Intravenous versus oral iron therapy in treatment of postpartum anaemia

Abstract

INTRODUCTIONPostpartum anaemia is a common problem throughout the world and for most women is self limiting, resolving within a week. For some women however, particularly in resource-poor countries, it is a major cause of maternal morbidity and mortality.1 Postpartum haemoglobin (Hb) levels of <10 g/dl are observed in up to 30% of women, with more severe anaemia (Hb < 8g/dl) seen in 10%. Iron deficiency is the principal cause. This is partly attributable to an iron deficit during pregnancy, caused by the increased iron demands of the fetoplacental unit and an increased maternal red cell mass. 2Irrespective of mode of delivery, blood loss is a contributing factor, with 5% of deliveries involving loss of more than 1L. It appears to be higher in unfavorable socioeconomic conditions. The symptoms of postpartum anaemia vary and may include breathlessness, fatigue, palpitations, dizziness, maternal infections particularly of the urinary tract, lactation failure and prolonged hospital stay depending on the severity of blood loss and related anaemia. It has also been shown to be strongly associated with depression, stress and cognitive function in the postpartum period and may result in difficulty for the ABSTRACT Background: Postpartum iron deficiency anaemia (IDA) is common in women. Most women are treated with either oral iron supplementation or blood transfusion. Hence, the aim of our study was to compare the effect of treatment with either oral ferrous sulphate or intravenous ferrous sucrose on postpartum IDA. Methods: 100 postpartum women with proven iron deficiency anaemia with hemoglobin <9gm/dl and serum ferritin <15 µgm/l were included in the study. They were randomized to receive either oral ferrous sulphate 200 mg twice daily for 6 weeks (group 1) or intravenous ferrous sucrose 200 mg, two to three doses given on alternate days (group 2). Total iron deficit was calculated using a standard formula. Target hemoglobin was 11 gm/dl. Results were analysed by the students t-test and chi-square test. Hemoglobin, hematocrit, red cell indices and ferritin were measured on day 2-3, 1-2 weeks and 6 weeks postpartum Results: By 1-2 weeks, hemoglobin level in women treated with intravenous iron had risen from 7.81±0.849 to 9.88±0.760 gm/dl which was more than those treated with oral iron (p<0.01); although by 6 weeks, there was no significant difference between the two groups. Ferritin levels rose rapidly in those treated with intravenous iron and remained significantly higher than in those treated with oral iron (p<0.01). Conclusions: Intravenous iron sucrose increases the hemoglobin level more rapidly than oral ferrous sulphate in women with postpartum IDA. It also replenishes iron stores more rapidly.

Intravenous Versus Oral Iron Therapy for Postpartum Anemia

“…It was administered in hospital where facilities for monitoring and resuscitation are available. Dose was calculated by the following Ganzoni formula: Weight (in kgs)×(Target hemoglobin-Actual hemoglobin)×2.4 [13].…”