DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20213857

Role of ferric carboxymaltose in the treatment of postpartum anemia in a tertiary care hospital in Andhra Pradesh

Kirtan Krishna, Achint Krishna, Divya Teja G. N.

Abstract


Background: Postpartum iron deficiency anemia is common in India as a consequence of postpartum hemorrhage.  Recent studies have evaluated the use of parenteral iron as a better tolerated treatment modality. Compared with oral iron supplements, parenteral iron is associated with a rapid rise in serum ferritin and hemoglobin and improved maternal fatigue scores in the postpartum period.  Parenteral iron may be considered for the treatment of postpartum anemia. The objective of the study was to evaluate the efficacy, safety, and tolerability of intravenous ferric carboxymaltose, in women with postpartum anemia.

Methods: A clinical observational study was undertaken in a tertiary care hospital,  50 women within six weeks of delivery with Hb ≥6 gm/dl and ≤10 gm/dl received 1000 mg/week,  over 15 minutes or less, repeated weekly to a calculated replacement dose (maximum 2500 mg) . Hemoglobin and serum ferritin levels were recorded prior to treatment and on day 21 after completion of treatment.

Results: Ferric carboxymaltose-treated subjects achieved a hemoglobin greater than 12 gm/dL in a short time period (21 days), achieve a hemoglobin rise of ≥3 gm/dL more quickly, and attain higher serum ferritin levels. It is also associated with better patient compliance, and shorter treatment period. Drug-related adverse events occurred less frequently with ferric carboxymaltose. The only noted disadvantage was that it is more expensive when compared to other iron preperations.

Conclusions: Intravenous ferric carboxymaltose was safe and well tolerated with good efficacy and better patient compliance in the treatment of postpartum iron deficiency anemia.


Keywords


Ferric carboxymaltose, Hemoglobin, Parenteral iron, Postpartum anemia, Serum ferritin

Full Text:

PDF

References


Bodnar LM, Scanlon KS, Freedman DS, Siega-Riz AM, Cogswell ME. High prevalence of postpartum anemia among low-income women in the United States. Am J Obstet Gynecol. 2001;185:438-43.

Bodnar LM, Cogswell ME, McDonald T. Have we forgotten the significance of postpartum iron deficiency? Am J Obstet Gynecol. 2005;193:36-44.

Kouser S, Kouser S, Malik M, Malik A. Safety and efficacy of intravenous iron therapy in postnatal patients with iron deficiency anemia. J South Asian Fed Obstet Gynaecol. 2011;3:25-7.

Somdatta P, Reddaiah VP, Singh B. Prevalence of anaemia in the postpartum period: A study of a North Indian village. Trop Doct. 2009;39:211-5.

Ahmed K, Saqid I, Yousuf AW. Injectable iron therapy: intramuscular vs. intravenous therapy. Biomedics. 2000;16:44-7.

Pernoll ML. Iron deficiency anemia. In: Pernoll ML, ed. Benson and Pernoll’s handbook of obstetrics and gynecology. 10th edn. Columbus (OH): The McGraw-Hill Companies, Inc.; 2001:435-437.

Sherrets D, Cusick S, Grosse S, Amendah D. Iron deficiency anemia among pregnant women: Screening and preventive medication. 2009. Available from: http://www.businessgrouphealth.org/preventive/topics/ida_pregnancy.cfm. Accessed on 10 May 2011.

Sutherland T, Bishai DM. Cost-effectiveness of misoprostol and prenatal iron supplementation as maternal mortality interventions in home births in rural India. Int J Gynaecol Obstet. 2009;104:189-93.

Milman N. Postpartum anemia I: Definition, prevalence, causes, and consequences. Ann Hematol. 2011;90:1247-53.

James A, Patel S, Dinh Q. Impact of anemia on medical resource utilization and hospital cost in women with obstetrical bleeding. Blood. 2007;110:5168.

Beard JL, Hendricks MK, Perez EM, Murray-Kolb LE, Berg A, Vernon-Feagans L, et al. Maternal iron deficiency anemia affects postpartum emotions and cognition. J Nutr. 2005;135:267-72.

Perez EM, Hendricks MK, Beard JL, Murray-Kolb LE, Berg A, Tomlinson M, et al. Mother-infant interactions and infant development are altered by maternal iron deficiency anemia. J Nutr. 2005;135:850-5.

Bodnar LM, Siega-Riz AM, Miller WC, Cogswell ME, McDonald T. Who should be screened for postpartum anemia? An evaluation of current recommendations. Am J Epidemiol. 2002;156:903-12.

CDC criteria for anemia in children and childbearing-aged women. MMWR Morb Mortal Wkly Rep. 1989;38:400-4.

Zimmermann MB. Methods to assess iron and iodine status. Br J Nutr. 2008;99(3):S2-9.

Silverman JA, Barrett J, Callum JL. The appropriateness of red blood cell transfusions in the peripartum patient. Obstet Gynecol. 2004;104:1000-4.

Hallberg L, Ryttinger L, Solvell L. Side effects of oral iron therapy. A double-blind study of different iron compounds in tablet form. Acta Med Scand Suppl. 1966;459:3-10.

Solvell L. Oral iron therapy-side effects. In: Hallberg L, Harwerth HG, Vannotti A, eds. Iron Deficiency: Pathogenesis, Clinical Aspects, Therapy. 1st edn. London: Academic Press; 1970:573-583.

National Institute for Health and Clinical Excellence: Clinical guideline 39: Anaemia management in people with chronic kidney disease (CKD). 2006. Available from: http://guidance.nice.org.uk/CG39. Accessed on 3 February 2011.

Brookhart MA, Schneeweiss S, Avorn J, Bradbury BD, Liu J, Winkelmayer WC. Comparative mortality risk of anemia management practices in incident hemodialysis patients. JAMA. 2010;303:857-64.

Folb PI. The safety of iron dextran and a comparison with iron sucrose for intravenous use: a short report to the world health organization advisory committee on the safety of medicines. Available from: http://www.who.int/medicines/areas/quality_safety/safety_efficacy/Addendum.pdf. Accessed on 3 February 2011.

Lyseng-Williamson KA, Keating GM. Ferric carboxymaltose: a review of its use in iron-deficiency anaemia. Drugs. 2009;69:739-56.

World Health Organization. Anemia prevention and control. Geneva, Switzerland: World Health Organization; 2011. Available from: http://www.who.int/medical_devices/initiatives/anaemia_control/en. Accessed on 10 February 2014.

Seid MH, Derman RJ, Baker JB, Banach W, Goldberg C, Rogers R. Ferric carboxymaltose injection in the treatment of postpartum iron deficiency anemia: A randomized controlled clinical trial. Am J Obstet Gynecol. 2008;199:435.e1-7.

Breymann C, Gliga F, Bejenariu C, Strizhova N. Comparative efficacy and safety of intravenous ferric carboxymaltose in the treatment of postpartum iron deficiency anemia. Int J Gynaecol Obstet. 2008;101:67-73.

Giannoulis C, Daniilidis A, Tantanasis T, Dinas K, Tzafettas J. Intravenous administration of iron sucrose for treating anemia in postpartum women. Hippokratia. 2009;13:38-40.

Van Wyck DB, Martens MG, Seid MH, Baker JB, Mangione A. Intravenous ferric carboxymaltose compared with oral iron in the treatment of postpartum anemia: A randomized controlled trial. Obstet Gynecol. 2007;110:267-78.

Singh U, Singh N. Anemia in peuperium: Comparative study of effcacy and safety of oral iron, iron sucrose and ferric carboxymaltose. Indian J Appl Res. 2015;6:741-2.

Mei Z, Cogswell ME, Parvanta I, Lynch S, Beard JL, Stoltzfus RJ, et al. Haemoglobin and ferritin are currently the most efficient indicators of population response to iron interventions: an analysis of nine randomised controlled trials. J Nutr. 2005;135:1974-80.

Van den Broek NR, Letsky EA, White SA, Shenkin A. Iron status in pregnant women: which measurements are valid? Br J Haematol. 1998;103:817-24.

Rathod S, Samal SK, Mahapatra PC, Samal S. Ferric carboxymaltose: a revolution in the treatment of postpartum anemia in Indian women. Int J Appl Basic Med Res. 2015;5(1):25-30.