Experiencia de uso de hierro intravenoso para el tratamiento de la anemia en niños y adolescentes. Respuesta terapéutica y evolución

Introducción: El hierro de administración intravenosa (iv) está indicado en los casos en que el tratamiento oral no es posible. El objetivo de este trabajo fue describir el perfil de uso, respuesta terapéutica y seguridad de la administración de hierro iv en el tratamiento de la anemia ferropénica en niños, niñas y adolescentes (NNA) asistidos en un centro de referencia de Uruguay entre 2018 y 2023. Método: Estudio retrospectivo mediante revisión de historias. Incluyó todos los NNA que recibieron hierro iv. Se registraron variables sociodemográficas, comorbilidades, clínica y severidad de la anemia. Se evaluó: motivos de la indicación y tipo de hierro iv, dosis, tiempo de infusión, respuesta terapéutica y efectos adversos. Resultados: Se incluyeron 35 pacientes, mediana de edad 4 años; 51,4% de sexo masculino, con comorbilidades 37,1%. Todos los menores de 3 años presentaban factores de riesgo para anemia ferropénica, la falta de adherencia al hierro oral se asoció con mayor severidad de la anemia (p<0,05). El motivo principal de indicación de hierro iv fue la severidad de la anemia e inadecuada respuesta al hierro oral concomitante en 37,1%. Todos recibieron hierro sacarato; mediana de dosis: 2 mg/kg y de tiempo de infusión: 1 hora. Se registró un caso de edema y exantema de cara vinculado a la rápida infusión. La evolución fue satisfactoria. Conclusiones: La administración de hierro iv fue segura. Es necesario establecer consensos respecto a la posología y monitorización. Se requieren nuevos estudios para continuar evaluando la eficacia y seguridad del hierro iv en sus diversas formulaciones.

Introduction: Intravenous (IV) iron administration it is indicated in cases where oral treatment is impossible. The objective of this work was to describe the profile of use, therapeutic response, and safety of the iron IV administration in treating anemia in children and adolescents (NNA) assisted in a reference center in Uruguay between 2018 and 2023. Method: Retrospective study through review of histories. It included all children and adolescents who received IV iron. Sociodemographic variables, comorbidities, clinical symptoms, and severity of anemia they were recorded. They were evaluated: reasons for the indication and type of IV iron, dose, infusion time, therapeutic response, and adverse effects. Results: we included 35 patients, with a median age of four years; 51.4% were male, and 37.1% had comorbidities. All children under three years of age had risk factors for iron deficiency anemia; greater severity of anemia was associated with lack of adherence to oral iron (p<0.05). The main reason for the indication of IV iron was the severity of anemia and inadequate response to concomitant oral iron at 37.1%. All received iron saccharate; median dose: 2 mg/kg and infusion time: 1 hour. A case of facial edema and rash linked to rapid infusion was recorded. The evolution was satisfactory. Conclusions: The administration of IV iron was safe. It is necessary to establish a consensus regarding dosage and monitoring. New studies are required to continue evaluating the efficacy and safety of IV iron in its various formulations.

Deficiencia de hierro en enfermedad renal crónica

Contexto: la deficiencia de hierro es un trastorno frecuentemente observado en pacientes con enfermedad renal crónica (ERC), sobre todo en estadios avanzados. Su presencia se asocia a una mayor morbilidad y mortalidad. La deficiencia de hierro puede ser absoluta o funcional. La deficiencia absoluta se refiere a una ausencia o una reducción de las reservas de hierro, mientras que la deficiencia funcional se define por la presencia de depósitos de hierro adecuados pero con una disponibilidad insuficiente de hierro para su incorporación en los precursores eritroides. Varios factores de riesgo contribuyen a la deficiencia absoluta y funcional de hierro en ERC, incluyendo pérdidas hemáticas, absorción alterada de hierro e inflamación crónica. Objetivo: con esta revisión narrativa se pretende presentar las definiciones, los aspectos fisiopatológicos, los criterios diagnósticos y las medidas terapéuticas en el paciente con diagnóstico de ERC con deficiencia de hierro. Metodología: se realizó una revisión no sistemática de la literatura en la base de datos PubMed, incluyendo además las guías internacionales más utilizadas que abordan el tema de deficiencia de hierro en ERC. Resultados: se incluyeron un total de 30 referencias bibliográficas. La deficiencia de hierro puede ser absoluta o relativa y el déficit absoluto de hierro se produce con valores de ferritina 100 mcg/l, pero con una TSAT < 20 %. El tratamiento del déficit absoluto consta de reposición de hierro oral o endovenoso y en pacientes que aún no reciben diálisis, se puede hacer una prueba terapéutica con hierro oral, de no haber respuesta se optará por hierro endovenoso, mientras que en pacientes que sí reciben diálisis, la medida ideal es el hierro endovenoso, preferiblemente en preparaciones que permitan esquemas de altas dosis y bajas frecuencias de administración. Las metas propuestas por las distintas guías presentan variaciones entre 500 y 700 mcg/l de ferritina. Conclusiones: el déficit de hierro debe buscarse activamente en pacientes con ERC, ya que su presencia y la falta de intervención conlleva a un incremento en los desenlaces adversos. La terapia con hierro es el pilar del tratamiento y la elección del agente a utilizar dependerá de las características individuales del paciente y de la disponibilidad de las preparaciones de hierro oral o endovenoso.

Background: Iron deficiency is a disorder frequently observed in patients with chronic kidney disease (CKD), especially in advanced stages. Its presence is associated with increased morbidity and mortality. Iron deficiency can be absolute or functional. Absolute deficiency refers to absent or reduced iron stores, while functional deficiency is defined by the presence of adequate iron stores but insufficient iron availability for incorporation into erythroid precursors. Several risk factors contribute to absolute and functional iron deficiency in CKD, including blood fi, impaired iron absorption, and chronic inflammation. Purpose: With this narrative review, it is intended to present the details, pathophysiological aspects, diagnostic criteria and therapeutic options in patients diagnosed with chronic kidney disease with iron deficiency. Methodology: A non-systematic review of the fi ron ra was carried out, in the PubMed database, also including the most used international guidelines that address the issue fi ron deficiency in chronic kidney disease. Results: A total of 30 bibliographical references were included. Iron deficiency can be absolute or relative. The absolute iron deficiency occurs with ferritin values 100 mcg/l but with a TSAT <20 % Treatment of absolute deficiency consists of oral or intravenous iron replacement. In a patient who is not yet receiving dialysis, a therapeutic trial with oral iron can be done, if there is no response, intravenous iron will be chosen. In patients receiving dialysis, the ideal measure is intravenous iron, preferably in preparations that allow high-dose schemes and low frequencies of administration. The goals proposed by the different guidelines present variations between 500 and 700 mcg/l d ferritin. Conclusions: iron deficiency should be actively sought in patients with CKD, since its presence and lack of intervention leads to an increase in adverse outcomes. Iron therapy is the mainstay of treatment; the choice of the agent to be used depends on the individual characteristics of the patient and the availability of oral or intravenous iron preparations.

A pilot study on effect of intravenous iron sucrose on oxidative stress and antioxidant status of pregnant women with iron deficiency anemia

Objectives: Iron deficiency anemia (IDA) is the most common nutritional deficiency among pregnant women in India. Iron can be supplemented orally or intravenously to treat IDA. Intravenous supplementation of iron can be risky as there is more possibility for the production of free iron in circulation. The role of free iron in the generation of free radicals and thereby oxidative stress is well known. The present study tends to evaluate oxidative stress and antioxidant status of intravenous iron sucrose treated pregnant women. Materials and Methods: This prospective study was conducted in ACS Medical College and Hospital, Chennai. Twenty pregnant women with moderate IDA (Hb: 7–9.9 g/dl) were included in the present study. Blood samples were collected before and after the treatment with intravenous iron sucrose to measure antioxidants such as reduced glutathione, catalase and superoxide dismutase, and lipid peroxidation marker such as malondialdehyde. Results: In the present study, plasma malondialdehyde levels were increased significantly after the treatment with intravenous iron sucrose. No significant alterations were observed in the levels of reduced glutathione and activities of catalase and superoxide dismutase. Conclusion: In the present study, intravenous iron sucrose infusion was associated with oxidative stress as evidenced by increased lipid peroxidation in antenatal women with IDA. Hence, treatment with antioxidants during iron infusions can be considered

The efficacy and safety of intravenous sucrose iron therapy for recurrent iron deficiency anemia / 中华血液学杂志

Objective: To evaluate the efficacy and safety of intravenous iron supplementation in patients with recurrent iron deficiency anemia (IDA) . Methods: This retrospective analysis of 90 patients with recurrent IDA from May 2012 to December 2021 was conducted, comparing the efficacy and safety of the intravenous iron therapy group and the oral iron therapy group. Results: Among the 90 patients with recurrent IDA, 20 were males and 70 were females, with a median age of 40 (range: 14-85) years. A total of 60 patients received intravenous iron supplementation and 30 received oral iron supplementation. The hematologic response rates in the intravenous iron group were significantly higher than those in the oral iron group at 4 and 8 weeks after treatment [80.0% (48/60) vs 3.3% (1/30) and 96.7% (58/60) vs 46.7% (14/30), all P<0.001, respectively]. The median increase in hemoglobin levels was also significantly higher in the intravenous iron group than in the oral iron group [38 (4, 66) g/L vs 7 (1, 22) g/L at week 4 and 44.5 (18, 80) g/L vs 19 (3, 53) g/L at week 8, all P<0.001]. The intravenous iron group had a significantly higher proportion of patients who achieved normal hemoglobin levels than the oral iron group (55.0% vs 0 and 90% vs 43.3%, all P<0.001, respectively). Iron metabolism indicators were tested before and after 8 weeks of treatment in 26 and 7 patients in the intravenous and oral iron groups, respectively. The median increase in serum ferritin (SF) levels in the intravenous iron group 8 weeks after treatment was 113.7 (49.7, 413.5) μg/L, and 54% (14/26) of these patients had SF levels of ≥100 μg/L, which was significantly higher than the median increase in SF levels in the oral iron group [14.0 (5.8, 84.2) μg/L, t=4.760, P<0.001] and the proportion of patients with SF levels of ≥100 μg/L (P=0.013). The incidence of adverse reactions was 3.3% (2/60) in the intravenous iron group, which was significantly lower than that in the oral iron group [20.0% (6/30), P=0.015]. Conclusion: Intravenous iron supplementation is more effective for hematologic response, faster hemoglobin increase, and higher iron storage replenishment rates compared with oral iron supplementation in patients with recurrent IDA, and it is well tolerated by patients.

Control de anemia y transfusión en el manejo perioperatorio de pacientes con fractura de cadera. Estudio de cohorte longitudinal / Control of anemia and transfusion in perioperative management of patients with hip fracture. A Cohort Study

Introducción El objetivo del estudio es pormenorizar los factores asociados a fracturas de cadera, prestando especial atención a las necesidades de transfusión de hemoderivados y sus factores de riesgo, así como su modificación a través del tratamiento preoperatorio mediante la administración de hierro intravenoso. Materiales y métodos Estudio observacional prospectivo de 119 pacientes ingresados por fractura de cadera. Descripción detallada del protocolo para la optimización prequirúgica de estos pacientes. Se recopilaron datos epidemiológicos, valores analíticos, así como datos acerca de la administración de hierro intravenoso y necesidad de transfusión. Resultados El 31,09% de los pacientes se encontraban antiagregados y el 21,85% estaban anticoagulados en el momento de la admisión. La hemoglobina media al ingreso fue de 12,5g/dl. El 43,2% se transfundieron durante la estancia hospitalaria. En el análisis de los factores de riesgo para la transfusión demostramos estadísticamente que tanto la hemoglobina al ingreso (p<0.001), como los diagnósticos previos de anemia crónica, hipertensión arterial e insuficiencia renal, tienen una relación con la necesidad de transfusión intrahospitalaria. Encontramos una relación estadísticamente significativa entre la administración de hierro y la cantidad de concentrados de hematíes trasfundidos (p<0.005). Los requerimientos de transfusión sanguínea fueron mayores en las fracturas extracapsulares que en las intracapsulares (p=0,024). Discusión Los pacientes con fractura de cadera presentan frecuentemente bajos niveles de hemoglobina al ingreso, así como comorbilidades y tratamientos que predisponen al desarrollo de anemia perioperatoria. La optimización preoperatoria de estos pacientes mediante la administración de hierro intravenoso podría reducir las necesidades transfusionales.

Background Aim of the study is to describe the elements associated with hip fractures about needs for transfusion of blood products and their risk factors, as well as their modification through preoperative treatment through the administration of intravenous iron. Material and methods A Cohort study of 119 patients admitted for hip fracture was conducted. Detailed description of the protocol for the pre-surgical optimization of these patients, epidemiological data, analytical values, as well as data on intravenous iron administration and need for transfusion were collected. Results 31.09% of the patients were using platelet aggregation inhibitors and 21.85% were were using anticoagulants at the time of admission. The mean hemoglobin on admission was 12.5g / dl. 43.2% were transfused during the hospital stay. In the analysis of risk factors for transfusion, we statistically demonstrated that both hemoglobin on admission (p <0.001), as well as previous diagnoses of chronic anemia, arterial hypertension, and renal failure, are related to the need for intra-hospital transfusion. We found a statistically significant relationship between iron administration and the amount of packed red blood cells transfused (p <0.005). Blood transfusion requirements were higher in extra-capsular than in intra-capsular fractures (p=0.024). Discussion Patients with hip fracture frequently present low hemoglobin levels upon admission, as well as comorbidities and treatments that predispose to the development of perioperative anemia. Preoperative optimization of these patients by administering intravenous iron could reduce transfusion requirements.

A comparative study of oral versus intravenous iron in the treatment of moderately anaemic pregnant women

Background: Anemia, the decrease of haemoglobin (Hb) concentration is a common disorder complicating pregnancy mostly due to hemodilution, increased demand of iron and poor dietary intake of iron. The aim of this study was to evaluate whether parenteral iron sucrose can be used as an alternative to daily oral iron during pregnancy.Methods: It was a prospective interventional study conducted in the Department of Obstetrics and Gynaecology, Rohilkhand Medical College and Hospital, Bareilly involving pregnant women at 16-24 weeks with Hb 7-10 g/dl. They were randomly allocated to two groups I and II. Group I (oral group) was given oral iron tablets containing 100 mg of elemental iron and 0.5 mg of folic acid as per therapeutic requirement. Group II (parenteral group) were admitted as day care patients and given a total calculated dose of iron sucrose in divided doses of 200 mg each in 100 ml of normal saline as slow intravenous infusion. Hb, packed cell volume (PCV), blood indices were measured at the start, 2 weeks and 4 weeks of treatment. Any side-effects of treatment were also studied.Results: A statistically significant increase in values of Hb, hematocrit, reticulocyte count, red blood cells (RBC's) indices: mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC) and mean corpuscular hemoglobin (MCH) coupled with no serious side effects with iron sucrose as compared with oral iron.Conclusions: Intravenous iron sucrose complex is safe, convenient and effective alternative to oral iron for treatment of iron deficiency anemia in pregnancy.

A comparative study of efficacy, safety and compliance of oral iron versus intravenous iron sucrose in treatment of iron deficiency anaemia of pregnancy

Background: Iron deficiency anemia is the most common form of anemia and nutritional disorder worldwide. Oral iron therapy and blood transfusion has many drawbacks like noncompliance and risk of transmittable infections and transfusion reaction. The modern alternative therapy is treatment with intravenous iron. Present study compares the efficacy, safety and tolerability between intravenous iron sucrose and oral iron in iron deficiency anemia during 20-36 weeks of pregnancy.Methods: It was a randomized controlled study between December 2017 to September 2019. 200 patients attending antenatal OPD in Al Ameen Medical College, with haemoglobin levels between 7-9.9 gm/dl and serum ferritin of <15 ng/ml were enrolled. In intravenous group, 200 mg iron sucrose in 100ml normal saline was infused alternate day till the required dose was met. The oral group received 200 mg of oral iron ascorbate along with folic acid 1.5 mg per day for 6 weeks.  Treatment efficacy was assessed by Hb and serum ferritin after 3 and 6 weeks.Results: Out of 200 patients, an increase in Hb was observed in both groups, rising from 9.7 g/dl to 10.3 g/dl and 10.9 g/dl after 3 weeks and 6 weeks respectively in oral group and from 8.6 g/dl to 9.8 g/dl and 10.8 g/dl after 3 weeks and 6 weeks respectively in intravenous group. Similar results were seen in ferritin levels. Rise in Hb and ferritin levels were greater in intravenous group than in oral group.Conclusions: Intravenous iron sucrose appears to be a better treatment option in comparison with oral iron, without serious side effects, better compliance and improved efficacy in correction of anaemia of pregnancy.

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 intravenous iron sucrose versus oral iron therapy in iron deficiency anemia during postpartum period

Background: Anemia is the commonest major contributing factor in maternal mortality and morbidity in developing countries and according to World Health Organization (WHO) criteria, it contributes to 20% of maternal deaths. Anemia in pregnancy defined as haemoglobin level <11 gm/dl (7.45 mmol/L) and haematocrit less than 33% (WHO). Aim of this study was to compare the efficacy of oral iron ferrous sulphate therapy with intravenous iron sucrose therapy in the treatment of iron deficiency anemia during postpartum period.Methods: This was a prospective randomized comparative clinical trial single center study conducted on 200 postpartum women aged >18 years (after normal delivery or LSCS) within 10 days of delivery with Hb level more or equal to 6 gm/dl but less than 10 gm/dl were included in the study. This was a one-year study conducted during 1st December 2018 to 30th November 2019.Results: There was a significant increase in the hemoglobin level in both the groups i.e. in IV iron group, from 8.26±1.03 gm/dl on day 1 to 11.62±0.94 gm/dl on day 45 as compared to oral iron group, from 8.24±1.09 gm/dl on day 1 to 11.07±1.14 gm/dl on day 45; and serum ferritin level from 41.69±40.45 ng/ml on day 1 to 77.34±41.60 ng/ml on day 45 in IV iron group as compared to the oral iron group from 22.20±8.82 ng/ml on day 1 to 31.72±9.72 ng/ml on day 45. So, there was a rapid increase in both hemoglobin and serum ferritin levels in IV iron group as compared to the oral iron group.Conclusions: Intravenous iron sucrose administration increases the hemoglobin level and serum ferritin more rapidly in compare to the oral intake of ferrous sulphate in women with iron deficiency anemia in postpartum women in our study.

Intravenous Iron sucrose and change in hemoglobin, ferritin, and oxidative stress markers among moderately anemic pregnant women attending a secondary care level Hospital in Northern India

Background: Intravenous iron is associated with oxidative stress, and very few studies have assessed change in oxidative stress markers post infusion. Objectives: The study aimed to measure the change in levels of hemoglobin (Hb), serum ferritin, and select oxidative stress markers (malondialdehyde [MDA], superoxide dismutase [SOD], and ferric reducing ability of plasma [FRAP]) 4 weeks following the administration of intravenous iron sucrose (IVIS) among moderately anemic pregnant women who were attending a secondary-level health-care facility, Haryana, North India. Methods: An observational study was conducted (May 2016 to Jan 2018) among pregnant women receiving intravenous iron sucrose i.e., IVIS (300 mg per dose) diluted in 300 mL of normal saline over 20� min and were followed up for a period of 4 weeks after the last dose of IVIS (end line). The study outcomes were measured in the levels of Hb, serum ferritin, MDA, SOD, and FRAP from the baseline to the end line. Results: The mean (95% confidence interval) change in the Hb and serum ferritin level 4 weeks after the last dose of IVIS was an increase of 2.5 (2.1�0) g/dL (P < 0.001) and 63.0 (44.7�.3) ng/mL (P < 0.001), respectively. There were no significant changes (baseline to end line) in mean (standard deviation [SD]) MDA level and mean (SD) FRAP level. The mean (SD) SOD level declined significantly (2.2 [0.4] U/mL to 1.6 [0.5] U/mL [P < 0.001]). No life-threatening adverse events were encountered during the study. Conclusion: IVIS was well tolerated and effective in treating moderate anemia in pregnancy. Body iron store was replenished following IVIS administration. There was no increase in oxidative stress following IVIS therapy.

Study of outcome of the treatment with intravenous iron sucrose in moderately anaemic pregnant women

Background: Moderate anaemia seen in about 15-20% of pregnant women. Iron sucrose complex which is used intravenously for the correction of Iron deficiency anaemia. The drug has been able to raise the haemoglobin to satisfactory level when used in moderately anaemic iron deficient pregnant women. The objective of this study was to study the improvement of Hb% after treatment with intravenous Iron sucrose complex in moderately anaemic pregnant women belonging to 24-32 weeks of gestational age.Methods: 50 antenatal patients between gestational age 24-32 weeks with hemoglobin between 8-9.5g/dl were selected and included in this study. They were subjected to blood hemoglobin estimation, hematocrit and peripheral smear study. In each infusion, the maximum total dose administered was 200 mg iron sucrose in 100 ml of normal saline, slow IV infused over 30 minutes. Monitoring was done throughout the infusion to observe for any side effects.Results: Mean hemoglobin among the 50 patients before starting the therapy was 8.172g/dl and the mean hemoglobin at the end of one month of completing the therapy was 11.066g/dl. The rise in mean hemoglobin i.e. the difference in the mean hemoglobin before and after treatment was 2.894g/dl. The p value is 0.0001 which is statistically significant. The mean hematocrit of the 50 patients studied before starting the treatment was 26.772% with a standard deviation of 1.914. The mean hematocrit after completing the therapy was 33.872% with a standard deviation of 1.321. The difference in the mean hematocrit was 7.100% with a p value of 0.0001 which is statistically significant.Conclusions: Intravenous iron sucrose complex is well tolerated and highly efficacious in improving hemoglobin, hematocrit in the treatment of iron deficiency anaemia in antenatal women.

A study for efficacy and safety of ferric carboxymaltose versus iron sucrose in iron deficiency anemia among pregnant women in tertiary care hospital

Background: Anemia is one of the common manageable problem among the pregnant women worldwide, which contributes to maternal and perinatal mortality. This study aims to compare the efficacy and safety of intravenous ferric carboxymaltose with intravenous iron sucrose in treating anemia during pregnancy. Objective of this study was to compare safety and efficacy of intravenous ferric carboxymaltose with intravenous ferric sucrose in iron deficiency anemia during pregnancy.Methods: It’s an interventional prospective study conducted in Department of Obstetrics and Gynecology at NIMS, Jaipur, Rajasthan, India constituting of 100 pregnant women. Group 1- 50 pregnant women were treated with intravenous ferric carboxymaltose and Group 2: 50 pregnant women were treated with intravenous iron sucrose. Hemoglobin and serum ferritin levels were measured pre and post treatment with parenteral iron therapy. The efficacy of intravenous ferric carboxymaltose in comparison to intravenous iron sucrose was assessed. The evaluation of safety and tolerance with the parenteral therapy was also performed.Results: Anemia during pregnancy was more prevalent among the reproductive age group and in multiparous women. The mean rise in the hemoglobin level with ferric carboxymaltose was 2.92 gm/dl and with that of iron, sucrose was 1.08 gm/dl. The man rise in the serum ferritin levels with ferric carboxymaltose was 64.97ng/ml and with iron sucrose was 31.64 ng/ml. Ferric carboxymaltose was observed to be safer with no adverse events in comparison to the Iron sucrose which was related with adverse events among 03 pregnant women.Conclusions: Intravenous ferric carboxymaltose was more efficacious and safer in comparison to intravenous iron sucrose among pregnant women. Hence, ferric carboxymaltose is the drug of choice in treatment of iron deficiency anemia during pregnancy.

Management of postpartum iron deficiency anemia: review of literature

Anemia is a condition in which either the number of circulating red blood cells or their hemoglobin concentration is decreased. As a result, there is decreased transport of oxygen from the lungs to peripheral tissues. The standard approach to treatment of postpartum iron deficiency anemia is oral iron supplementation, with blood transfusion reserved for more server or symptomatic cases. There are a number of hazards of allogenic blood transfusion including transfusion of the wrong blood, infection, anaphylaxis and lung injury, any of which will be devastating for a young mother. These hazards, together with the national shortage of blood products, mean that transfusion should be viewed as a last resort in otherwise young and healthy women. Currently, there are many iron preparations available containing different types of iron salts, including ferrous sulfate, ferrous fumarate, ferrous ascorbate but common adverse drug reactions found with these preparations are mainly gastrointestinal intolerance like nausea, vomiting, constipation, diarrhoea, abdominal pain, while ferrous bis-glycinate (fully reacted chelated amino acid form of iron) rarely make complication. Two types of intravenous (IV) preparations available are IV iron sucrose and IV ferric carboxymaltose. IV iron sucrose is safe, effective and economical. Reported incidence of adverse reactions with IV iron sucrose is less as compared to older iron preparations (Iron dextran, iron sorbitol), but it requires multiple doses and prolonged infusion time. Intramuscular iron sucrose complex is particularly contraindicated because of poor absorption. It was also stated that when iron dextran is given intravenously up to 30% of patients suffer from adverse effects which include arthritis, fever, urticaria and anaphylaxis.

Ferricarboxy maltose to treat iron deficiency anemia in pregnancy: is it a feasible option?

Background: Iron deficiency is a common cause of anaemia in pregnancy which influences the health of mother and developing fetus. Intravenous (IV) iron preparations are considered, when oral iron therapy is ineffective or intolerant. Ferric carboxymaltose is an IV preparation that can be given with ease of administration and better tolerated. The aim of this study was to assess the efficacy and safety of IV ferric carboxymaltose in pregnant mother with all grades of anemia in the second and third trimester.Methods: This is a prospective observational study where 44 pregnant women with iron deficiency anemia [IDA] received ferric carboxymaltose up to 15mg/kg in second and third trimester. The parameters that were taken into account, to assess the effectiveness of the treatment was repeat haemoglobin [Hb] measurements and the subjective sense of wellbeing in the patient. The safety of the drug was analysed by continuous fetal heart rate [FHR] monitoring during the infusion and observation of any adverse reactions.Results: Ferric carboxymaltose intravenous infusion significantly increased Hb levels above baseline values in all women. The Increase in Hb levels were observed at 3- and 6-weeks post infusion therapy. FHR monitoring did not show any drug related unfavourable effect on the fetus. Of the 44 women interviewed, 33 (75%) women reported sense of well-being, 7 (15.9%) women could not feel any difference after the infusion and 4 (9.1%) patients could not comment. No serious adverse effects were noticed but minor side effects occurred in 3 (6.8%) patients.Conclusions: This prospective study showed safety and efficacy of ferric carboxymaltose in pregnancy with IDA which is consistent with available observational data.

Hypophosphatemia induced encephalopathy after intravenous iron carboxymaltase administration – A rare and important complication

@#Recently, intravenous iron supplements has become increasingly popular because it allows administration of large quantity of iron dosage with simple infusion and is more effective in raising the hemoglobin levels and have less drug-related side effects as compared to oral iron supplementation. Multiple IV formulations of iron are available. However, there have been reports of transient asymptomatic hypophosphatemia with its use. We report here a patient with iron deficiency anemia secondary to menorrhagia, who presented with confusion, disorientation, muscle cramps and severe fatigue 3 weeks following intravenous ferric carboxymaltase from hypophosphatemia.

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.

Effect of intravenous iron sucrose combined with psychological intervention on gynecological anemia / 中国生化药物杂志

Objective To investigate the efficacy of intravenous iron sucrose combined with psychological intervention in the treatment of gynecological anemia. Methods A total of 76 patients with gynecological anemia admitted in our hospital from September 2000 to March 2017 were randomly divided into study group and control group, 38 cases in each group.The control group and gynecological anemia patients were treated with intravenous sucrose iron, the study group was treated with intravenous iron sucrose, and the corresponding psychological intervention measures were used. Results There was no significant difference in HGB and SF between the two groups before treatment., the study group after treatment HGB, SF detection value is higher than that of control group (P<0.05); study group increased to HGB for normal values of time required significantly less than the control group (P<0.05); two gynecological patients with anemia treatment in the process of research the rate of adverse reactions was 13.16%, the control group is as high as 28.95% (P<0.05). Conclusion Intravenous iron sucrose based treatment combined with psychological intervention can significantly improve the index of gynecological patients with anemia effect, reduce adverse drug reactions, to ensure the effectiveness and safety of patients are of positive significance.

Iron deficiency in cancer patients

ABSTRACT Anemia is a frequent complication in cancer patients, both at diagnosis and during treatment, with a multifactorial etiology in most cases. Iron deficiency is among the most common causes of anemia in this setting and can develop in nearly half of patients with solid tumors and hematologic malignancies. Surprisingly, this fact is usually neglected by the attending physician in a way that proper and prompt investigation of the iron status is either not performed or postponed. In cancer patients, functional iron deficiency is the predominant mechanism, in which iron availability is reduced due to disease or the therapy-related inflammatory process. Hence, serum ferritin is not reliable in detecting iron deficiency in this setting, whereas transferrin saturation seems more appropriate for this purpose. Besides, lack of bioavailable iron can be further worsened by the use of erythropoiesis stimulating agents that increase iron utilization in the bone marrow. Iron deficiency can cause anemia or worsen pre-existing anemia, leading to a decline in performance status and adherence to treatment, with possible implications in clinical outcome. Due to its frequency and importance, treatment of this condition is already recommended in many specialty guidelines and should be performed preferably with intravenous iron. The evidences regarding the efficacy of this treatment are solid, with response gain when combined with erythropoiesis stimulating agents and significant increments in hemoglobin as monotherapy. Among intravenous iron formulations, slow release preparations present more favorable pharmacological characteristics and efficacy in cancer patients.

Evaluation of Anemia Management in Hemodialysis Patients in Gezira Hospital, in Sudan.

Anemia of kidney disease is a common but under recognized co-morbid condition that is known to place patients at greater risk of hospitalization, cognitive impairment, cardiovascular diseases and even death. Aims: The aims of this work to investigate current practice of anemia management in hemodialysis patients and to assess the appropriateness of anemia management. Study Design: The study was conducted in Gezira Hospital for Renal Diseases and Surgery. Data on anemia parameters, comorbidities, ESAs dosing and iron supplementation were collected. The data were collected for 6 months retrospectively from December 2005 to July 2006. Patients with ESRD undergoing hemodialysis were included. Patients were excluded if they have cancer or receiving chemotherapy or radiotherapy. Results: Data were collected from 83 patients under hemodialysis. The base line hemoglobin levels in December 2005 revealed that of the 97% of the patients were anemic, because they had hemoglobin levels below the recommended target level (11.0 g/d1). The patients started treatment with erythropoietin (4000IU/wk) for six months, and we found that 6% of patients received regular EPO, 56.6% received it irregularly and 37.3% not received EPO, regarding intravenous iron (100 mg/wk or 100 mg/2wk), 7.2% of patients received regular intravenous iron, 48.2% received it irregularly and 44.6% of patients did not received it, Hemoglobin levels were measured in July 2006 to evaluate the effect of treatment in hemoglobin level, we found that 95% of patients were still anemic. This indicates that current treatment strategies were ineffective because the majority of patient failed to reach the recommended hemoglobin level after six months of treatment. This study demonstrate that there is no regular periodical laboratory tests, follow up and treatment for renal anemia.

Anemia Management Practice in French Hemodialysis Centers.

Objective: Evaluate the hemoglobin (Hb) target values in hemodialysis (HD) patients treated with erythropoiesis-stimulating agents (ESA). Methods: Records of anemia parameters of HD patients treated during year 2012 in 5 French dialysis centers were retrospectively analyzed. Patients were stratified into “annual Hb categories” according to their monthly mean Hb: Low Hb (< 10 g/dL), Ideal Hb (from 10 to ≤ 12 g/dL), High Hb (> 12 g/dL) if they spent ≥ 75% of time in the respective category; otherwise patients were classified as Fluctuating Hb. Results: Out of 636 evaluable patients (mean age 66.6 [SD 14.9] years; male 59.4%), 91.4% received ESA treatment and 74.2% received intravenous iron. Most patients (68.9%) belonged to the Fluctuating Hb category (Ideal 18.7%; High 9.6%; Low 2.8%). Patients in the Fluctuating category experienced more frequently ESA dose changes, transfusions, hospitalizations and comorbidities compared with patients in other Hb categories. Multinomial logistic regression identified presence of at least one comorbidity (odds-ratio [OR]=7.6), hospitalization (OR=2.2), transfusion (OR=2.9), male gender (OR=0.6) and serum ferritin ≥500 vs. <200 μg/L (OR = 0.4) as predictors of Fluctuating vs. Ideal annual Hb category. Conclusions: Only 18.7% of patients had stable Hb levels within the target range according to French and international guidelines; most had fluctuating Hb levels and few patients had a consistently low annual Hb. These findings suggest that development and implementation of improved hematologic assessment and anemia treatment strategies are needed to minimize fluctuating Hb values in HD patients.