Effect of total dose infusion of iron dextran on the storage iron content of the human placenta.

Abstract

SUMMARY In a series of pregnant women with iron deficiency anaemia treated by a total dose infusion of iron dextran, the non-haem iron content of the placenta at term was studied histochemically and by chemical analysis. Within a few days of the infusion the Prussian blue reaction on the placenta was very strong, but was negative by ten days after the infusion. Chemical analysis showed that both the water-insoluble fraction (haemosiderin) and the water-soluble fraction (ferritin) of the non-haem iron were increased soon after the infusion, but three weeks after the infusion they were almost the same as in untreated controls. Pinocytosis of iron dextran by the trophoblast and increased transport of transferrin-bound iron to the placenta are considered as possible causes for this large uptake of iron by the placenta.The histochemical examination of a placenta obtained from a stillbirth which occurred three days after the mother had received a total dose infusion of iron dextran, at 32 wk gestation, revealed very large amounts of haemosiderin in the trophoblast. This is in contrast to the findings of Pathak et all who concluded from a study of a large series of irondeficient patients treated with total dose infusion of iron dextran that there was no resulting increase of stainable iron in the placenta. There are two features of the stillborn baby which may have contributed to the accumulation of an unusually large amount of haemosiderin in the placenta. First, the foetus was macerated, so that transfer of iron to the foetus must have ceased soon after the infusion, and secondly, the gestational age of the placenta was only 32 wk when it was examined. Further studies were therefore made to assess in more detail the effect on placental iron of infusions of iron dextran given at different stages of pregnancy. In addition to histochemical examination of the placenta, the two forms of storage iron, haemosiderin and ferritin, were estimated respectively as the water-insoluble and water-soluble fractions of the non-haem iron. Non-haem iron For the estimation of non-haem iron the amnion and chorion were removed from the rest of the placenta which was then blotted dry between layers of filter paper and the whole of it was homogenised. The homogenate was again blotted dry to remove released blood and a weighed aliquot was shaken for 15 min with water, which had been deionised and then glass-distilled, to extract the water-soluble iron. After centrifugation the supernatant was removed for estimation of its iron content and the deposit was extracted once more with water.

Management of Restless Legs Syndrome in Pregnancy and Lactation

“…Although low-molecular-weight iron dextran crosses the placenta there are several studies demonstrating its safety in pregnancy. 27,36 A practical aspect to consider is that it is frequently out of stock in pharmacies. On the other hand, there are only 2 studies evaluating the safety of ferric carboxymaltose in pregnancy.…”