Intravenous Iron Sucrose Therapy in Iron Deficiency Anemia in Antenatal and Postnatal Patients

Abstract

Introduction: Iron deficiency anemia is the most common nutritional deficiency in pregnancy and more common in developing countries which is aggravated due to increased demand and blood loss during delivery. Though there are different methods for treating iron deficiency anemia. Iron sucrose is being used because of its minimal side effects. This study was undertaken to evaluate the response and effect of intravenous iron sucrose given to patient in antenatal and postnatal period with moderate iron deficiency anemia.
 Methods: A hospital based prospective study was conducted 1st Jan 2013-30th Dec 2014 in the department of obstetrics and gynecology Kathmandu Medical College, Teaching Hospital Kathmandu, Nepal. Antenatal and postnatal patients with hemoglobin between 5-9 gm% with diagnosed iron deficiency anemia were included in the study. The aim was to bring her hemoglobin level to 11gm%.
 Results: All together 37 patients were enrolled out of which two patient were dropped due to allergic reaction and 35 patients were included in study. Iron sucrose therapy is effective in achieving target hemoglobin of 11gm/dl in 80% of patients. It showed that intravenous iron sucrose significantly (P < 0.001) increase hemoglobin level within two weeks of therapy without any major adverse effects.
 Conclusions: Iron sucrose therapy is safe, effective and well tolerated for the treatment of iron deficiency anemia. Parental iron therapy was effective in increasing hemoglobin, serum ferritin and other hematological parameters in antenatal and postnatal patients with anemia. The treatment will help to reduce the risk of maternal complication during pregnancy and postpartum and its adverse effect to fetus. 
 Keywords: iron deficiency anemia; intravenous iron; pregnancy.

A systematic review and narrative synthesis of antenatal interventions to improve maternal and neonatal health in Nepal

“…Of note, 6 studies were RCTs, 21 , 22 , 23 , 24 , 25 , 26 and 6 more were nonrandomized controlled, that is, cluster-controlled 27 , 28 , 29 , 30 or were before and after studies. 31 , 32 In addition, 9 were cohort studies, 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 2 were cross-sectional, 42 , 43 1 was a pure qualitative study 44 , and another had cluster-controlled and qualitative elements. 45 Notably, 15 of the studies involved community-based interventions, 22 , 23 , 26 , 27 , 28 , 29 , 31 , 34 , 36 , 37 , 38 , 39 , 40 , 44 , 45 9 were hospital-based, 21 , 24 , 25 , 30 , 32 , 33 , 35 , 42 , 43 , and 1 contained elements of both.…”

“…31 , 32 In addition, 9 were cohort studies, 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 2 were cross-sectional, 42 , 43 1 was a pure qualitative study 44 , and another had cluster-controlled and qualitative elements. 45 Notably, 15 of the studies involved community-based interventions, 22 , 23 , 26 , 27 , 28 , 29 , 31 , 34 , 36 , 37 , 38 , 39 , 40 , 44 , 45 9 were hospital-based, 21 , 24 , 25 , 30 , 32 , 33 , 35 , 42 , 43 , and 1 contained elements of both. 41 The detailed summaries of the included studies can be found in Table 4 .…”

“…More than half of all studies (14/25) 22 , 23 , 24 , 27 , 31 , 32 , 33 , 34 , 35 , 37 , 40 , 41 , 43 , 44 were of medium or low quality, and a similar number (13/25) 22 , 23 , 27 , 31 , 32 , 33 , 37 , 40 , 41 , 42 , 43 , 44 , 45 were at a medium or high risk of bias ( Table 1 ).…”

“… Institutional deliveries: Significantly more institutional deliveries (OR, 1.46; 95% CI, 1.03–2.06; n=2651) and lower rates of colostrum discarding (OR, 0.71; 95% CI, 0.54–0.93; n=2548) were observed in the PLA+food arm compared with control (institutional delivery, n=2251; colostrum, n=2087). Cost: Cash transfer amount and some staff costs documented, but overall costs of intervention/implementation not documented Sharma and Tiwari 32 2015 Iron sucrose infusion: Iron sucrose was administered as 200 mg elemental iron in 100 mL of 9% normal saline infusion over 1 h everyday up to total calculated dose. Design: Before and after study Setting: Hospital Duration: 12 mo District: Kathmandu No.…”

“…Notably, 6 studies involved iron supplementation, and all showed reductions in the rates of iron deficiency anemia. The mean hemoglobin (Hb) increased following treatment with iron sucrose therapy 32 , 39 , 46 and with iron supplementation alongside vitamin A and riboflavin. 22 Greater improvements in the Hb levels were seen when an educational package was delivered alongside the supplementation, compared with supplementation alone or supplementation with pill counting, although the differences in the mean change to hemoglobin were small.…”