Role of preoperative erythropoietin in the optimization of preoperative anemia among surgical patients — A systematic review and meta-analysis

Abstract Preoperative anemia is a common finding. Preoperative allogeneic transfusion, iron therapy, vitamin supplementation and erythropoietin therapy are the current management strategies for preoperative anemia. Previous reviews regarding erythropoietin were limited to specialties, provided little evidence regarding the benefits and risks of erythropoietin in managing preoperative anemia and included non-anemic patients. The purpose of our systematic review was to determine the role of erythropoietin solely in preoperatively anemic patients and to investigate the complications of this treatment modality to produce a guideline for preoperative management of anemic patients for all surgical specialties. The PubMed/Medline, Google Scholar, and Cochrane Library were searched for randomized trials evaluating the efficacy of erythropoietin in preoperative anemia. The risk ratio (RR) and standardized mean difference (SMD) was used to pool the estimates of categorical and continuous outcomes, respectively. Allogeneic transfusion and complications and the 90-day mortality were the primary outcomes, while the postoperative change in hemoglobin, bleeding in milliliters and the number of red blood cell (RBC) packs transfused were the secondary outcomes. Results: Eight studies were included, comprising 734 and 716 patients in the erythropoietin group and non-erythropoietin group, respectively. The pooled estimate by RR for allogeneic transfusion was 0.829 (p = 0.049), while complications and the 90-day mortality were among the 1,318 (p = 0.18) patients. Conclusion: Preoperative erythropoietin provides better outcomes, considering the optimization of preoperative anemia for elective surgical procedures. The benefits of erythropoietin are significantly higher, compared to the control group, while the risks remain equivocal in both groups. We recommend preoperative erythropoietin in anemic patients.

Anaemia in pregnancy: prevalence and treatment response to various modalities: a prospective study

Background: Anaemia seen in pregnancy are largely preventable and easily treatable if detected in time, despite this, anaemia still continues to be a common cause of maternal and perinatal morbidity and mortality in India.Methods: A prospective observational study of 200 pregnant women with anaemia was carried out from Jun 2017 to December 2018 at a Tertiary care hospital with pan India population. Patients underwent clinical examination and laboratory tests to find out the severity and type of anaemia and were treated accordingly. Iron deficiency anaemia was treated with oral or intravenous iron therapy depending upon the hemoglobin concentration. Patients were followed up after 28 days of treatment and hemoglobin estimation was done to monitor the treatment response.Results: A total 36.49% pregnant women had hemoglobin less than 10 gm%. 151 out of 200 women had serum ferritin <12 ng/ml which indicates that iron deficiency anaemia is the commonest type of anaemia in pregnancy. Overall, out of 200 patients 5.5% patients were found to have hemoglobinopathies (β thalassemia trait). After 28 days of treatment mean increase in hemoglobin was 2.40 gm% and 4.24 gm% in patients receiving oral and intravenous iron therapy respectively.Conclusions: A total 36.49% pregnant women were found to have anaemia during pregnancy and iron deficiency anaemia is the commonest type of anaemia. Therefore, there is still a need for dietary counselling and health education in the community. 5.5% patients were found to have beta thalassemia trait which was detected only after conducting hemoglobin electrophoresis. Both oral and intravenous iron therapy are effective in treatment of iron deficiency anaemia but intravenous iron therapy results in a more rapid resolution of anaemia.

A comparative study of ferric carboxymaltose and iron sucrose as a parenteral iron treatment in iron deficiency anaemia during pregnancy

Background: Iron deficiency anemia during pregnancy is a serious global concern specially in developing country, which is preventable with effective measures. In women who cannot tolerate oral iron or have moderate to severe anemia, parenteral iron in the form of iron sucrose or ferric carboxymaltose can be very much useful. This study aimed to compare efficacy and safety of iron sucrose and ferric carboxymaltose in iron deficiency anemia during pregnancy.Methods: This prospective interventional comparative study was conducted during May 2016 to April 2018 at tertiary care hospital and total 100 antenatal women from 28 to 34 weeks of gestation having moderate to severe anemia were included in this study and all women were divided in to 2 groups randomly and were given either iron sucrose or ferric carboxymaltose according to iron requirement. Rise in haemoglobin and serum ferritin were noted and data analysed statistically.Results: The mean rise of haemoglobin with iron sucrose was 1.8 gm% and with ferric carboxymaltose was 2.6 gm%. The mean rise of serum ferritin with iron sucrose was 82.4 ng/ml and with ferric carboxymaltose was 100.9 ng/ml. Other than minimal local reaction one woman had developed severe anaphylactic reaction after receiving iron sucrose.Conclusions: Intravenous ferric carboxymaltose is better and safe molecule than iron sucrose and it has advantage of ability to administer large dose in single sitting which reduce overall cost of therapy.  Hence ferric carboxymaltose is a drug of choice as parenteral iron therapy in iron deficiency anemia during second trimester of pregnancy.

Clinical profile of hypochromic microcytic anemia in Chittoor district, India

Background: Anemia is not a diagnosis by itself like fever but merely is an objective sign of the presence of disease. The correct diagnostic terminology for a child with anemia requires the detection of etiology, pathology, and pathogenesis of the anemia. To evaluate the role of therapeutic oral iron therapy as a diagnostic approach to hypochromic microcytic anemia.Methods: The present study is a retrospective study conducted at the teaching hospital, Chittoor district from September 2019 to December 2019. A total number of 350 cases of anemia were studied from both inpatient and outpatient services in the age group 2 months to 12 years. Hemogram, Hb Electrophoresis, and bone marrow study as necessary based on individual cases.Results: From the above analysis, the mean Hb% at the time of entry to study was 7.36gms%. The mean Hb% after the iron therapy was 11.8gms%. The mean increase in Hb was 4.4gms%. In this study, the average RBC count was 2.9 million cells/cumm.Conclusions: A therapeutic trial of oral iron is an appropriate initial step in the diagnostic approach of hypochromic microcytic anemia. Costly investigations like Hb electrophoresis and bone marrow study are required only in selected cases.

El tratamiento de la anemia por deficiencia de hierro durante el embarazo y el puerperio

Anemia, the most common hematological abnormality in the world, is a reduction in concentration of erythrocytes or hemoglobin in blood. The most frequent cause of anemia in pregnancy is nutritional-derived iron deficiency, and in the puerperium, acute blood loss. Iron requirements increase during pregnancy, and failure to maintain iron levels may lead to serious and adverse consequences for both the mother and the developing fetus and newborn. From a global perspective, anemia during pregnancy is more frequent and severe in countries with poor social and economic development. Consensus recommendations define anemia as hemoglobin level (Hb) <10.5 g / dL during pregnancy and <10 g / dL during the postpartum period, cut-off values to initiate therapy with oral iron, intravenous iron or red blood cell transfusion. This paper attempts to compile recommendations for a safe and effective treatment in order to reduce the morbidity and mortality associated with nutritional-derived iron deficiency in pregnant women and / or acute blood loss in the postpartum.

La anemia, la anormalidad hematológica más común en el mundo, es una reducción en la concentración de eritrocitos o hemoglobina en la sangre. La principal causa de anemia en el embarazo es la deficiencia de hierro de causa nutricional (ADHN), mientras que en el puerperio es la pérdida aguda de sangre (PAS). Los requerimientos de hierro aumentan durante el embarazo, y el hecho de no mantener niveles suficientes de hierro puede tener consecuencias adversas y graves tanto para la madre como para el feto en desarrollo y el recién nacido. Desde una perspectiva mundial, la anemia durante el embarazo es más frecuente y severa en países con pobre desarrollo social y económico. Las recomendaciones de consenso definen la anemia como un nivel de hemoglobina (Hb) <10,5 g / dL durante el embarazo y <10 g / dL durante el período posparto como líneas de corte para iniciar la terapia con hierro oral, hierro intravenoso o transfusión de glóbulos rojos. En el presente artículo se intenta recopilar las recomendaciones para un tratamiento seguro y efectivo, de manera de reducir la morbilidad y mortalidad asociadas con la ADHN en la gestación y/o la PAS en el posparto.

Compare the safety and efficacy of intravenous iron supplementation with iron sucrose to the oral supplementation with ferrous ascorbate in subjects with post-partum anemia

Background: The post-partum period is challenging enough for most new mothers. Recovering from birth, learning to parent, and taking care of her child requires lot of energy. Having anemia in postpartum period can make this process much more difficult. According to WHO, in India incidence of anemia in postnatal mother is around 58% and according to ICMR prevalence of anemia in Tamil Nadu population 76% during pregnancy. The objective of this study was to compare the efficacy of intravenous iron supplementation with Iron sucrose to the oral supplementation with ferrous ascorbate in management of patient with post-partum anemia. To study the safety and side effects of these two preparations.Methods: This was a prospective study conducted on 100 post-partum anemic women in KG Hospital  in Coimbatore, October 2012 to November 2013 with hemoglobin less than 10g/dl but more than 6g/dl within 24-48 hours of delivery ,after satisfying inclusion and exclusion criteria were included in the study.Results: Mean hemoglobin of oral group was 8.49±0.75 and mean hemoglobin of IV group was 8.43±0.76; 24 hours after delivery. After treatment, that is after 4 weeks mean hemoglobin of oral group was 10.38±0.79 and mean hemoglobin of IV group was 11.20±0.71.on comparing both groups, the increase in hemoglobin in the IV groups was significant. Reticulocyte count and other parameters increased significantly after four wks of starting therapy in IV group compare to the oral group. No major side effects or anaphylactic reactions were noted during study period.Conclusions: Intravenous iron sucrose complex is safe, convenient and effective in postpartum anemic women as compared with the oral ferrous ascorbate. Intravenous iron sucrose have shorter treatment periods, increased likelihood of compliance, a lack of gastrointestinal side effects, and rapid replenishment of iron stores, making them superior to oral ferrous ascorbate.

A study on management of maternal anemia with infusion of intravenous iron sucrose and its outcome in management of anemia

Background: In India, women become pregnant with low baseline hemoglobin level resulting in high incidence of moderate to severe anemia in pregnancy where oral iron therapy cannot meet the requirement. Pregnant women with moderate anemia are to be treated with parenteral iron therapy. The aim of the study is to the infusion of intravenous iron sucrose and its outcome in the management of anemia.Methods: Totally 100 pregnant females were included in the study. The study period was from January 2018-July 2018 at vanavil medical center in Chennai. 50 Patients of Group A was given oral iron tablets containing100mg of elemental iron. 50 patients of Group B was given a total of 1000 mg of intravenous iron sucrose divided into five doses of 200 mg each at weekly intervals. Estimation of hemoglobin was started 4 weeks after commencement of iron therapy and then repeated every 4 weeks till 36 weeks of gestation, pre-delivery and postpartum.Results: Target hemoglobin levels were achieved in 4 weeks’ time in 19 (76%) patients in the iron sucrose group as compared to 08 (32%) of patients in the oral iron group. There was a significant improvement in the various hematological parameters in iv sucrose group as compared to patients in the oral iron group. There were no significant allergic reactions in iv sucrose group.Conclusions: Our results showed that intravenous iron sucrose therapy was effective to treat moderate anemia in pregnant women. Intramuscular preparations are known to be associated with local side-effects. Iron sucrose complex iv therapy was with negligible side effects. It caused a rapid rise in hemoglobin level and the replacement of stores was faster. Long term comparative studies are required to assess if they can be used at a peripheral level.

Outcomes of patients with left ventricular ejection fraction preserved heart failure and iron deficiency treated with intravenous iron / 实用医学杂志

Objective The aim of this study was to evaluate the benefits of i.v. iron therapy in iron-defi-cient patients with left ventricular ejection fraction preserved heart failure (HFpEF). Methods 61 HFpEF pa-tients with iron deficiency were randomized to treatment with or without i.v. iron,as ferric carboxymaltose(FCM, n = 31)or placebo(saline,n = 29)for 24 weeks of a double-blind,placebo-controlled trial. The primary end-point was the change in 6-min-walk-test(6MWT)distance from baseline to Week 24. Secondary end-points includ-ed changes in New York Heart Association(NYHA)class,health-related quality of life(QoL),with NT-proBNP under observation. Results Compared with the control group at week 16 and 24,the iron treatment group has much more improve in 6MWT and the health-related quality of life(HRQoL)(P0.05). Conclusion In this study,Treatment with intravenous ferric carboxymaltose can improve symptoms, functional capacity,and quality of life.

Deficiencia de hierro e insuficiencia cardíaca / Iron deficiency and heart failure / Deficiência de ferro e insuficiência cardíaca

El hierro es un micronutriente esencial para la energía celular y el metabolismo, necesario para el mantenimiento de la homeostasis del cuerpo. La deficiencia de hierro (DH) es una importante comorbilidad en pacientes con insuficiencia cardíaca (IC). No sólo es un factor importante en la patogénesis de la anemia, sino que también provoca graves consecuencias clínicas y de mal pronóstico en pacientes con IC. La DH afecta a más del 50% de los pacientes con IC, siendo particularmente común en ancianos y pacientes con ciertas enfermedades crónicas. La prevalencia del déficit de hierro es mayor en las etapas más avanzadas de la IC, en mujeres, en pacientes con valores elevados de marcadores inflamatorios (por ej.: la proteína C reactiva), así como con incremento del NT-proBNP. Pero aun en los pacientes de bajo riesgo tales como los CF I-II (NYHA) la prevalencia se mantiene por encima del 30%. La DH se asocia a una mala calidad de vida, deterioro de la tolerancia al ejercicio y mayor tasa de mortalidad, independiente de los efectos hematopoyéticos. Las Guías internacionales recomiendan detectar precozmente la DH en pacientes con sospecha de IC. Los datos indican que la DH tiene efectos perjudiciales en pacientes con enfermedad arterial coronaria, IC e hipertensión pulmonar, como así también en pacientes sometidos a cirugía cardíaca. La absorción intestinal de hierro, administrada por vía oral es pobre y hasta el 60% de los pacientes experimentan efectos secundarios gastrointestinales. Estos problemas pueden agravarse en la IC debido a la disminución de la absorción gastrointestinal y la escasa adherencia de estos pacientes debido a la polimedicación que reciben. La evidencia clínica de los beneficios del hierro vía oral es insuficiente. La administración de hierro por vía intravenosa (IV) ha demostrado que mejora la capacidad de ejercicio, la función cardíaca, la gravedad de los síntomas y la calidad de vida. Existe evidencia que sugiere que estas mejoras se producen independientemente de la presencia de anemia. Se observaron resultados similares en pacientes con IC sistólica y alteración de la fracción de eyección en los estudios FAIR-HF y CONFIRM-HF (doble ciego, controlado con placebo). La terapia con hierro IV puede ser mejor tolerada que el hierro por vía oral, aunque se espera la confirmación en estudios clínicos más grandes. Son necesarios el diagnóstico rutinario y el tratamiento de la DH en pacientes con IC sintomática, independientemente del estado de la anemia, convirtiéndose en un importante objetivo terapéutico; sin dejar de tener en cuenta que el exceso de hierro puede ser perjudicial en la enfermedad cardiovascular. En esta actualización revisaremos el metabolismo del hierro en el contexto de anemia e IC; como así también, la importancia del diagnóstico precoz y del tratamiento de la DH con hierro IV en pacientes con IC.

Iron is a micronutrient essential for cellular energy and metabolism, necessary for maintaining body homoeostasis. Iron deficiency (ID) is an important co-morbidity in patients with heart failure (HF). A major factor in the pathogenesis of anaemia, it is also a separate condition with serious clinical consequences (e.g. impaired exercise capacity) and poor prognosis in HF patients. ID affects up to 50% of HF patients, being particularly common in the elderly and patients with certain chronic diseases. The prevalence of iron deficiency is higher in the more advanced stages of HF, in women, in patients with elevated levels of inflammatory markers (e.g. C-reactive protein) as well as increased NT-proBNP. But even in low-risk patients such as NYHA I-II the prevalence remains at over 30%. ID is associated with a poor quality of life, impaired exercise tolerance, and mortality independent of haematopoietic effects in this patient population. International Guidelines recommend a diagnostic work-up for iron deficiency in patients with suspected HF. Data indicate that ID has detrimental effects in patients with coronary artery disease, HF, and pulmonary hypertension, and possibly in patients undergoing cardiac surgery. Iron absorption from oral iron preparations is generally poor, with slow and often inefficient iron repletion; moreover, up to 60% of patients experience gastrointestinal side effects. These problems may be exacerbated in HF due to decreased gastrointestinal absorption and poor compliance due to pill burden. Evidence for clinical benefits using oral iron is lacking. Intravenous (IV) iron administration has been shown to improve exercise capacity, symptom severity, and quality of life. Evidence suggests that these improvements occur independently of the presence of anemia. Similar findings were observed in patients with systolic HF and impaired ejection fraction in the double-blind, placebo-controlled FAIR-HF and CONFIRM-HF trials. IV iron therapy may be better tolerated than oral iron, although confirmation in longer clinical trials is awaited. Routine diagnosis and management of ID in patients with symptomatic HF regardless of anaemia status is advisable, and, based on current evidence, prompt intervention using IV iron therapy should now be considered, while still having into account that excess iron can be detrimental in cardiovascular disease. This update will review the iron metabolism in the context of anemia and HF; as well as the importance of early diagnosis and treatment of ID with IV iron in patients with HF.

O ferro é um micronutriente essencial para energia celular e metabolismo, necessário para a manutenção da homeostase do organismo. A deficiência de ferro (DH) é uma comorbidade importante em pacientes com insuficiência cardíaca (IC). Não é apenas um fator importante na patogênese da anemia, também provoca consequências clínicas graves e de prognóstico reservado em pacientes com IC. A DH afeta mais de 50% dos pacientes com IC, ela é particularmente comum em idosos e pacientes com determinadas doenças crônicas. A prevalência de deficiência de ferro é maior nos estágios mais avançados da IC, nas mulheres, em pacientes com níveis elevados de marcadores inflamatórios (Ex: proteína C reativa), bem como o aumento de NT-proBNP. Mas mesmo em pacientes de baixo risco tais como CF I-II (NYHA) a prevalência permanece acima de 30%. A DH está associada a uma qualidade de vida pobre, diminuição da tolerância ao exercício e maior taxa de mortalidade, independente dos efeitos hematopoiéticos. Diretrizes internacionais recomendam a detecção precoce da DH em pacientes com IC suspeita. Os dados indicam que a DH tem efeitos nocivos em pacientes com doença arterial coronariana, IC e hipertensão pulmonar, bem como em pacientes submetidos à cirurgia cardíaca. A absorção intestinal de ferro, administrado por via oral é pobre e até 60% dos doentes experimentam efeitos secundários gastrointestinais. Estes problemas podem ser agravados no IC devido à diminuição da absorção gastrointestinal e adesão pobre dos pacientes, porque eles recebem polifarmácia. A evidência clínica de os benefícios de ferro oral é insuficiente. A administração de ferro intravenoso (IV) tem demonstrado melhorar a capacidade de exercício, a função cardíaca, a severidade dos sintomas e qualidade de vida. As evidências sugerem que estas melhorias produzam independentemente da presença de anemia. Resultados similares foram observados em pacientes com IC sistólica e fração de ejeção diminuída nos estudos FAIR-HF e CONFIRM-HF (double-blind, placebo-controlado). A terapia com ferro IV pode ser melhor tolerada do que o ferro oral, mas a confirmação é esperada em ensaios clínicos maiores. O diagnóstico de rotina e o tratamento de DH em pacientes com IC sintomática, independentemente do estado de anemia, são necessários, tornando-se um objetivo terapêutico importante, tendo presente que o excesso de ferro pode ser prejudicial na doença cardiovascular. Esta atualização irá rever o metabolismo do ferro no contexto de anemia e IC; bem como a importância do diagnóstico precoce e tratamento de DH com ferro IV em pacientes com IC.

Evaluation of effectiveness of intravenous iron sucrose in antenatal patients of iron deficiency anemia.

Background: Iron deficiency anaemia (IDA) is the most common nutritional deficiency in pregnancy. Prophylactic oral iron is recommended during pregnancy to meet the increased requirement of iron. In India, more than 50% women become pregnant with low baseline haemoglobin level resulting in high incidence of moderate to severe anaemia in pregnancy where oral iron therapy cannot meet the requirement. This study was undertaken for critical evaluation of iron sucrose in terms of efficacy, safety, and feasibility along with any reduction in blood transfusion rate. Aims & Objective: To evaluate the efficacy of intravenous Iron sucrose in antenatal patients with Iron deficiency anaemia and to study the side effects of intra venous Iron sucrose. Material and Methods: This prospective study was conducted from Nov 2012 to June 2013 at VS General Hospital, Ahmedabad. 60 antenatal patients found to have anaemia having Hb level < 9 gm% were admitted and given intravenous iron sucrose therapy 100mg alternate day after calculating the dose of the iron requirement. Results: In patients having moderate anaemia (Hb 7-9 gm%), the rise in Hb found to be 2.17 ± 0.45 gm% from pre-treatment Hb of 7.88 ± 0.58 gm% to 9.9 ± 0.53 gm%. In patients with severe anaemia (Hb < 7 gm%), the rise in Hb was observed up to 2.73 ± 0.51 (SD) gm% after 1 month of iron sucrose treatment. No major side effects or anaphylactic reactions were noted during the study period. Conclusion: Parenterally administered iron sucrose elevates Hb and restores iron stores earlier and also that intravenous iron administration has led to the reduction in the rate of blood transfusion rate.

Intravenous iron sucrose therapy for moderate to severe anaemia in pregnancy.

Background & objectives: Iron deficiency anaemia (IDA) is the most common nutritional deficiency in pregnancy. Prophylactic oral iron is recommended during pregnancy to meet the increased requirement. In India, women become pregnant with low baseline haemoglobin level resulting in high incidence of moderate to severe anaemia in pregnancy where oral iron therapy cannot meet the requirement. Pregnant women with moderate anaemia are to be treated with parentral iron therapy. This study was undertaken to evaluate the response and effect of intravenous iron sucrose complex (ISC) given to pregnant women with IDA. Methods: A prospective study was conducted (June 2009 to June 2011) in the department of Obstetrics & Gynecology, All India Institute of Medical Sciences, New Delhi. One hundred pregnant women with haemoglobin between 5-9 g% with diagnosed iron deficiency attending antenatal clinic were given intravenous iron sucrose complex in a dose of 200 mg twice weekly schedule after calculating the dose requirement. Results: The mean haemoglobin raised from 7.63 ± 0.61 to 11.20 ± 0.73 g% (P<0.001) after eight wk of therapy. There was significant rise in serum ferritin levels (from 11.2 ± 4.7 to 69 ± 23.1 μg/l) (P<0.001). Reticulocyte count increased significantly after two wk of starting therapy (from 1.5 ± 0.6 to 4.6±0.8%).Other parameters including serum iron levels and red cell indices were also improved significantly. Only one woman was lost to follow up. No major side effects or anaphylactic reactions were noted during study period. Interpretation & conclusions: Parentral iron therapy was effective in increasing haemoglobin, serum ferritin and other haematological parameters in pregnant women with moderate anaemia. Intravenous iron sucrose can be used in hospital settings and tertiary urban hospitals where it can replace intramuscular therapy due to injection related side effects. Further, long-term comparative studies are required to recommend its use at peripheral level.

Small Bowel Pseudomelanosis Associated with Oral Iron Therapy

An accumulation of pigment deposits on mucosa, called melanosis or pseudomelanosis, of the small bowel is observed infrequently during endoscopic examination. We describe 6 cases of small bowel pseudomelanosis; the possible etiology of which was chronic iron intake. We observed numerous brown spots in duodenum, jejunum, and terminal ileum during upper and lower endoscopy. Interestingly, all patients have been taking oral iron for several years. Histology showed pigment depositions within macrophages of the lamina propria and a positive Prussian blue stain indicating hemosiderin deposition. Herein, we demonstrate that long term iron therapy may result in pseudomelanosis of small bowel, such as duodenum, jejunum, and ileum.

Comparison of efficacy of GnRH agonist and intravenous iron therapy for preoperative correction of anemia in gynecologic patients / 대한산부인과학회지

OBJECTIVE: This study is aimed to compare the efficacy of GnRH agonist and intravenous iron therapy in women who need correction of anemia prior to hysterectomy for uterine myoma and adenomyosis. METHODS: We reviewed retrospectively the data of 105 patients with initial hemoglobin level under 10g/dl, who had undergone total abdominal hysterectomy after correction of anemia with GnRH agonist (Group 1) or intravenous iron therapy (Group 2) from January 2004 to April 2006. RESULTS: Initial hemogloblin level was not different between the two groups. After administration, hemoglobin level increased by 3.9+/-2.3 g/dl and 2.6+/-1.7 g/dl, respectively. Therefore, group 1 was superior in anemia correction (p<0.01). On postoperative 1st day, hemoglobin level was 10.3+/-1.6 g/dl and 9.0+/-1.0 g/dl. Correction duration was 7.8+/-4.7weeks (1-18weeks) in group 1 and 4.0+/-4.8weeks (1-30 weeks) in group 2. Shorter duration was needed for correction in group 2 (p<0.01). Surgically removed uterine weight was 391.4+/-195.1 gm and 630.6+/-648.9 gm, respectively. Uterine weight was heavier in Group 2 (p<0.01). CONCLUSION: In comparison of efficacy of GnRH agonist with intravenous iron therapy for the correction of preoperative anemia, corrected hemoglobin level was higher and removed uterine weight was smaller in group 1. But duration of therapy for the correction of anemia was shorter and cost-effectiveness was superior in group 2. Clinicians should consider the patients' condition prior to the selection of drug for preoperative anemia correction.

Intravenous Iron in the Treatment of Postoperative Anemia Following Obstetric and Gynecologic Surgery / 대한산부인과학회지

OBJECTIVE: This study is aimed to evaluate the efficacy and safety of intravenous iron therapy (iron III hydroxide sucrose complex) in ptatients with postoperative anemia following obstetric and gynecologic operations. METHODS: We reviewed the data of 69 patients with postoperative anemia who had undergone obstetric and gynecologic surgery from September 2003 to September 2004, who refused transfusion for correction of post-operative anemia and agreed on treatment with intravenous iron therapy. Iron III hydroxide sucrose complex 200 mg diluted in 100 mL of 0.9% sodium chloride was administrated over 2 hours on postoperative day 1st, 3rd and 5th days. Hemoglobin levels checked and side effects were reviewed. RESULTS: After treatment of intravenous iron therapy, the hemoglobin levels increased rapidly. The lowest hemoglobin levels were observed on postoperative 3rd day but rapid increase of homoglobin levels were observed continously. After 2 weeks from operation, the hemoglobin levels have increased by 0.6+/-1.3 g/dL in the patients with cesarean section and 2.1+/-1.2 g/dL in the patients with gynecology operation. Major side effects such as anaphylaxis and allergic reaction were not observed, and minor side effects were observed in three patients (4%). Emesis, pain on the injection site and skin rash was observed in each patients. CONCLUSION: Intravenous iron sucrose therapy was safe and effective in anemia following obstetric and gynecologic surgery.

Usefulness of Intravenous Iron Supplement During Recombinant Human Erythropoietin(rHuEPO) Therapy in Hemodialysis(HD) Patients / 대한신장학회잡지

Compared with iron dextran, iron chondroitin sulfate(ICS) is much cheaper and has better bioavailability. To evaluate the efficacy and safety of ICS in maintenance HD patients, i.v. ICS was given to 37 HD patients [20 M, 17 F, median age 51 years, median duration of HD 21 months] whose ferritin(Fer)or=100microgram/L and TFS>or=20% [Group II, 8 M, 7 F]. The patients had taken oral iron [227+/-73mg/day(mean+/-SD)] before this study. All patients received 120mg i.v. ICS weekly for 1 month. Then, ICS dosage was adjusted to 40-120mg/week depending on Hb, Fer and TFS in the following 3 months. Hb, Fer, TFS, rHuEPO dose and side effects were monitored monthly. The results were as follows : 1) I.v. iron therapy produced a significant rise in Hb(8.3+/-0.9g/dL to 9.7+/-0.9g/dL; P<0.01), a significant reduction in rHuEPO dose(95+/-50U/kg/wk to 69+/-28U/kg/wk; P<0.05), a significant increase in serum ferritin levels(162+/-149microgram/L to 472+/-255microgram/L; P<0.01) and TFS(24+/-13% to 41+/-18%; P<0.05). 2) In group 1, i.v. iron therapy produced a significant rise in Hb(8.5+/-1.1g/dL to 9.9+/-0.9g/dL; P< 0.01), a significant reduction in rHuEPO dose(87+/-45U/kg/wk to 69+/-27U/kg/wk; P<0.05), increased serum ferritin levels(90+/-48microgram/L to 379+/-186microgram/L; P<0.01) and TFS(18+/-9% to 36+/-16%; P<0.05). 3) In group 2, i.v. iron therapy produced a significant rise in Hb(8.1+/-0.6g/dL to 9.3+/-0.9g/dL; P<0.01), a significant reduction in rHuEPO dose(108+/-55U/kg/ wk to 69+/-31U/kg/wk; P<0.05) and increased serum ferritin levels(274+/-185microgram/L to 602+/-287microgram/L; P< 0.01) with a tendency of increase in TFS(35+/-13% to 41+/-18%; P=0.06). 4) No significant side effect was observed. 5) An annual cost reduction of 221 US dollars per patient was expected. In conclusion, ICS is an effective and safe intravenous iron preparation in HD patients.