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Liu C, Zhang Q, Hui P, Wang Y, Li G, Cao G, Xue Z, Zhang J, Zhang H, Huang X, Wu J, Sun F, Yan M. Safety monitoring of oral iron supplements in pregnant women with anemia: a multi-center observational clinical study. Ther Adv Drug Saf 2023; 14:20420986231181335. [PMID: 37377748 PMCID: PMC10291403 DOI: 10.1177/20420986231181335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
Aims To investigate the safety of oral iron therapy in pregnant women with iron-deficiency anemia (IDA) in the real world. Methods A retrospective analysis was performed on 1792 pregnant patients with IDA who received oral iron supplements from 12 hospitals in Shandong Province from 1 April to 31 June 2021; follow-up and adverse reactions were recorded. They were divided into six groups according to the treatment drugs. Results The overall adverse reaction rate was 15.4%, and the main adverse reaction site was the digestive system. The incidence of all kinds of oral iron adverse reactions from high to low in order: compound ferrous sulfate and folic acid tablets (21.88%); iron proteinsuccinylate oral solution (20.90%); ferrous succinate tablets (19.76%); ferrous succinate sustained-release tablets (18.00%); iron polysaccharide complex capsule (12.06%); and iron dextran oral solution (6.94%). It was found that there was a significant difference in the incidence of adverse reactions among the six drugs (p < 0.05). Pairwise comparison showed that the incidence of adverse reactions was higher in the iron proteinsuccinylate oral solution than that in the iron polysaccharide complex capsule (p < 0.05). There was no significant difference in the incidence of adverse reactions in different ages (p > 0.05), but there was a significant difference in the incidence of adverse reactions in different gestational ages (p < 0.05). In Adverse Drug Reaction (ADR) patients, the adverse reaction result of most patients is recovery or improvement, and there was no serious adverse reaction outcome such as sequela and death. Conclusion All the adverse reactions of oral iron were mainly gastrointestinal adverse reactions, and no heavy adverse reactions were found. Iron proteinsuccinylate oral solution has a higher incidence of adverse reactions than iron polysaccharide complex capsule. The results showed that oral iron was safer for anemia patients during pregnancy.
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Affiliation(s)
- Chang Liu
- Ocean University of China, Qingdao, Shandong, China
- Qingdao University Affiliated Qingdao Women and Children’s Hospital, Qingdao, Shandong, China
| | | | - Peiye Hui
- Weifang Maternal and Child Health Hospital, Weifang, Shandong, China
| | - Yan Wang
- Tengzhou Maternal and Child Health Hospital, Tengzhou, Shandong, China
| | - Guohui Li
- Jinan Maternal and Child Health Hospital, Jinan, Shandong, China
| | - Guangchao Cao
- Linyi Maternal and Child Health Hospital, Linyi, Shandong, China
| | - Zicheng Xue
- Zaozhuang Maternal and Child Health Hospital, Zaozhuang, Shandong, China
| | - Jing Zhang
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Heng Zhang
- Qingdao Haici Hospital, Qingdao, Shandong, China
| | - Xin Huang
- Shandong Qianfuo Mountain Hospital, Jinan, Shandong, China
| | - Jiyong Wu
- The Second People’s Hospital of Shandong Province, Jinan, Shandong, China
| | - Fusehng Sun
- Qingdao Municipal Hospital Group, Qingdao, Shandong, China
| | - Meixing Yan
- Qingdao University Affiliated Qingdao Women and Children’s Hospital, No. 217, Liaoyang East Road, North District, Qingdao, Shandong, China
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Das SN, Devi A, Mohanta BB, Choudhury A, Swain A, Thatoi PK. Oral versus intravenous iron therapy in iron deficiency anemia: An observational study. J Family Med Prim Care 2020; 9:3619-3622. [PMID: 33102339 PMCID: PMC7567229 DOI: 10.4103/jfmpc.jfmpc_559_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/27/2020] [Accepted: 05/13/2020] [Indexed: 11/04/2022] Open
Abstract
Background: Intravenous (IV) iron sucrose is claimed to have better safety profile and efficacy in treatment of iron deficiency anemia than conventional oral iron supplements. Aim: The aim of the study was to compare the efficacy and safety of IV iron therapy with oral iron supplements in iron deficiency anemia. Methods: An observational study was carried out by allocating 100 patients with baseline hemoglobin between 5 and 10 g/dL into two groups of oral iron and IV iron group. Hemoglobin and serum ferritin levels were measured at admission, on day 14 and on day 28. Adverse effect profile for each group was tabulated. Mean and standard deviation were calculated for each group and compared. Results: A total of 100 patients participated consisting of 37 males and 63 females. Baseline hemoglobin and serum ferritin for both groups were comparable. After initiation of therapy, hemoglobin in oral iron group raised from 6.45 (0.72) to 8.84 (0.47) on day 14 and to 9.69 (0.47) on day 28. Hemoglobin in IV iron group increased from 6.34 (0.86) to 10.52 (0.61) on day 14 and to 11.66 (0.84) on day 28. Serum ferritin in oral iron group increased from 8.3 (1.9) to 33.8 (1.29) on day 14 and to 43.61 (8.8) on day 28. Serum ferritin in IV iron group raised from 8.23 (4.64) to 148.23 (11.86) on day 14 but decreased to 115.76 (15.3) on day 28. The data were statistically significant for IV iron therapy on day 14 and day 28. Of 100 patients, 18 patients (12 in oral and 6 in IV iron groups) had adverse effects. Among the oral iron group, metallic taste and constipation were major side effects followed by heart burn and nausea. In the IV iron group, arthralgia (4 patients of 6) was the major side effect observed. One patient (of 6) in IV group had hypotension. Anaphylaxis was not observed in any patient in either group. Conclusion: IV iron therapy is effective and safe for management of iron deficiency anemia.
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Affiliation(s)
- Samarendra N Das
- Department of Medicine, PRM Medical College, Baripada, Odisha, India
| | - Amruta Devi
- Department of Nephrology, SCB Medical College, Cuttack, Odisha, India
| | - Bibhuti B Mohanta
- Department of Medicine, IMS and SUM Hospital, Bhubaneswar, Odisha, India
| | - Anurag Choudhury
- Department of Medicine, SCB Medical College, Cuttack, Odisha, India
| | - Abinash Swain
- Department of Medicine, SCB Medical College, Cuttack, Odisha, India
| | - Pravat K Thatoi
- Department of Medicine, SCB Medical College, Cuttack, Odisha, India
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Neogi SB, Devasenapathy N, Singh R, Bhushan H, Shah D, Divakar H, Zodpey S, Malik S, Nanda S, Mittal P, Batra A, Chauhan MB, Yadav S, Dongre H, Saluja S, Malhotra V, Gupta A, Sangwan R, Radhika AG, Singh A, Bhaskaran S, Kotru M, Sikka M, Agarwal S, Francis P, Mwinga K, Baswal D. Safety and effectiveness of intravenous iron sucrose versus standard oral iron therapy in pregnant women with moderate-to-severe anaemia in India: a multicentre, open-label, phase 3, randomised, controlled trial. LANCET GLOBAL HEALTH 2020; 7:e1706-e1716. [PMID: 31708151 DOI: 10.1016/s2214-109x(19)30427-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 08/27/2019] [Accepted: 09/17/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Intravenous iron sucrose is a promising therapy for increasing haemoglobin concentration; however, its effect on clinical outcomes in pregnancy is not yet established. We aimed to assess the safety and clinical effectiveness of intravenous iron sucrose (intervention) versus standard oral iron (control) therapy in the treatment of women with moderate-to-severe iron deficiency anaemia in pregnancy. METHODS We did a multicentre, open-label, phase 3, randomised, controlled trial at four government medical colleges in India. Pregnant women, aged 18 years or older, at 20-28 weeks of gestation with a haemoglobin concentration of 5-8 g/dL, or at 29-32 weeks of gestation with a haemoglobin concentration of 5-9 g/dL, were randomly assigned (1:1) to receive intravenous iron sucrose (dose was calculated using a formula based on bodyweight and haemoglobin deficit) or standard oral iron therapy (100 mg elemental iron twice daily). Logistic regression was used to compare the primary maternal composite outcome consisting of potentially life-threatening conditions during peripartum and postpartum periods (postpartum haemorrhage, the need for blood transfusion during and after delivery, puerperal sepsis, shock, prolonged hospital stay [>3 days following vaginal delivery and >7 days after lower segment caesarean section], and intensive care unit admission or referral to higher centres) adjusted for site and severity of anaemia. The primary outcome was analysed in a modified intention-to-treat population, which excluded participants who refused to participate after randomisation, those who were lost to follow-up, and those whose outcome data were missing. Safety was assessed in both modified intention-to-treat and as-treated populations. The data safety monitoring board recommended stopping the trial after the first interim analysis because of futility (conditional power 1·14% under the null effects, 3·0% under the continued effects, and 44·83% under hypothesised effects). This trial is registered with the Clinical Trial Registry of India, CTRI/2012/05/002626. FINDINGS Between Jan 31, 2014, and July 31, 2017, 2018 women were enrolled, and 999 were randomly assigned to the intravenous iron sucrose group and 1019 to the standard therapy group. The primary maternal composite outcome was reported in 89 (9%) of 958 patients in the intravenous iron sucrose group and in 95 (10%) of 976 patients in the standard therapy group (adjusted odds ratio 0·95, 95% CI 0·70-1·29). 16 (2%) of 958 women in the intravenous iron sucrose group and 13 (1%) of 976 women in the standard therapy group had serious maternal adverse events. Serious fetal and neonatal adverse events were reported by 39 (4%) of 961 women in the intravenous iron sucrose group and 45 (5%) of 982 women in the standard therapy group. At 6 weeks post-randomisation, minor side-effects were reported by 117 (16%) of 737 women in the intravenous iron sucrose group versus 155 (21%) of 721 women in the standard therapy group. None of the serious adverse events was found to be related to the trial procedures or the interventions as per the causality assessment made by the trial investigators, ethics committees, and regulatory body. INTERPRETATION The study was stopped due to futility. There is insufficient evidence to show the effectiveness of intravenous iron sucrose in reducing clinical outcomes compared with standard oral iron therapy in pregnant women with moderate-to-severe anaemia. FUNDING WHO, India.
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Affiliation(s)
- Sutapa B Neogi
- Indian Institute of Public Health-Delhi, Public Health Foundation of India, Gurgaon, India.
| | | | - Ranjana Singh
- Indian Institute of Public Health-Delhi, Public Health Foundation of India, Gurgaon, India
| | | | - Duru Shah
- Breach Candy Hospital, Mumbai, India; Indian College of Obstetricians and Gynaecologists, Federation of Obstetrics and Gynaecology Society of India, Mumbai, India
| | | | - Sanjay Zodpey
- Indian Institute of Public Health-Delhi, Public Health Foundation of India, Gurgaon, India
| | - Sunita Malik
- Department of Obstetrics and Gynaecology, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Smiti Nanda
- Department of Obstetrics and Gynaecology, Pt Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences (PGIMS), Rohtak, India
| | - Pratima Mittal
- Department of Obstetrics and Gynaecology, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Achla Batra
- Department of Obstetrics and Gynaecology, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Meenakshi B Chauhan
- Department of Obstetrics and Gynaecology, Pt Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences (PGIMS), Rohtak, India
| | - Sunita Yadav
- Department of Obstetrics and Gynaecology, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Harsha Dongre
- Department of Obstetrics and Gynaecology, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sumita Saluja
- Department of Hematology, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Vani Malhotra
- Department of Obstetrics and Gynaecology, Pt Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences (PGIMS), Rohtak, India
| | - Anjali Gupta
- Department of Obstetrics and Gynaecology, Pt Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences (PGIMS), Rohtak, India
| | - Roopa Sangwan
- Department of Obstetrics and Gynaecology, Pt Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences (PGIMS), Rohtak, India
| | - A G Radhika
- Department of Obstetrics and Gynaecology, Guru Teg Bahadur Hospital, New Delhi, India
| | - Alpana Singh
- Department of Obstetrics and Gynaecology, Guru Teg Bahadur Hospital, New Delhi, India
| | - Sruti Bhaskaran
- Department of Obstetrics and Gynaecology, Guru Teg Bahadur Hospital, New Delhi, India
| | - Mrinalini Kotru
- Department of Pathology, Guru Teg Bahadur Hospital, New Delhi, India
| | - Meera Sikka
- Department of Pathology, Guru Teg Bahadur Hospital, New Delhi, India
| | - Sonika Agarwal
- Department of Obstetrics and Gynaecology, Guru Teg Bahadur Hospital, New Delhi, India
| | | | | | - Dinesh Baswal
- Ministry of Health and Family Welfare, Government of India, New Delhi, India
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Chua S, Gupta S, Curnow J, Gidaszewski B, Khajehei M, Diplock H. Intravenous iron vs blood for acute post-partum anaemia (IIBAPPA): a prospective randomised trial. BMC Pregnancy Childbirth 2017; 17:424. [PMID: 29258541 PMCID: PMC5735511 DOI: 10.1186/s12884-017-1596-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 11/24/2017] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Acute post-partum anaemia can be associated with significant morbidity including a predisposition for postnatal depression. Lack of clear practice guidelines means a number of women are treated with multiple blood transfusions. Intravenous iron has the potential to limit the need for multiple blood transfusions but its role in the post-partum setting is unclear. METHODS/DESIGN IIBAPPA is a multi-centre randomised non-inferiority trial. Women with a primary post-partum haemorrhage (PPH) >1000 mL and resultant haemoglobin (Hb) 5.5-8.0 g/dL after resuscitation with ongoing symptomatic anaemia who are otherwise stable (no active bleeding) are eligible to participate. Patients with sepsis or conditions necessitating rapid Hb restoration are excluded. Eligible participants are randomised to receive a blood transfusion or a single dose of intravenous iron polymaltose calculated using the Ganzoni formula. Primary outcome measures include Hb, Ferritin and C-Reactive Protein levels on Day 7. Secondary outcomes evaluate (i) Hb, Ferritin and CRP levels on Day 14, 28, (ii) anaemia symptoms on Day 0, 7, 14 and 28 using structured health related quality of life questionnaires, (iii) treatment safety by assessing adverse reactions and infection endpoints and (iv) the quantitative impact of anaemia on breast feeding quality using a hospital designed questionnaire. DISCUSSION If equivalence in Hb and ferritin levels, symptom scores and safety endpoints is demonstrated, intravenous iron may become the preferred treatment for women with acute post-partum anaemia to minimise transfusion reactions and costs. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry: ACTRN12615001370594 on 16th December, 2015 (prospective approval).
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Affiliation(s)
- Seng Chua
- Department of Obstetrics and Gynaecology, Westmead Hospital, Westmead, NSW 2145 Australia
- Department of Medicine and Public Health, University of Sydney, Camperdown, NSW 2050 Australia
| | - Sarika Gupta
- Department of Medicine and Public Health, University of Sydney, Camperdown, NSW 2050 Australia
- Department of Maternity and Gynaecology, John Hunter Hospital, Newcastle, NSW 2305 Australia
| | - Jennifer Curnow
- Department of Haematology, Westmead Hospital, Westmead, NSW 2145 Australia
| | - Beata Gidaszewski
- Department of Obstetrics and Gynaecology, Westmead Hospital, Westmead, NSW 2145 Australia
| | - Marjan Khajehei
- Department of Obstetrics and Gynaecology, Westmead Hospital, Westmead, NSW 2145 Australia
| | - Hayley Diplock
- Department of Obstetrics and Gynaecology, Westmead Hospital, Westmead, NSW 2145 Australia
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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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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: 40] [Impact Index Per Article: 5.7] [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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Bhavi SB, Jaju PB. Intravenous iron sucrose v/s oral ferrous fumarate for treatment of anemia in pregnancy. A randomized controlled trial. BMC Pregnancy Childbirth 2017; 17:137. [PMID: 28482869 PMCID: PMC5422878 DOI: 10.1186/s12884-017-1313-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 04/24/2017] [Indexed: 11/25/2022] Open
Abstract
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.
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Affiliation(s)
- Shruti B Bhavi
- Gadag institute of medical sciences (GIMS), C/o Dr B R Patil, house No 6679/ B18, Near K.V.S.R College Vidyanagar extension, Gadag, Karnataka, India.
| | - Purushottam B Jaju
- Shri B M Patil Medical college Hospital and Research Center, B.L.D.E University's, Bijapur, 586103, India
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8
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El Khouly NI. Comparison of intravenous ferrous sucrose and oral ferrous sulphate in treatment of postpartum iron deficiency anemia. J Matern Fetal Neonatal Med 2016; 30:967-971. [DOI: 10.1080/14767058.2016.1192602] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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10
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Abstract
Anemia is a common problem in obstetrics and perinatal care. Any hemoglobin below 10.5 g/dL can be regarded as true anemia regardless of gestational age. Reasons for anemia in pregnancy are mainly nutritional deficiencies, parasitic and bacterial diseases, and inborn red blood cell disorders such as thalassemias. The main cause of anemia in obstetrics is iron deficiency, which has a worldwide prevalence between estimated 20%-80% and consists of a primarily female population. Stages of iron deficiency are depletion of iron stores, iron-deficient erythropoiesis without anemia, and iron deficiency anemia, the most pronounced form of iron deficiency. Pregnancy anemia can be aggravated by various conditions such as uterine or placental bleedings, gastrointestinal bleedings, and peripartum blood loss. In addition to the general consequences of anemia, there are specific risks during pregnancy for the mother and the fetus such as intrauterine growth retardation, prematurity, feto-placental miss ratio, and higher risk for peripartum blood transfusion. Besides the importance of prophylaxis of iron deficiency, the main therapy options for the treatment of pregnancy anemia are oral iron and intravenous iron preparations.
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Affiliation(s)
- Christian Breymann
- Department of Obstetrics and Gynaecology, University Hospital Zurich, Obstetric Research, Feto- Maternal Haematology Research Group, Zurich, Switzerland.
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Basora M, Colomina MJ, Tio M, Mora L, Sánchez-Etayo G, Salazar F, Ciércoles E, Paños M, Guerrero E, Berge R. Optimizing preoperative haemoglobin in major orthopaedic surgery using intravenous iron with or without erythropoietin. An epidemiologic study. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2015; 62:313-321. [PMID: 25698609 DOI: 10.1016/j.redar.2014.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 07/06/2014] [Accepted: 07/10/2014] [Indexed: 06/04/2023]
Abstract
AIM To evaluate the effectiveness of intravenous iron treatment, with or without associated erythropoietin (rHuEPO), measured as haemoglobin (Hb) increase. The relationships between the Hb increase and parameters used to evaluate anaemia were analysed. MATERIAL AND METHOD Retrospective observational study carried out in two third-level hospitals between January 2005 and December 2009. The study included patients with iron deficiency anaemia scheduled for elective orthopaedic surgery and treated with intravenous iron sucrose alone or associated with rHuEPO. Treatment efficacy was analysed based on the Hb increase from baseline to just before surgery. RESULTS A total of 412 patients who received a median of 800mg of iron sucrose were included; 125 of them (30.4%) additionally received 2.4 vials of rHuEPO. The Hb increase was 0.8 (1.1) g/dL in patients treated with intravenous iron and 1.5 (1.3) g/dL in those additionally given rHuEPO(P<.01). The percentage of hypochromic red blood cells (r=0.52) and soluble transferrin receptor (r=0.59) value were significantly correlated to the Hb increase in patients receiving iron. CONCLUSIONS In patients with iron deficiency anaemia, the effectiveness of iron sucrose treatment to optimize Hb before surgery was moderate; adjuvant administration of erythropoietin improved the results. Determination of functional iron status parameters may improve the treatment effectiveness.
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Affiliation(s)
- M Basora
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Clínic, Barcelona, España.
| | - M J Colomina
- Servicio de Anestesiología y Reanimación, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - M Tio
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Clínic, Barcelona, España
| | - L Mora
- Servicio de Anestesiología y Reanimación, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - G Sánchez-Etayo
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Clínic, Barcelona, España
| | - F Salazar
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Clínic, Barcelona, España
| | - E Ciércoles
- Servicio de Anestesiología y Reanimación, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - M Paños
- Servicio de Anestesiología y Reanimación, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - E Guerrero
- Servicio de Anestesiología y Reanimación, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - R Berge
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Clínic, Barcelona, España
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Shi Q, Leng W, Wazir R, Li J, Yao Q, Mi C, Yang J, Xing A. Intravenous Iron Sucrose versus Oral Iron in the Treatment of Pregnancy with Iron Deficiency Anaemia: A Systematic Review. Gynecol Obstet Invest 2015; 80:170-8. [DOI: 10.1159/000376577] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 01/26/2015] [Indexed: 11/19/2022]
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Devasenapathy N, Singh R, Moodbidri P, Bhushan H, Gupta S, Zodpey SP, Neogi SB. An Observational Study on the Use of IV Iron Sucrose Among Anaemic Pregnant Women in Government Healthcare Facilities from Two States of India. J Obstet Gynaecol India 2014; 65:230-5. [PMID: 26243988 DOI: 10.1007/s13224-014-0588-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 06/17/2014] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND/PURPOSE OF THE STUDY In India oral iron tablets for anaemia have been distributed through the health system since many years, but there has been no significant change in the burden of anaemia. The objective of the present study was to capture the existing practices on the use of intravenous iron sucrose (an alternative treatment for anaemia) in the public health system in two states of India (Tamil Nadu and Uttar Pradesh). METHODS An observational study in the form of a registry was maintained for 3 months at purposively chosen public health facilities in the above-mentioned states of India. Anaemic pregnant women (n = 764) who were given intravenous iron sucrose during the antenatal or post-partum period were included in the registry. Information was collected on severity of anaemia at which intravenous iron sucrose therapy was initiated, the dose and schedule given and any adverse events noted during and immediate post-infusion period. RESULTS 99 % of the infusions were given as slow infusion over a mean duration of 30 min, diluted with 0.9 % sodium chloride. The mean haemoglobin level at the time of start of intravenous therapy was 8.3 gm/dl. In Uttar Pradesh, 46 % of women received only one dose of iron sucrose in contrast with 15 % in Tamil Nadu. CONCLUSIONS Although intravenous iron sucrose is commonly used in pregnant anaemic women, standard protocols and guidelines for its usage are lacking. These need to be formulated before scaling it up across public health facilities in India.
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Affiliation(s)
- Niveditha Devasenapathy
- Indian Institute of Public Health, Delhi, Sector 44, Institutional Area, Gurgaon, 122002 Haryana India
| | - Ranjana Singh
- Indian Institute of Public Health, Delhi, Sector 44, Institutional Area, Gurgaon, 122002 Haryana India
| | - Premjeeth Moodbidri
- Indian Institute of Public Health, Delhi, Sector 44, Institutional Area, Gurgaon, 122002 Haryana India
| | - Himanshu Bhushan
- Maternal Health, Ministry of Health and Family Welfare, New Delhi, India
| | | | - Sanjay P Zodpey
- Indian Institute of Public Health, Delhi, Sector 44, Institutional Area, Gurgaon, 122002 Haryana India
| | - Sutapa B Neogi
- Indian Institute of Public Health, Delhi, Sector 44, Institutional Area, Gurgaon, 122002 Haryana India
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Jain G, Palaria U, Jha SK. Intravenous iron in postpartum anemia. J Obstet Gynaecol India 2013; 63:45-8. [PMID: 24431599 DOI: 10.1007/s13224-012-0240-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Accepted: 06/14/2012] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE To compare effectiveness of intravenous iron-sucrose versus oral ferrous fumarate in postpartum anemia. METHODS In this study, 40 women with postpartum anemia with hemoglobin (Hb) less than 8 g/dl within 48 h postpartum were randomised into two groups. Group I consisted of 20 women who received 300-600 mg of intravenous iron-sucrose every alternate day for 3 days. Group II consisted of 20 women who were given 300 mg ferrous fumarate orally daily for 14 days. RESULTS On day 14, the increase in mean Hb level in group I was 2.4 g/dl in comparison to 1.2 g/dl in group II. Women in group I had significantly higher mean Hb values on days 7 and 14 (p < 0.001) than women in group II. CONCLUSION These results suggest that intravenous iron-sucrose increases the Hb level more rapidly than oral ferrous fumarate in postpartum anemia without any serious side effects.
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Affiliation(s)
- Geeta Jain
- Department of O&G, Govt. Medical College, Haldwani, Rampur Road, Haldwani, Uttarakhand India
| | - Urmila Palaria
- Department of Anaesthesia, Govt. Medical College, Haldwani, Rampur Road, Haldwani, Uttarakhand India
| | - S K Jha
- Department of PSM, Govt. Medical College, Haldwani, Rampur Road, Haldwani, Uttarakhand India
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Devasenapathy N, Neogi SB, Zodpey S. Is intravenous iron sucrose the treatment of choice for pregnant anemic women? J Obstet Gynaecol Res 2012; 39:619-26. [PMID: 23167561 DOI: 10.1111/j.1447-0756.2012.02033.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Accepted: 07/18/2012] [Indexed: 11/29/2022]
Abstract
Anemia during pregnancy remains an important public health problem in developing countries like India. Anemia is the direct cause of 12-15% of maternal deaths. Iron deficiency is the commonest cause for anemia in the Indian subcontinent. Several preventive and therapeutic approaches are in practice. The available routes of iron supplementation are oral and intravenous. In spite of oral iron being least invasive, cheap and safe, the ineffectiveness of oral iron due to dietary inhibitors and poor compliance are well known. Intravenous iron sucrose can be a promising therapy for moderate to severely anemic pregnant women and has been in practice for quite some time in private and public health practices. In this article, we report the current evidence on the safety and efficacy of intravenous iron sucrose in anemic pregnant women on hematological and clinical outcomes. Though the evidence on its efficacy in improving hemoglobin and serum ferritin is convincing, its effect on maternal and fetal outcomes are unclear. This is primarily due to lack of well-designed and larger studies powered to detect difference in clinical outcomes. Hence, there is a need to gather evidence from a well-designed large randomized clinical trial conducted in a developing country. The results of such a study would feed into the national policy and would form the basis to frame guidelines for management of anemia in developing countries.
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Singh S, Singh S, Singh PK. A study to compare the efficacy and safety of intravenous iron sucrose and intramuscular iron sorbitol therapy for anemia during pregnancy. J Obstet Gynaecol India 2012; 63:18-21. [PMID: 24431594 DOI: 10.1007/s13224-012-0248-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Accepted: 06/14/2012] [Indexed: 11/26/2022] Open
Abstract
AIMS AND OBJECTIVES To compare the efficacy, safety, and rate of response of intravenous iron sucrose and intramuscular iron sorbitol therapy for anemia during pregnancy. MATERIAL AND METHODS 100 antenatal cases of gestational age 14-32 weeks were included in this prospective study. Cases were randomly divided into two groups. Group A, having 50 cases received intravenous iron sucrose, and 50 cases in Group B received intramuscular iron sorbitol. Response to therapy in both groups was studied and compared. RESULTS The mean pretherapy hemoglobin in group A was 6.49 gm/dl and in group B was 6.48 gm/dl. The rise in hemoglobin after 4 weeks of starting therapy was 3.52 gm/dl in group A and 2.33 gm/dl in group B. The difference was statistically significant (P < 0.01). The mean time taken to achieve target hemoglobin (≥11 gm/dl) was 6.37 weeks in group A and 9.04 weeks in group B. In group A, 8 % (four) cases had grade I adverse effects. In group B, 24 % (12) cases had grade I adverse effects. The difference was statistically significant (P = 0.027). In both the groups, no case discontinued the therapy. CONCLUSION Intravenous iron sucrose is safe, convenient, more effective, and faster acting therapy than intramuscular iron sorbitol therapy for treating moderate to severe anemia during pregnancy.
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Affiliation(s)
- Subhadra Singh
- Department of Obstetrics and Gynaecology, Dr. S. N. Medical College, B-33, Subhash Enclave, Air Force Area, Jodhpur, Rajasthan India
| | - Saroj Singh
- Department of Obsterics and Gynaecology, S. N. Medical College, Agra, UP India
| | - Punit Kumar Singh
- Department of Ophthalmology, Dr. S. N. Medical College, Jodhpur, Rajasthan India
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Guerra Merino S, López Picado A, Muñoz Hernández H, Marín Mesa J, Lete Lasa I, Aizpuru Barandiarán F. Ensayo clínico aleatorizado para evaluar la efectividad de dos vías de administración de hierro, oral e intravenosa, en el tratamiento de la anemia ferropénica posparto. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2012. [DOI: 10.1016/j.gine.2011.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kochhar PK, Kaundal A, Ghosh P. Intravenous iron sucrose versus oral iron in treatment of iron deficiency anemia in pregnancy: a randomized clinical trial. J Obstet Gynaecol Res 2012; 39:504-10. [PMID: 22925176 DOI: 10.1111/j.1447-0756.2012.01982.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Iron deficiency is a leading cause of anemia in pregnancy. The present study aimed to compare the efficacy of oral and intravenous iron therapy in improving iron deficiency anemia in pregnancy and restoring iron stores, compare the obstetric outcome in the two groups and evaluate the safety of intravenous iron sucrose. MATERIAL AND METHODS This was a prospective study, where 100 anemic antenatal women with hemoglobin 7-9 g/dL, mean corpuscular volume <85 fL and serum ferritin <15 ng/mL, were randomized into two groups. In group A (n=50), the women received 200 mg tablets of ferrous sulphate, each containing 60 mg elemental iron, three times a day for 4 weeks. In group B (n=50), iron sucrose was given in divided doses of 200 mg each on alternate days by slow intravenous infusion. Primary outcome measure was treatment efficacy, assessed by measurement of hemoglobin, red blood cell indices and reticulocytes on days 7, 14, 21, and 30 and at delivery, and of ferritin on day 30 and at delivery. Any side-effects of treatment and the neonatal outcome were studied as secondary outcome measures. RESULTS There was a statistically significant difference in increase of hemoglobin levels (3.1g/dL in group A vs 5.1 g/dL in group B; P=0.002) and ferritin levels between the two groups on day 30 (P=0.005). The adverse effects from iron treatment were mild but more prominent in group A. Neonatal outcome was comparable in the two groups. CONCLUSION Intravenous administration of iron sucrose is a safe treatment for correction of anemia in pregnancy, without serious side-effects.
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Affiliation(s)
- Puneet Kaur Kochhar
- Department of Obstetrics and Gynaecology, Lady Harding Medical College and Smt. Sucheta Kriplani Hospital, New Delhi, India.
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Dewan B, Philipose N, Balasubramanian A. Assessment of intravenous iron sucrose in the management of anemia in gynecological and obstetrical practice. J Obstet Gynaecol India 2012; 62:281-5. [PMID: 23730030 DOI: 10.1007/s13224-012-0216-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Accepted: 05/29/2012] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE The present study was undertaken to assess the impact of intravenous iron sucrose (Feronia IV) in the treatment of iron deficiency anemia observed in gynecological and obstetrical practice. METHODS Seventy-seven practicing gynecologists and obstetricians throughout India collaborated in the recruitment of 145 women over a period of 1 year, of which 143 were analyzable cases. RESULTS The overall mean rise in hemoglobin level was observed to be 2.43 gm % at the end of 4 weeks. The dose of iron sucrose administered ranged from 100 to 1,050 mg. In women who received 200 mg of the drug, and the mean Hb rise was found to be 2.21 ± 1.06 gm %. The highest observable rise in hemoglobin level was 5.5 gm % with 800 mg of iron sucrose. No serious adverse reactions were reported during the observation period. CONCLUSION Intravenous Iron sucrose is a safe and effective treatment for the rapid reversal of iron deficiency anemia, in obstetric and gynecological settings.
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Affiliation(s)
- Bhupesh Dewan
- Zuventus Healthcare Ltd, 5119 'D' Wing, Oberoi Garden Estate, Chandivilli, Mumbai 400 072 India
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Pavord S, Myers B, Robinson S, Allard S, Strong J, Oppenheimer C. UK guidelines on the management of iron deficiency in pregnancy. Br J Haematol 2012; 156:588-600. [PMID: 22512001 DOI: 10.1111/j.1365-2141.2011.09012.x] [Citation(s) in RCA: 269] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Iron deficiency is the most common deficiency state in the world, affecting more than 2 billion people globally. Although it is particularly prevalent in less-developed countries, it remains a significant problem in the developed world, even where other forms of malnutrition have already been almost eliminated. Effective management is needed to prevent adverse maternal and pregnancy outcomes, including the need for red cell transfusion. The objective of this guideline is to provide healthcare professionals with clear and simple recommendations for the diagnosis, treatment and prevention of iron deficiency in pregnancy and the postpartum period. This is the first such guideline in the UK and may be applicable to other developed countries. Public health measures, such as helminth control and iron fortification of foods, which can be important to developing countries, are not considered here. The guidance may not be appropriate to all patients and individual patient circumstances may dictate an alternative approach.
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Toblli J, Cao G, Oliveri L, Angerosa M. Effects of iron deficiency anemia and its treatment with iron polymaltose complex in pregnant rats, their fetuses and placentas: Oxidative stress markers and pregnancy outcome. Placenta 2012; 33:81-7. [DOI: 10.1016/j.placenta.2011.11.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Revised: 11/08/2011] [Accepted: 11/19/2011] [Indexed: 01/18/2023]
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Efficacy of Intravenous Administration of Iron Sucrose for Treatment of Iron Deficiency Anaemia in Patients With Abnormal Uterine Bleeding. ACTA FACULTATIS MEDICAE NAISSENSIS 2012. [DOI: 10.2478/v10283-012-0009-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Crary SE, Hall K, Buchanan GR. Intravenous iron sucrose for children with iron deficiency failing to respond to oral iron therapy. Pediatr Blood Cancer 2011; 56:615-9. [PMID: 21298748 PMCID: PMC3079959 DOI: 10.1002/pbc.22930] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Accepted: 11/03/2010] [Indexed: 02/03/2023]
Abstract
BACKGROUND For decades, parenteral iron has been used in patients with iron deficiency unresponsive to oral iron therapy and in hemodialysis-dependent patients receiving erythropoietin. Newer intravenous (IV) iron formulations such as iron sucrose have replaced high-molecular weight iron (HMW) dextran in dialysis patients; however, the use of parenteral iron in children without renal disease has not been well defined. PROCEDURE Pharmacy records were reviewed on children (≤ 18 years of age) who received IV iron sucrose at Children's Medical Center Dallas between January 1, 2004 and June 30, 2009. Patients who received iron sucrose for chronic renal disease were excluded from analysis. RESULTS Thirty-eight children received iron sucrose for non-renal indications, 13 with iron deficiency refractory to oral iron therapy, 13 with iron malabsorption or dependence on parenteral nutrition, 7 for chronic gastrointestinal blood loss, and 5 for miscellaneous indications. Among these 38 children, who received a total of 510 doses of IV iron sucrose, there were only six adverse reactions. Patients in all categories had a good response to the iron sucrose, with a median hemoglobin rise of 1.9-3.1 g/dl depending on the indication. CONCLUSIONS Parenteral iron is a safe and effective means to treat iron deficiency in children who cannot receive or do not respond to oral iron due to intolerance, poor adherence, or iron malabsorption.
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Affiliation(s)
- Shelley E. Crary
- Department of Pediatrics, The University of Texas Southwestern Medical Center at Dallas, Dallas, TX,Center for Cancer and Blood Disorders, Children's Medical Center, Dallas, TX
| | - Katherine Hall
- Department of Pediatrics, The University of Texas Southwestern Medical Center at Dallas, Dallas, TX,Center for Cancer and Blood Disorders, Children's Medical Center, Dallas, TX
| | - George R. Buchanan
- Department of Pediatrics, The University of Texas Southwestern Medical Center at Dallas, Dallas, TX,Center for Cancer and Blood Disorders, Children's Medical Center, Dallas, TX
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Breymann C, Bian XM, Blanco-Capito LR, Chong C, Mahmud G, Rehman R. Expert recommendations for the diagnosis and treatment of iron-deficiency anemia during pregnancy and the postpartum period in the Asia-Pacific region. J Perinat Med 2011; 39:113-21. [PMID: 21070128 DOI: 10.1515/jpm.2010.132] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Anemia during pregnancy and the postpartum period is commonly caused by iron deficiency and is a significant worldwide issue with severe consequences for both mother and developing fetus. From a worldwide perspective, iron-deficiency anemia (IDA) during pregnancy is highest in the Asia-Pacific region; however, there has been little guidance in this region for safe and effective treatment. An expert panel was convened to develop a concise and informative set of recommendations for the treatment of IDA in pregnant and postpartum women in the Asia-Pacific region. This manuscript provides these recommendations and aims to reduce the morbidity and mortality associated with IDA in pregnant and postpartum women in the Asia-Pacific region. The consensus recommendations define anemia as a hemoglobin (Hb) level <10.5 g/dL during pregnancy and <10 g/dL during the postpartum period, and provide cut-off Hb levels to initiate therapy with oral iron, intravenous iron or red blood cell transfusion.
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Affiliation(s)
- Christian Breymann
- Feto-maternal Hematology Unit, University Hospital, Zurich, Switzerland.
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Madrazo González Z, García Barrasa A, Rafecas Renau A. Anemia, hierro, transfusión y alternativas terapéuticas. Revisión desde una perspectiva quirúrgica. Cir Esp 2010; 88:358-68. [DOI: 10.1016/j.ciresp.2010.03.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2009] [Revised: 11/27/2009] [Accepted: 03/12/2010] [Indexed: 12/31/2022]
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Asma S, Boga C, Ozdogu H. Safety, therapeutic effectiveness, and cost of parenteral iron therapy. Int J Hematol 2009; 90:24-27. [PMID: 19495930 DOI: 10.1007/s12185-009-0352-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2008] [Revised: 05/13/2009] [Accepted: 05/14/2009] [Indexed: 11/29/2022]
Abstract
Patients have to discontinue the use of oral iron therapy due to the development of side effects and lack of long-term adherence to medication for iron deficiency anemia. This study aimed to evaluate the therapeutic effectiveness, safety, and cost of intravenous iron sucrose therapy. The computerized database and medical records of 453 patients diagnosed with iron deficiency anemia who received intravenous iron sucrose therapy for iron deficiency anemia between 2004 and 2008 were reviewed. The improvement of hematologic parameters and cost of therapy were evaluated 4 weeks after therapy. 453 patients (443 females, 10 males; age: 44.2 +/- 12.3 years) received iron sucrose therapy. Mean hemoglobin, hematocrit, and mean corpuscular volume values were 8.2 +/- 1.4 g/dL, 26.9 +/- 3.8%, and 66.1 +/- 7.8 fL, respectively, before therapy and 11.5 +/- 1.0 g/dL, 35.8 +/- 2.5%, 76.5 +/- 6.1 fL, respectively, after therapy (P < 0.001). A mean ferritin level of 3.4 +/- 2.4 ng/mL before therapy increased to 65.9 +/- 40.6 ng/mL after therapy (P < 0.001). All patients responded to intravenous iron therapy (transferrin saturation values of the patients were >50%). The mean cost of therapy was 143.07 +/- 29.13 US dollars. The therapy was well tolerated. Although the cost of intravenous iron sucrose therapy may seem high, a lack of adherence to therapy and side effects including gastrointestinal irritation during oral iron therapy were not experienced during intravenous therapy.
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Affiliation(s)
- Suheyl Asma
- Department of Family Medicine, Baskent University Adana Research and Training Hospital, Adana, Turkey.
| | - Can Boga
- Department of Hematology, Baskent University Adana Research and Training Hospital, Adana, Turkey
| | - Hakan Ozdogu
- Department of Hematology, Baskent University Adana Research and Training Hospital, Adana, Turkey
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Synthesis and characterization of glucosyl-curcuminoids as Fe3+ suppliers in the treatment of iron deficiency. Biometals 2009; 22:701-10. [DOI: 10.1007/s10534-009-9213-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2008] [Accepted: 01/22/2009] [Indexed: 10/21/2022]
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Synthesis, chemical and biological studies on new Fe3+-glycosilated β-diketo complexes for the treatment of iron deficiency. Eur J Med Chem 2008; 43:2549-56. [DOI: 10.1016/j.ejmech.2008.02.045] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2007] [Revised: 02/25/2008] [Accepted: 02/29/2008] [Indexed: 12/13/2022]
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Breymann C, von Seefried B, Stahel M, Geisser P, Canclini C. Milk iron content in breast-feeding mothers after administration of intravenous iron sucrose complex. J Perinat Med 2007; 35:115-8. [PMID: 17302514 DOI: 10.1515/jpm.2007.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To study the transfer of parenteral iron sucrose into maternal milk in the postpartum period. STUDY DESIGN Ten healthy lactating mothers with functional iron deficiency 2-3 days after delivery received 100 mg intravenous iron sucrose and were observed together with a control group (n=5) without iron treatment during four days. Milk samples were taken before the treatment and every day afterwards. RESULTS Mean milk iron levels at baseline were 0.43 and 0.46 mg/kg in the treatment and control group and decreased until the end of observation in both groups by 0.11 mg/kg. No significant difference between the groups was found on any study day as well as in the mean change from baseline over all four days. CONCLUSION We could not show transfer of iron-sucrose into maternal milk for the given dosage. Since parenteral iron sucrose is widely used in obstetrics, the results provide information about safety of parenteral iron sucrose in the lactation period. The findings are also in agreement with other reports on active biological mammary gland regulation of milk iron concentration.
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Affiliation(s)
- Christian Breymann
- Department of Obstetrics and Gynecology, Unit of Obstetrics, University of Zurich, Switzerland.
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Bhandal N, Russell R. Author response to: Intravenous versus oral iron therapy for postpartum anaemia. BJOG 2007. [DOI: 10.1111/j.1471-0528.2007.01318.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
OBJECTIVE Postpartum iron deficiency anaemia (IDA) is common in women. Most women are treated with either oral iron supplementation or blood transfusion. Hence, the aim of our study was to compare the effect of treatment with either oral ferrous sulphate or intravenous ferrous sucrose on postpartum IDA. DESIGN A single centre, prospective randomised controlled trial. SETTING Women's Centre, John Radcliffe Hospital, Oxford, UK. POPULATION Forty-four women with haemoglobin (Hb) of <9 g/dl and ferritin of <15 microgram/l at 24-48 hours postdelivery. METHODS Women were randomised to receive either oral ferrous sulphate 200 mg twice daily for 6 weeks (group O) or intravenous ferrous sucrose 200 mg (Venofer; Vifor International Ltd, St Gallen, Switzerland), two doses given on days 2 and 4 following recruitment (group I). RESULTS were analysed by the Students t-test, chi-square test and analysis of variance. MAIN OUTCOME MEASURES Hb, haematocrit, red cell indices, ferritin and serum iron levels were measured on days 0, 5, 14 and 40. Results By day 5, the Hb level in women treated with intravenous iron had risen from 7.3 +/- 0.9 to 9.9 +/- 0.7 g/dl, while there was no change in those treated with oral iron. Women treated with intravenous iron had significantly higher Hb levels on days 5 and 14 (P < 0.01) than those treated with oral iron; although by day 40, there was no significant difference between the two groups. Throughout the study, ferritin levels rose rapidly in those treated with intravenous iron and remained significantly higher than in those treated with oral iron (P < 0.01). CONCLUSIONS Intravenous iron sucrose increases the Hb level more rapidly than oral ferrous sulphate in women with postpartum IDA. It also appears to replenish iron stores more rapidly. However, this study was not large enough to address the safety of this strategy.
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Affiliation(s)
- N Bhandal
- Department of Anaesthesia, Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford, UK.
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Iron deficiency and anaemia in pregnancy: Modern aspects of diagnosis and therapy. Eur J Obstet Gynecol Reprod Biol 2005. [DOI: 10.1016/s0301-2115(05)80401-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Cuciti C, Mayer DC, Arnette R, Spielman FJ. Anaphylactoid reaction to intravenous sodium ferric gluconate complex during pregnancy. Int J Obstet Anesth 2005; 14:362-4. [PMID: 16140521 DOI: 10.1016/j.ijoa.2005.05.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2005] [Revised: 04/27/2005] [Accepted: 05/05/2005] [Indexed: 11/28/2022]
Abstract
We report the first case of a severe anaphylactic or anaphylactoid reaction to sodium ferric gluconate complex in a pregnant patient. Sodium ferric gluconate complex is felt to be one of the safest forms of iron therapy during pregnancy. This case highlights the need for extreme caution and vigilance in pregnant patients receiving any type of parenteral iron therapy.
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Affiliation(s)
- C Cuciti
- Department of Anesthesiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
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Kumar A, Jain S, Singh NP, Singh T. Oral versus high dose parenteral iron supplementation in pregnancy. Int J Gynaecol Obstet 2005; 89:7-13. [PMID: 15777891 DOI: 10.1016/j.ijgo.2005.01.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2004] [Revised: 01/03/2005] [Accepted: 01/05/2005] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To compare the effect of daily oral iron supplementation with two injections of high dose parenteral iron. METHOD A total of 220 pregnant women with a singleton pregnancy and hemoglobin between 8 to 11 g% at 16-24 weeks gestation were identified and randomly divided into two groups. Group A was started on daily oral iron therapy of 100 mg of elemental iron. Group B was given 250 mg of iron sorbitol intramuscularly and repeated at an interval of 4-6 weeks. Blood indices were evaluated at the beginning of study and at 36 weeks to see the effect after iron supplementation in the two groups. The data were analyzed using SPSS software, version 10.1. RESULTS Definitive and comparable improvement in hemoglobin and all the blood indices (hematocrit, MCH, MCHC, MCV, Serum iron and TIBC) was observed. The absolute change in hemoglobin and hematocrit was 1.18+/-0.68 g% and 4.02+/-2.59% in oral group, 1.34+/-0.77 g% and 4.93+/-3.65% in parenteral group, respectively. Serum ferritin showed statistically significant absolute rise (10.43+/-7.92 microg/dl) after parenteral iron supplementation as compared to oral iron supplementation (9.76+/-4.78 microg/dl). Obstetric outcome was comparable in two groups. CONCLUSION Two treatment regimens are biologically equivalent in terms of hematological response. Two high doses of intramuscular iron can be a good substitute to meet iron requirement in pregnancy.
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Affiliation(s)
- A Kumar
- Department of Obstetrics and Gynecology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi 110002, India.
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Krafft A, Hess T. Response to: Lavey, RS et al. Recombinant human erythropoietin as an adjunct to radiation therapy and cisplatin for stage IB-IVA carcinoma of the cervix: a Southwest Oncology Group Study. Gynecol. Oncol. 95 (2004) 145-151. Gynecol Oncol 2005; 97:980. [PMID: 15944000 DOI: 10.1016/j.ygyno.2005.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2004] [Revised: 12/08/2004] [Accepted: 01/25/2005] [Indexed: 10/25/2022]
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Komolafe JO, Kuti O, Ijadunola KT, Ogunniyi SO. A comparative study between intramuscular iron dextran and oral ferrous sulphate in the treatment of iron deficiency anaemia in pregnancy. J OBSTET GYNAECOL 2004; 23:628-31. [PMID: 14617464 DOI: 10.1080/01443610310001604394] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A comparative study was conducted to demonstrate the difference, if any, in effectiveness of treatment of iron deficiency anaemia in pregnancy with either iron dextran or ferrous sulphate. Sixty pregnant women with iron deficiency anaemia were assigned randomly to either group and treated for 6 weeks. The age and parity distributions with mean packed cell volumes (PCVs) and gestational age at onset of treatment in the two groups were comparable. Comparing the mean PCVs at week 2, week 4 and week 6 of treatment the iron dextran group recorded higher and statistically significant mean PCVs (P<0.001). Thirty-six per cent of patients in the iron dextran group compared to 3.3% in the oral iron group (P=0.004) had their anaemia corrected by the sixth week. No significant side effects accompanied the use of intramuscular iron dextran. It was concluded that iron dextran corrects iron deficiency anaemia faster than ferrous sulphate. Parenteral iron should be considered in pregnant woman with moderate and asymptomatic severe anaemia between gestation ages of 28 weeks and 34 weeks; this may reduce the frequency of blood transfusion both in the antenatal and postnatal periods in these patients.
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Affiliation(s)
- J O Komolafe
- Department of Obstetrics and Gynaecology, Obafemi Awolowo University Teaching Hospitals Complex, Ife-Ife, Nigeria.
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Abstract
BACKGROUND Iron-deficient nonanaemic parturients risk underdiagnosis as a result of the reliance on postpartum ferritin and haemoglobin as markers of iron status. Ferritin is an acute-phase protein whose levels increase during the inflammatory response, as occurs after delivery. Our aims were to evaluate the impact of parturition on iron status, erythropoiesis and the inflammatory response, and identify the optimal parameters and timing for diagnosing iron deficiency in the presence of postpartum inflammation. MATERIALS AND METHODS Conventional parameters of iron status, erythropoiesis and the inflammatory response (serum ferritin, serum iron, transferrin saturation, C-reactive protein) were compared with more recent parameters [soluble transferrin receptors (sTfR), hypochromic red cells, reticulocyte indices] within 48 h either side of delivery in 64 iron-deficient nonanaemic women (defined by a prepartum serum ferritin < or =15 microg L(-1), and a pre- and postpartum haemoglobin of > or =11.0 g dL(-1) and > or =10.0 g dL(-1), respectively). RESULTS Mean sTfR decreased pre to postpartum from 7.3 to 5.8 microg mL(-1) (P<0.01), while mean serum ferritin increased from 9.7 to 16.9 microg L(-1) (P<0.01). Serum ferritin did not correlate with haemoglobin pre or postpartum (r=0.04, P=0.7; r=0.2, P=0.09), but a correlation persisted postpartum between hypochromic red blood cells and haemoglobin (r=-0.26; P<0.05). The percentage of hypochromic red cells remained virtually unchanged pre- and postpartum (4.0% vs. 3.8%; NS). Postpartum mean reticulocyte haemoglobin content (CHr) was 27.1 +/- 1.6 pg. CONCLUSION Iron status should be tested prepartum, in the absence of an inflammatory response, rather than in the early postpartum. A valuable additional parameter, where available, might be the hypochromic red cell percentage, which is virtually uninfluenced by the inflammatory response. Furthermore, hypochromic red cell percentage, CHr and sTfR can be helpful to differentiate between functional iron deficiency and depleted iron stores.
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Affiliation(s)
- A Krafft
- Department of Obstetrics & Gynaecology, Zurich University Hospital, Zurich, Switzerland.
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Besarab A, Yee J. In Reply. Am J Kidney Dis 2003. [DOI: 10.1016/s0272-6386(03)00259-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Breymann C. Iron Deficiency and Anaemia in Pregnancy: Modern Aspects of Diagnosis and Therapy. Blood Cells Mol Dis 2002. [DOI: 10.1006/bcmd.2002.0597] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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