DOI: https://dx.doi.org/10.18203/2320-1770.ijrcog20163422
Published: 2016-12-15

Intravenous iron sucrose for treatment of anemia in gynecology patients awaiting surgery

Animesh Gandhi, Meena N. Satia

Abstract


Background: Anemia refers to reduction in the total circulatory erythrocyte mass which results in decrease in the oxygen carrying capacity of the blood. Patients who require a surgical intervention as regards their complaints are many a times denied fitness because of anemia. Current anesthetic and surgical practice ideally recommend a hemoglobin level of > 10 g/dl or a hematocrit of >30 % for any surgical intervention. Surgery is postponed until cause of anemia is identified and the anemia corrected without resorting to blood transfusions. The current study evaluates other alternatives to increase the hemoglobin as early as possible without resorting to blood transfusion. The efficacy and safety of intravenous iron sucrose along with   the achievement of the desired hemoglobin values for patients posted for elective gynecological surgeries within the next menstrual cycle was evaluated.

Methods: This study was an open label, single arm, and prospective study of women with iron deficiency anemia in gynecological disorders. 100 patients attending Gynecology OPD of Seth G. S. Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India requiring surgical intervention but not given fitness due to anaemia were the subjects of this study. All patients with surgically treatable conditions with hemoglobin level >7g/dL but < 10 g/dl were the inclusion criteria Selected subjects received intravenous iron sucrose. Maximum dose 200mg/weekX3 weeks initially. At the end of three weeks of starting therapy Hb estimation was done and compared with the baseline levels as regarding the hemoglobin rise. The results were statistically analyzed using the “paired t” test.

Results: The requirement of iron-sucrose for the individual patient was calculated based on the weight of the patient. The analysis of iron requirement-sucrose combination showed a mean of 481.7 mg with standard deviation (SD) of 62.72 mg and a range of 378.85 mg. The minimum iron-sucrose requirement was 361.55 mg and the maximum was 740.40 mg The mean Hb (gm%) value before intervention was 8.43 with a standard deviation of 0.56, whereas, the mean Hb (gm %) value after intervention was higher, 10.41 with standard deviation (SD) of .56 the mean Hb (gm %) Increase in 2 weeks was 1.60 with standard deviation (SD) of 0.31, whereas, in 3 weeks was 2.03 with standard deviation (SD) of 0.51. The mean Hb (gm %) increase was higher in participants with 3 weeks, which was statistically significant (p<0.05).

Conclusions: Parenteral iron therapy was not safe in the past but iron sucrose has made it the safest and effective therapy. Parenteral iron therapy can be used for patients with Hb level between 6-8mg/dl It is highly efficacious and reliable way to achieve the desired Hb level patient compliance is assured with intravenous iron sucrose patient can be satisfactorily posted for surgery within a period of 3 weeks i.e. within her next menstrual period by reliably and effectively correcting her anemia with intravenous iron sucrose.


Keywords


Parenteral Fe therapy, Fe Sucrose, AUB

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References


Blanc B, Finch CA, Hallberg L. Nutritional anemia. Report of a WHO Scientific Group. WHO Tech Rep Ser. 1968;405:1-40.

Beutler E, Waalen J. The definition of anemia: what is the lower limit of normal of the blood hemoglobin concentration? Blood. 2006;107(5):1747-50.

World Health Organization. The prevalence of anemia in women: a tabulation of available information, 2nd edition, Geneva: WHO. 1992.

Luwang NC, Gupta VM, Khanna S. Anemia in pregnancy in a rural community of Varanasi. Indian Journal of Preventive Social Medicine. 1980;11:83-8.

Agarwal V, Tejawani S. Prevalence of iron deficiency anemia in Indian antenatal women especially in rural areas. Indian Medical Gazette. 1999;10:300-3.

Kumar V, Aster JC. Red blood cell and bleeding disorders. In Robbins and Cotran. Pathologic basis of disease, 7th edition; Elsevier. 2015:621.

Auerbach M, Rodgers GM. Intravenous iron. N Engl J Med. 2007;357:93.

Chertow GM, Mason PD, Nilsen VO, Ahlmen J. Update on adverse drug events associated with parenteral iron. Nephrol Dial Transplant. 2006;21:378.

Bailie GR, Clark JA, Lane CE, Lane PL. Hypersensitivity reactions and deaths associated with intravenous iron preparations. Nephrol Dial Transplant. 2005;20:1443-9.

Momen A, Meshari A, Nuaim L, Saddique A, Abotalib Z, Khashogji T, Abbas M. Intravenous iron sucrose complex in the treatment of iron deficiency anemia during pregnancy. Eur J Obstet Gynecol Reprod Biol. 1996;69:121-4.

Hallak M, Sharon AS, Diukman R, Auslender R, Abramovici H. Supplementing iron intravenously in pregnancy, a way to avoid blood transfusion. J Reprod Med. 1997;42:99-103.

Auerbach M, Goodnough LT, Picard D, Maniatis A. The role of intravenous iron in anemia management and transfusion avoidance. Transfusion. 2008;48:988.

World Health Organization iron deficiency anemia. Assessment, prevention and control. A guide for programme managers. Geneva: WHO; 2001. Available at http: //www.who.int /nutrition /publications/en/ida_assessment_prevention_control.pdf. Accessed on 10 January 2016.

World Health Organization. The World Health Report 2002. Reducing risks, promoting healthy life. Geneva: World Health Organization: 2002:1-248.

Alleyne M, Horne MK, Miller JL. Individualized treatment for iron-deficiency anemia in adults. Am J Med. 2008;121(11):943-8.

Cançado RD, Lobo C, Friedrich JR. Tratamento da anemia ferropriva com ferro via oral. Rev Bras Hematol Hemoter. 2010;32(2):114-20.

Auerbach M, Ballard H. Clinical use of intravenous iron: administration, efficacy and safety. Hematology Am Soc Hematol Educ Program. 2010:338-47.

Cançado RD, Lobo C, Friedrich JR. Tratamento da anemia ferropriva com ferro via parenteral. Rev Bras Hematol Hemoter. 2010;32(2):121-8.

Cançado RD, Figueiredo PON, Olivato MCA, Chiattone CS. Efficacy and safety of intravenous iron sucrose in treating adults with iron deficiency anemia. Rev Bras Hematol Hemoter. 2011;33(6):439-43.

Fishbane S, Kowalski EA. The comparative safety of intravenous iron dextran, iron saccharate, and sodium ferric gluconate. Semin Dial. 2000;13(6):381-4.

Chertow GM, Mason PD, Nilsen VO, Ahlmen J. Update on adverse drug events associated with parenteral iron. Nephrol Dial Transplant. 2006;21(2):378-82.

Auerbach M, Ballard H, Glaspy J. Clinical update: intravenous iron for anaemia. Lancet. 2007;369(9572):1502-4.

Levy TS, Hernández VS, Guerra GA, Rosas MV, Rodríguez MF, Islas CP. Anemia in Mexican women: results of two national probabilistic surveys. Salud Publica Mex. 2009;51(4):515-2.

Younis N, Khattab H, Zurayk H, Mouelhy M, Amin MF, Farag AM. A community study of gynecological and related morbidities in rural Egypt. Stud Fam Plann. 1993;24(3):175-86.

Vercellini P, Vendola N, Ragni G, Trespidi L, Oldani S, Crosignani PG. Abnormal uterine bleeding associated with iron-deficiency anemia. Etiology and role of hysteroscopy. J Reprod Med. 1993;38(7):502-4.

Kim YH, Chung HH, Kang SB, Kim SB, KimYT. Safety and usefulness of intravenous iron sucrose in the management of preoperative anemia in patients with menorrhagia: a phase iv, open-label, prospective, randomized study. Acta Haematol. 2009;121:37-41.

Munoz M, Garcia JA, Diez LAI, Campos A, Sebastianes C, Bisbe E. Usefulness of the administration of intravenous iron sucrose for the correction of preoperative anemia in major surgery patients. Med Clin (Barc). 2009;132(8):303-6.

Giannoulis C, Daniilidis A, Tantanasis T, Dinas K, Tzafettas J. Intravenous administration of iron sucrose for treating anemia in postpartum women. Hippokratia. 2009;13(1):38-40.

Dangsuwan P, Manchana T. Blood transfusion reduction with intravenous iron in gynecologic cancer patients receiving chemotherapy. Gynecol Oncol. 2010;116(3):522-5.

Dede A, Uygur D, Yilmaz B, Mungan T, Ugur M. Intravenous iron sucrose complex vs. oral ferrous sulfate for postpartum iron deficiency anemia. Int J Gynecol Obst. 2005;90:238-9.