DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20193561

Role of IV administered Iron sucrose with recombinant erythropoietin in the treatment of moderate and severe iron deficiency anemia in the third trimester of pregnancy

Namrita Sandhu, Sanjay Singh

Abstract


Background: Iron deficiency Anemia in pregnancy is one of the most common and intractable nutritional problems in the world today. The objective of this study was to investigate the therapeutic efficacy and safety of rHuEPO combined with IV iron sucrose, in the treatment of pregnant women in third trimester with moderate and severe iron deficiency anemia and whether addition of erythropoietin will increase the rate of rise of Hb without compromising on the safety of the therapy.

Methods: 60 pregnant women in the third trimester, diagnosed as cases of moderate and severe iron deficiency anemia were enrolled in this study with 30 subjects in each of the 2 groups. Recombinant Erythropoietin 2000 IU s/c and Inj Iron sucrose 100 mg slow intravenously in 100 ml 0.9% NS over 1 hr on alternate days was administered to the case group and the control group was administered only iron sucrose slow IV in the same dose on alternate days till target Hb (11gm%) was reached. Efficacy measures were reticulocyte count, increase in Hb/week, time to target Hb level and need for continued therapy after 4 weeks.

Results: In the case group, the increases in Hb were greater after 1 week of treatment and this was found to be significant (P < .01), the median duration of therapy was shorter in the case group (22 versus 34 days), with more patients reaching the target hemoglobin level by 4 weeks as opposed to 7 weeks in the control group. Average rise in Hb/week was much more in the case group. The groups did not differ with respect to maternal and fetal safety parameters.

Conclusions: Iron sucrose plus rhEPO is an effective treatment for iron deficiency anemia in pregnancy probably because of a synergistic action, with rhEPO stimulating erythropoiesis and iron sucrose delivering iron for hemoglobin synthesis.

 


Keywords


Haemoglobin, Inj Iron sucrose, Iron deficiency anemia, Recombinant Erythropoietin, Reticulocyte count, Serum Ferritin, Third trimester pregnancy

Full Text:

PDF

References


Alper BS, Kimber R, Kudumala Reddy A. Using ferritin levels to determine iron-deficiency anemia in pregnancy. J Fam Pract. 2000;49(9):829-32.

Breymann C, Fibach E, Visca E, Huettner C, Huch A, Huch R. Induction of fetal hemoglobin synthesis with recombinant human erythropoietin in anemic patients with heterozygous betathalassemia during pregnancy. J Matern Fetal Med. 1999;8(1):1-7.

Hamstra R, Block M, Schocket A. Intravenous iron dextran in clinical medicine. JAMA. 1980;243(17):1726.

Macdougall I, Hutton R, Cavill I. Poor response to treatment of renal anemia with erythropoietin corrected by iron given intravenously. Br Med J. 1989;299(6692):157.

Singh K, Fong YF, Kuperan P. A comparison between intravenous iron polymatose complex (ferrum Hausmann) and oral ferrous fumarate in the treatment of iron deficiency anaemia in pregnancy. Eur J Haematol. 1998;60(2):119-24.

Breymann C, Major A, Richter C, Huch R, Huch A. Recombinant human erythropoietin and parenteral iron in the treatment of pregnancy anemia: a pilot study. J Perinat Med. 1995;23(1-2):89-98.

Adamson JW. Iron deficiency and other hypoproliferative anemias. In: Braunwald E, Fauci AS, Kasper DL, editors. Harrison's textbook of internal medicine. 17th ed. New York: McGraw Hill; 2008: 628-33.

Van Wyck DB. Safety and efficacy of iron sucrose in patients sensitive to iron dextran: North American clinical trial. Am J Kidney Dis. 2000;36(1):88-97.

Allen LH. Anemia and iron deficiency: effects on pregnancy outcome. Am J Clin Nutr. 2000 May; 71(5 Suppl):1280S-4S.

Makrydimas G, Lolis D, Lialios G, Tsiara S, Georgiou I, Bourantas KL. Recombinant human erythropoietin treatment of postpartum anemia: preliminary results. Eur J Obstet Gynecol Reprod Biol. 1998;81:27-31.

Braga J, Marques R, Branco A, Gonçalves J, Lobato L, Pimentel JP, et al. Maternal and perinatal implications of the use of human recombinant erythropoietin. Acta Obstet Gynecol Scand. 1996;75(5):449-53.

Harris SA, Payne G Jr, Putman JM. Erythropoietin treatment of erythropoietin-deficient anemia without renal disease during pregnancy. Obstet Gynecol. 1996;87(5 Pt 2):812-4.

Juncà J, Vela D, Orts M, Riutort N, Feliu E. Treating the anaemia of a pregnancy with heterozygous β thalassemia with recombinant human erythropoietin(r-HuEPO). Eur J Haematol. 1995;55(4):277-8.

Danko J, Huch R, Huch A: Epoetin - alfa for treatment of postpartum anemia. Lancet. 1990;335(8691):737-8.

Breymann C, Zimmermann R, Huch R, Huch A. Use of recombinant human erythropoietin in combination with parenteral iron in the treatment of postpartum anemia. Eur J ClinInvest. 1996;26(2):123-30.

Junca J, Vela D, Orta M, Riutort N, Feliu E. Treating theanemia of a pregnancy with heterozygous beta - thalassaemia with recombinant human erythropoietin ( r-HuEPO). Eur J Haematol. 1995:55(4)-277-8.

Bourantas K, Makrydimas G, Georgiou J, Tsiara S, Lolis D. Preliminary results with administration of recombinant human erythropoietin in sickle cell / beta- thalassemia patients during pregnancy . Eur J Haematol. 1996:56(5):326-8.

Breymann C, Visca E, Huch R, Huch A. Efficacy and safety of intravenously administered iron sucrose with and without adjuvant recombinant human erythropoietin for the treatment of resistant iron deficiency anemia during pregnancy. Am J Obstet Gynecol. 2001;184(4):662-7.

Sifakis S, Angelakis E, Vardakia E, Koumantaki Y, Matalliotakis I, Koumantakis E. Erythropoietin in the treatment of iron deficiency anemia during pregnancy. Gynecol Obstet Invest. 2001;51(3):150-6.

Goodnough LT, Price TH, Rudnick S. Iron-restricted erythropoiesis as a limitation to autologous blood donation in the erythropoietin stimulated bone marrow. J Lab Clin Med. 1991;118(3):289-96.

Macdougall IC, Hutton RD, Cavill I, Coles GA, Williams JD. Poor response to treatment of renal anaemia with erythropoietin corrected by iron given intravenously. BMJ. 1989;299(6692):157-8.

Cazzola M, Mercuriali F, Brugnara C. Use of recombinant human erythropoietin outside the setting of uremia. Blood. 1997;89(12):4248-67.

Goldstein JD, Garry DJ, Maulik D. Obstetric conditions and erythropoietin levels. Am J Obstet Gynecol. 2000;182(5):1055-7.

Beguin Y, Lipscei G, Thoumsin H, Fillet G. Blunted erythropoietin production and decreased erythropoiesis in early pregnancy. Blood. 1991;78(1):89-91.

Fuchs D, Weiss G, Werner-Felmayer G, Wachter H. Erythropoietin and decreased erythropoiesis in pregnancy. Blood. 1992;79(2):533.

Hudon L, Belfort MA, Broome DR. Diagnosis and management of placenta percreta: a review. Obstet Gynecol Surv. 1998;53:509-17.

Vora M, Gruslin A. Erythropoietin in obstetrics [published erratum appears in Obstet Gynecol Surv 1998;53:736]. Obstet Gynecol Surv. 1998;53(8):500-8.