Intravenous iron therapy in pregnancy anemia: hematological response in relation to gestational age.

This study was undertaken to evaluate the response to parenteral administration of iron in 62 pregnant patients with asiderotic anemia and mean initial hemoglobin (Hb) concentrations (Hb1) of 9.91+/-(SD) 1.13 g/dl. Iron (742+/-366 mg) was administered intravenously, and the response to treatment was classified according to the rise in Hb (VarHb; 0.97+/-0.77 g/dl) and evaluated after 19.5+/-14.6 (range 4-57) days. It was found that the VarHb was inversely correlated with the Hb1 value (r = -0.46; p<0.001) and only weakly correlated with the number of vials administered. In addition, two-cluster analysis of patients on the basis of VarHb and gestational age resulted in two significantly different groups (p<0.001): >28 weeks of pregnancy (n = 39, group 1: 1.27+/-0.66, range 0.1-3.3 g/dl) and < or =28 weeks of pregnancy (n = 23, group 2: 0.45+/- 0.69, range 0.4-2.3 g/dl). No difference was found between groups 1 and 2 in relation to Hb1, iron dose, and therapy duration. The number of patients with VarHb >0.8 g/dl was found to be higher in group 2 than in group 1: 31/39 versus 8/23 (p<0.001). These results indicate that the response to intravenous iron therapy in pregnancy anemia is related to Hb1 level and gestational age at the onset of treatment and probably depends on the erythropoietin response to anemia.

Intravenous iron therapy for severe pregnancy anemia with high erythropoietin levels.

BACKGROUND: To demonstrate that intravenous (IV) iron therapy rapidly can secure the physiologic correction of severe nonhemorrhagic anemia more safely than blood component therapy and recombinant erythropoietin treatment. CASE: An 18-year-old woman with beta-thalassemia in her 33rd week of gestation had a hemoglobin level of 4.8 g/dL and an erythropoietin value of 191 mU/mL. After IV iron administration, erythropoietin rapidly decreased and hemoglobin increased to 8.1 g/dL in correlation with estriol elevation. A healthy infant with normal hemoglobin and ferritin levels was delivered at 42 weeks by cesarean. CONCLUSION: Intravenous iron administration rapidly corrected severe nonhemorrhagic anemia in a pregnant patient and may produce an improvement in fetal indices. High erythropoietin levels predict a good response to iron and may obviate the need for blood transfusions and recombinant erythropoietin administration, at least until this therapy is tried.