Effect of Total Dose Infusion of Iron-dextran on Iron, Folate, and Vitamin B12 Nutrition in Postpartum Anaemia

The deoxyuridine suppression test

The deoxyuridine suppression (dU) test, first described in 1964, has gained an important place both in the diagnosis of megaloblastic anemias and in the study of vitamin B12 folate interrelationships in the pathogenesis of megaloblastic anemia. The test measures the integrity of the de novo synthetic pathway of DNA synthesis, in which vitamin B12 and folate play an essential role. The exact mechanism of the test is still largely unknown. However, it is probably the most sensitive and specific functional test for the establishment of vitamin B12 and/or folate deficiency. As such, it is an important diagnostic tool in the investigation of patients suspected of suffering from deficiency of either or both of these vitamins. The test may also have applications towards the study of other factors required for the de novo synthesis of DNA.

Treatment of iron deficiency in Nigerians with daily intramuscular Ferastral

Treatment of severe iron deficiency with iron-poly(sorbitol-gluconic acid) complex (Ferastral) intramuscular 10 ml (iron 500 mg) on alternate days has been shown highly effective and well tolerated. In order to see whether the time of treatment could be shortened, 20 Nigerians with severe iron deficiency (mostly from hookworm infection) were treated with daily intramuscular Ferastral 10 ml until their calculated total requirement of iron was met. The total iron deficit was 877-2763 mg (mean 1875 mg). Supportive treatment included antimalarials, folic acid and anthelmintics. No patient complained of undue pain at injection sites or of any other undesirable side-effects. There was no evidence of hepatic or renal toxicity in any patient, including eight who were followed at intervals up to eight weeks from the start of treatment. The initial haemoglobin (Hb) level was 2.2-7.8 g/dl (mean 4.6 g/dl). Daily regeneration of Hb in the first 14 days was 0.12-0.49 g/dl (mean 0.30 g/dl), and haematological indices were generally normal by eight weeks. Recovery was slow or incomplete in six patients, all of whom had complications other than iron deficiency. Serum iron was measured in five patients, rose to around 8000 micrograms/dl on about day 4, and fell to physiological levels by day 14. The serum unsaturated iron binding capacity fell to nil in five out of six patients on around day 3, and reappeared between days 7 and 10. Five patients who had persistent blood loss from continued hookworm infestation received a further single dose of Ferastral (iron 1000 mg) 10 ml into each buttock after four weeks, and one patient after two weeks. This large dose was also acceptable to patients if given slowly; it was followed by an accelerated Hb regeneration, but no toxicity. Daily intramuscular Ferastral 10 ml until the calculated iron requirements are met (usually in less than five days) is recommended for the treatment of severe iron deficiency. Patients with continued blood loss or Hb less than 10 g/dl after four weeks without other cause of anaemia, may receive a boost of one intramuscular injection of Ferastral 20 ml (10 ml into each buttock).

Systemic reactions with total dose infusion of iron dextran complex in obstetric patients

Iron dextran complex (Imferon) total dose infusion (TDI) was used to treat iron deficiency anemia in 310 obstetric patients. Systemic reactions were reported for 13.5% of the group. Most (90.5%) of the severe reactions occurred during the test dose, while 66.6% recorded during or after TDI were mild. Antihistamine premedication included administration of promethazine hydrochloride to 104 patients and intramuscular and intravenous drip chlorpheniramine hydrogen maleate to 206 patients. Total systemic reactions were statistically greater with intramuscular promethazine hydrochloride than with intramuscular and intravenous chlorpheniramine maleate (p less than 0.001). On the other hand, the rates of severe reactions and reactions during the test dose were similar for both antihistamine schedules (p greater than 0.05). The incidence of all systemic reactions was the same for pregnant and postnatal women (p greater than 0.05), but severe reactions were more frequent among pregnant than postnatal patients (p less than 0.001). There were no fatalities.

Iron, folate, and vitamin B 12 nutrition in pregnancy: a study of 1000 women from southern India

As part of a WHO collaborative programme the prevalence of anaemia was studied and the serum concentrations of iron, folate, and vitamin B(12) were measured in 1 000 pregnant women from southern India. The results of the study show a high prevalence of anaemia, resulting from iron and folate deficiency with iron deficiency predominating. Interrelationships between these nutrients and their effect on pregnancy and the fetus were investigated. The results indicate that, in comparison with populations in developed countries, there was a high prevalence of iron and vitamin B(12) deficiency in the community, but the state of folate nutrition was similar to that found elsewhere.