Comparison of intravenous and oral iron treatment in patients with iron deficiency anemia in postpartum period

Yıl 2018, , 336 - 341, 28.12.2018

Pınar Kadiroğulları , Kerem Doğa Seçkin , Olgu İçten Bafali İbrahim Polat

https://doi.org/10.18663/tjcl.468809

Cited By: 1

Öz

Aim: The aim of the study is to
evaluate the efficacy, safety and tolerability of intravenous ferric
carboxymaltose in women with postpartum anemia compared to oral ferrous
sulfate.

Material and Methods: Our study was created by
reviewing the records from patients who had hemoglobin levels between 8 and 10
g/dl on postpartum first day, and those who received intravenous iron treatment
during hospitalization and who received oral iron treatment after discharge.
Patients in group 1; In the postpartum first day, patients who were treated
with ferric carboxymaltose treatment at a rate of 15 mg / kg maximum 1000 mg
and patients in the second group were treated with oral ferrous sulphate (100
mg) 2x1 for 6 weeks after postpartum discharge. The data of the patients in
both groups and their results were analyzed and hemoglobin, hematocrit and
ferritin levels were recorded on the postpartum 1st, 14th and 40th day.

Results: The mean age of these patients
was 29.8 ± 7.1 in group 1, and 29.0 ± 5.3 in group 2, respectively. There was
no significant difference between the groups in terms of gravidity, parity
numbers, delivery patterns and Hb and Htc levels before the treatment. The Hb and
Htc levels on first day after treatment were significantly higher in the group
1 received iv iron treatment compared to the group 2 received oral iron therapy
(p <0.005). Iv iron treatment was found to increase Hb and Htc levels
rapidly. The mean of Hb, Htc and ferritin levels on 14th day was significantly
higher in group 1 (p <0.005). No significant difference was observed between
the groups at the 40th day.

Discussion: Intravenous ferric carboxymaltose
is safe and well tolerated in the treatment of postpartum iron deficiency
anemia. Intravenous iron therapy increases the hemoglobin levels in women with
postpartum anemia faster than oral ferrous sulphate. It also fills iron store
more quickly.

Anahtar Kelimeler

Ferric carboxymaltose, Ferrous sulfate, Intravenous treatment, Oral treatment, Postpartum iron deficiency anemia

Postpartum dönemde demir eksikliği anemisi olan hastalarda intravenöz ve oral demir tedavisinin karşılaştırması

Öz

Amaç : Kadınlarda postpartum demir
eksikliği anemisi oldukça yaygındır. Çoğu kadın oral veya intravenöz (iv) demir
ile ya da kan transfüzyonu ile tedavi edilir. Bu çalışmanın amacı, intravenöz
ferrik karboksimaltozun postpartum anemisi olan kadınlarda ferröz sülfatla
karşılaştırıldığında etkinliğini, güvenilirliğini ve tolere edilebilirliğini
değerlendirmektir.

Gereç ve Yöntemler: Çalışmamız postpartum 1.günde
hemoglobin değeri 8 ile 10 g/dl arasında olan hastalardan, hastanede yatışı
süresince iv demir tedavisi verilen ve taburculuk sonrası oral demir tedavisi
alan hastaların dosyalarının incelenmesi ile oluşturuldu. 1.grubu oluşturan
hastalar; postpartum 1.günde 15mg/kg den maksimum 1000 mg iv ferrik
karboksimaltoz tedavisi alan (n:100), 2.grubu oluşturan hastalar ise postpartum
taburculuk ile beraber oral ferroz sulfat (100 mg) / 2x1 den 6 hafta boyunca
tedavisi düzenlenen hastalardı (n:100). Her iki grupta yer alan hastaların
sistem üzerinden bilgileri ve tetkik sonuçları incelendi ve postpartum 1.gün,
14.gün ve 40.gün hemoglobin, hematokrit ve ferritin düzeyleri kaydedildi.

Bulgular: Bu hastalardan 1. grubun yaş
ortalaması 29.8, 2. grubun yaş ortalaması 29.0 olarak
saptandı. Gruplar arasında gravida ve parite sayıları, doğum şekilleri ve
tedavi öncesi bakılan hemoglobin (Hb) ve hematokrit (Htc) değerleri arasında
fark yoktu. Tedavi sonrası 1. Gün bakılan Hb ve Htc değerleri iv demir tedavisi
alan 1.grupta, oral demir tedavisi alan 2.gruba göre anlamlı derecede yüksekti
(p<0.005). İv demir tedavisinin Hb ve Htc değerlerini hızlı artırdığı
saptandı. 14. Gün bakılan Hb, Htc ve ferritin değerleri ortalaması 1. grupta
anlamlı olarak daha yüksekti (p<0.005). Gruplar arasında 40. Gün bakılan
parametrelerde anlamlı fark görülmedi.

Tartışma : Postpartum demir eksikliği
anemisinin tedavisinde intravenöz ferrik karboksimaltoz güvenli ve iyi tolere
edilebilmektedir. İntravenöz demir tedavisinin postpartum anemisi olan
kadınlarda hemoglobin seviyesini oral ferröz sülfattan daha hızlı arttırdığı
gösterilmiştir. Ayrıca demir depolarını daha hızlı bir şekilde doldurduğu
görülmüştür.

Anahtar Kelimeler

Demir Karboksimaltoz, Demir Sülfat, Postpartum anemi, İntravenöz tedavi, Oral tedavi

Kaynakça

• 1. Bailie GR, Mason NA, Valaoras TG. Safety and tolerability of intravenous ferric carboxymaltose in patients with iron deficiency anemia. Hemodial Int 2010; 14: 47 – 54.
• 2. Bashiri A, Burstein E, Sheiner E, Mazor M. Anemia during pregnancy and treatment with intravenous iron: review of the literature. Eur J Obstet Gynecol Reprod Biol 2003; 110: 2 – 7.
• 3. 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.
• 4. Bodnar LM, Cogswell ME, McDonald T. Have we forgotten the significance of postpartum iron deficiency? Am J Obstet Gynecol 2005; 193: 36-44.
• 5. Bhandal N, Russell R. Intravenous versus oral iron therapy for postpartum anaemia. Br J Obstet Gynaecol 2006; 113: 1248 – 52.
• 6. Beard JL, Hendricks MK, Perez EM et al. Maternal iron deficiency anemia affects postpartum emotions and cognition. J Nutr 2005; 135: 267-72.
• 7. Ahmed K, Saqid I, Yousuf AW. Injectable iron therapy: intramuscular vs. intravenous therapy. Biomedics 2000; 16: 44-47.
• 8. Pernoll ML. Iron deficiency anemia. In: Pernoll ML (ed). Benson and Pernoll’s handbook of obstetrics and gynecology10th ed. Columbus (OH): The McGraw-Hill Companies, Inc; 2001. p. 435-7.
• 9. Seid MH, Derman RJ, Baker JB, Banach W, Goldberg C, Rogers R. Ferric carboxymaltose injection in the treatment of post partum iron defi ciency anemia: a randomized controlled clinical trial. Am J Obstet Gynecol 2008; 199: 4351 – 57.
• 10. 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 [Abstract].
• 11. Danielson BG, Geisser P, SchneiderW [eds]. Iron therapy with special emphasis on intravenous administration. 1st ed. St. Gallen, Switzerland: Vifor (International) Inc; 1996.
• 12. Huch R, Breymann C. Anaemia in pregnancy and postpartum. 2nd ed. Bremen, Germany: Uni-Med Science Verlag; 2006.
• 13. Chamate E. Treatment of iron deficiency anemia in pregnancy and the immediate puerperium and other ferropenic conditions with saccharated iron administered intravenously in fractionated doses. Abstract at XIVth International Congress of Haematology; 1972; 1972. Sao Paolo, Brasil.
• 14. Auerbach M, Coyne D, Ballard H. Intravenous iron: from anathema to standard of care. Am J Hematol 2008; 83: 580 – 88.
• 15. Seid MH, Mangione A, Valaoras TG et al. Safety profile of iron carboxymaltose, a new high dose intravenous iron in patients with iron deficiency anemia. Blood 2006; 108: 3739 [Abstract].
• 16. Breymann C, Honegger C, Holzgreve W, Surbek D. Diagnosis and treatment of iron deficiency anaemia during pregnancy and postpartum. Arch Gynecol Obstet 2010; 282: 577-80.
• 17. 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.
• 18. Breymann C, Gliga F, Bejenariu C, Strizhova N. Comparative efficacy and safety of intravenous ferric carboxymaltose in the treatment of postpartum iron deficiency anemia. International Journal of Gynecology and Obstetrics 2008; 101: 67-73
• 19. Beshara S, Lundqvist H, Sundin J, Lubberink M, Tolmachev V, Valind S, et al. Pharmacokinetics and red cell utilization of iron (III) hydroxidesucrose complex in anaemic patients: a study using positron emission tomography. Br J Haematol 1999; 104: 296–302.
• 20. Hallberg L, Ryttinger L, Sölvell 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.
• 21. Bonnar J, Goldberg A, Smith JA. Do pregnant women take their iron? Lancet 1969; 1: 457-58.
• 22. Breymann C. The use of iron sucrose complex for anemia in pregnancy and the postpartum period. Semin Hematol 2006; 43: 628–31.
• 23. Burns DL, Mascioli EA, Bistrian BR. Parenteral iron dextran therapy: a review. Nutrition 1995; 11: 163–68.
• 24. Venofer: iron sucrose injection USP. Full prescribing information. http://www.venofer.com/VenoferHCP/images/Venofer_ Package.pdf.
• 25. Perewunsnyk G, Huch R, Huch A, Breymann C. Parenteral iron therapy in obstetrics: 8 years experience with iron-sucrose complex. Br J Nutr 2002; 88: 3–10.
• 26. Crichton R, Danielson B, Geisser P. Iron therapy. Bremen, Germany: Uni-Med Verlag; 2005.
• 27. Al-Momen AK, al-Meshari A, al-Nuaim L, Saddique A, Abotalib Z, Khashogji T, et al. Intravenous iron sucrose complex in the treatment of iron deficiency anemia during pregnancy. Eur J Obstet Gynecol Reprod Biol 1996; 69: 121–24.