerland
| | - F. Goffinet
- Department of Obstetrics and Gynecology, Port-Royal Maternity; Groupe Hospitalier Cochin-Broca-Hôtel Dieu, Assistance Publique des Hôpitaux de Paris; Paris France
| | - J. Nizard
- Department of Obstetrics and Gynecology, Groupe Hospitalier Pitié Salpêtrière; Université Pierre et Marie Curie-Paris 6; Paris France
| | - F. Christory
- Network for the Advancement of Patient Blood Management; Haemostasis and Thrombosis (NATA); Paris France
| | - C.-M. Samama
- NATA Chair, Professor of Anaesthesiology, Department of Anaesthesiology; Centre Hospitalier de l'Universite de Montréal; Montreal QC Canada
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19
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How I treat anemia in pregnancy: iron, cobalamin, and folate. Blood 2017; 129:940-949. [DOI: 10.1182/blood-2016-08-672246] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 12/21/2016] [Indexed: 01/28/2023] Open
Abstract
AbstractAnemia of pregnancy, an important risk factor for fetal and maternal morbidity, is considered a global health problem, affecting almost 50% of pregnant women. In this article, diagnosis and management of iron, cobalamin, and folate deficiencies, the most frequent causes of anemia in pregnancy, are discussed. Three clinical cases are considered. Iron deficiency is the most common cause. Laboratory tests defining iron deficiency, the recognition of developmental delays and cognitive abnormalities in iron-deficient neonates, and literature addressing the efficacy and safety of IV iron in pregnancy are reviewed. An algorithm is proposed to help clinicians diagnose and treat iron deficiency, recommending oral iron in the first trimester and IV iron later. Association of folate deficiency with neural tube defects and impact of fortification programs are discussed. With increased obesity and bariatric surgery rates, prevalence of cobalamin deficiency in pregnancy is rising. Low maternal cobalamin may be associated with fetal growth retardation, fetal insulin resistance, and excess adiposity. The importance of treating cobalamin deficiency in pregnancy is considered. A case of malarial anemia emphasizes the complex relationship between iron deficiency, iron treatment, and malaria infection in endemic areas; the heightened impact of combined etiologies on anemia severity is highlighted.
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20
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Auerbach M, Deloughery T. Single-dose intravenous iron for iron deficiency: a new paradigm. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2016; 2016:57-66. [PMID: 27913463 PMCID: PMC6142502 DOI: 10.1182/asheducation-2016.1.57] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Iron-deficiency anemia is the most common hematologic problem in the world. Although oral iron is often viewed as front-line therapy, extensive published evidence has accumulated that IV iron is superior, in both efficacy and safety, to oral iron in many clinical situations and should be introduced much sooner in the treatment paradigm of iron-deficient patients. In this chapter, we will review the formulations of IV iron that allow total complete replacement doses in 1 or 2 sessions including practical tips for administration. We realize safety concerns abound and therefore will analyze evidence based overstated concerns regarding serious adverse events highlighting unnecessary interventions for minor, self-limiting infusion reactions, which infrequently occur with intravenous iron administration. Recent data for the use of IV iron in a variety of clinic situations will be reviewed including women with heavy uterine bleeding, pregnancy, bariatric surgery, inflammatory bowel disease, and restless legs syndrome. Briefly discussed is the new frontier of IV iron's use in the prevention of acute (high altitude) mountain sickness. It is clear that in many clinical situations IV iron is a new and improved standard of care offering advantages over oral iron in efficacy, toxicity, and convenience to patients and health care providers.
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Affiliation(s)
- Michael Auerbach
- Private Practice, Baltimore, MD
- Clinical Professor of Medicine, Georgetown University School of Medicine, Washington, DC; and
| | - Thomas Deloughery
- Department of Hematology and Medical Oncology, Division of Laboratory Medicine, and
- Department of Pathology, Oregon Health Sciences University, Portland, OR
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21
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Auerbach M, Derman R. Adolescent fatigue: Is intravenous iron a better solution? Am J Hematol 2016; 91:971-2. [PMID: 27416033 DOI: 10.1002/ajh.24480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 07/12/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Michael Auerbach
- Georgetown University School of Medicine, Washington, District of Columbia.
| | - Richard Derman
- Thomas Jefferson University School of Medicine, Philadelphia, Pennsylvania
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22
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Wong L, Smith S, Gilstrop M, Derman R, Auerbach S, London N, Lenowitz S, Bahrain H, McClintock J, Auerbach M. Safety and efficacy of rapid (1,000 mg in 1 hr) intravenous iron dextran for treatment of maternal iron deficient anemia of pregnancy. Am J Hematol 2016; 91:590-3. [PMID: 26971581 DOI: 10.1002/ajh.24361] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 03/05/2016] [Accepted: 03/07/2016] [Indexed: 11/09/2022]
Abstract
Maternal iron deficiency anemia (IDA) is associated with risk of adverse perinatal outcomes. Oral iron is recommended to reverse anemia, but has gastrointestinal toxicity and frequent non-adherence. Intravenous (IV) iron is reserved for intolerance of, or unresponsiveness to, oral therapy, malabsorption, and severe anemia (1% with hemoglobin [Hgb] levels <7 g/dL). With rare (<100 per one million) adverse events (AEs) ability to infuse a sufficient dose of low molecular weight iron dextran (LMWID) over 60 min, LMWID is an attractive option. This study demonstrated safety and efficacy of rapid IV infusion of 1,000 mg LMWID to gravidas with moderate to severe IDA. An observational treatment study of 1,000 mg LMWID administered over 1 hr for IDA in 189 consecutive, unselected second and third trimester gravidas after oral iron failure was conducted. All received a test dose of 25 mg LMWID and were monitored for AEs during the 60-min infusion. No premedication was administered unless more than one drug allergy or asthma was present in which case IV methylprednisolone was administered. All were followed through pregnancy and delivery. Monitored parameters included Hgb, mean corpuscular volume, serum ferritin, and percent transferrin saturation. About 189 subjects received 1,000 mg LMWID. No serious AEs occurred. About 2% experienced transient infusion reactions. Hgb improved by 1-1.9 g/dL in 82% and ≥2 g/dL in 24%. Second trimester treatment was not associated with greater Hgb improvement than third trimester treatment. Anemia resolved in 95%. Administration of a single large dose of IV LMWID was effective, safe, and convenient. Am. J. Hematol. 91:590-593, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Lee Wong
- Department of Obstetrics and Gynecology; MedStar Franklin Square Medical Center; Baltimore Maryland
| | - Samuel Smith
- Department of Obstetrics and Gynecology; MedStar Franklin Square Medical Center; Baltimore Maryland
| | - Marisa Gilstrop
- Department of Obstetrics and Gynecology; Christiana Care Health System; Newark Delaware
| | - Richard Derman
- Department of Obstetrics and Gynecology; Christiana Care Health System; Newark Delaware
| | - Sarah Auerbach
- West Virginia School of Osteopathic Medicine; Lewisburg West Virginia
| | - Nicola London
- Department of Obstetrics and Gynecology; MedStar Franklin Square Medical Center; Baltimore Maryland
| | - Steven Lenowitz
- Department of Obstetrics and Gynecology; MedStar Franklin Square Medical Center; Baltimore Maryland
| | | | - Jessica McClintock
- Department of Obstetrics and Gynecology; MedStar Franklin Square Medical Center; Baltimore Maryland
| | - Michael Auerbach
- Department of Medicine; Georgetown University School of Medicine; Washington DC
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23
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Auerbach M, Adamson JW. How we diagnose and treat iron deficiency anemia. Am J Hematol 2016; 91:31-8. [PMID: 26408108 DOI: 10.1002/ajh.24201] [Citation(s) in RCA: 156] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 09/23/2015] [Indexed: 12/18/2022]
Abstract
It is estimated that one-third of the world's population is anemic, the majority being due to iron deficiency (ID). In adults, ID is associated with fatigue in the absence of anemia, restless legs syndrome, pica and, in neonates, delayed growth and development. In adolescents, ID is associated with decrements in learning and behavioral abnormalities. In the absence of a clear cause, search for a source of bleeding is indicated. No single test is diagnostic of ID unless the serum ferritin is low or the percent transferrin saturation is low with an elevated total iron binding capacity. Oral iron is considered front line therapy except for conditions such as gastric bypass, heavy uterine bleeding, inflammatory bowel disease, and hereditary hemorrhagic telangiectasia. Oral iron has many unpleasant side effects, resulting in low patient adherence. For patients intolerant of, or unresponsive to, oral iron, intravenous (IV) administration is the preferred route. While early formulations were associated with a high incidence of serious adverse events (SAEs), newer formulations are much safer with SAEs occurring very infrequently. Full replacement doses can be administered in a matter of minutes to a few hours. Nevertheless, there remains a reluctance to use IV iron due to a misunderstanding of the safety of the available formulations. IV iron is safe and effective in all clinical circumstances including pregnancy. The preponderance of published evidence suggests IV iron therapy is underutilized and we believe that IV iron should be moved forward in the treatment of ID and iron deficiency anemia (IDA).
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Affiliation(s)
- Michael Auerbach
- Clinical Professor of Medicine; Georgetown University, Washington, DC, Private Practice; Baltimore Maryland
| | - John W. Adamson
- Clinical Professor of Medicine; University of California San Diego; San Diego California
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24
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Safety and Efficacy of Ferric Carboxymaltose in Anemic Pregnant Women: A Retrospective Case Control Study. Obstet Gynecol Int 2015; 2015:728952. [PMID: 26688686 PMCID: PMC4672138 DOI: 10.1155/2015/728952] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 11/08/2015] [Accepted: 11/10/2015] [Indexed: 12/21/2022] Open
Abstract
Background. Anemia during pregnancy is commonly caused by iron deficiency and can have severe consequences for both the mother and the developing fetus. The aim of this retrospective study was to assess the safety and efficacy of intravenous ferric carboxymaltose (FCM) in pregnant women. Methods. All women treated with FCM for anemia during pregnancy between 2010 and 2012 at our institution were included. A matched control group was selected, including women who either were nonanemic or had anemia but were not considered for intravenous iron. Main outcome measures were maternal safety and pregnancy outcomes. Results. The study included 128 patients (FCM: 64; control: 64). Median FCM dose was 1000 mg and median gestational age at the time of first treatment was 34 weeks and 6 days. Median Hb increased from 8.4 g/dL (interquartile range 7.7; 8.9 g/dL) at the first FCM administration to 10.7 g/dL (9.8; 11.5 g/dL; n = 46 with available Hb at delivery) at the time of delivery, achieving levels similar to those in the control group (10.8 g/dL [9.8; 11.8 g/dL; n = 48]). No treatment-related adverse events were reported and no statistically significant differences in pregnancy outcomes were observed between groups. Conclusions. Within the limitations of this case control study, FCM was a safe and efficient treatment of anemia during pregnancy.
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25
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Auerbach M, Adamson J, Bircher A, Breymann C, Fishbane S, Gafter-Gvili A, Gasche C, Gilreath J, Grazzini G, Henry D, Liumbruno G, Locatelli F, Macdougall I, Munoz M, Rampton D, Rodgers G, Shander A. On the safety of intravenous iron, evidence trumps conjecture. Haematologica 2015; 100:e214-5. [PMID: 25944640 DOI: 10.3324/haematol.2014.121004] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
| | - John Adamson
- University of California San Diego, San Diego, CA, USA
| | | | | | - Steven Fishbane
- Long Island Jewish-Northshore Medical Center, Manhasset, NY, USA
| | | | | | | | - Giuliano Grazzini
- Italian National Blood Center, National Institute of Health, Rome, Italy
| | - David Henry
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | - Manuel Munoz
- Perioperative Transfusion Medicine, School of Medicine, University of Málaga, Spain
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