Patient blood management in obstetrics: management of anaemia and haematinic deficiencies in pregnancy and in the post‐partum period: NATA consensus statement

Múñoz, Manuel; Peña-Rosas, Juan Pablo; Robinson, S.; Milman, Nils; Holzgreve, Wolfgang; Breymann, Christian; Goffinet, François; Nizard, J.; Christory, F.; Samama, Charles‐Marc; Hardy, Jean‐François

doi:10.1111/tme.12443

Cited by 173 publications

(327 citation statements)

References 113 publications

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“…4 Consider intravenous iron for women with confirmed IDA who fail to respond to or are intolerant of oral iron [37]. …”

Section: Resultsmentioning

confidence: 99%

Perinatal Iron Deficiency: Implications for Mothers and Infants

Juul¹,

Derman²,

Auerbach³

2019

Neonatology

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Iron deficiency, with or without anemia, is common in pregnant women. In fact, nearly 30% of reproductive-age women are anemic worldwide, and anemia in pregnancy has an estimated global prevalence of 38%. Severe anemia can substantially increase the risk of maternal mortality, and can adversely affect fetal development. In this review, we examine the available data regarding epidemiology and consequences of iron deficiency in mothers and infants, current treatment strategies, and make recommendations for screening and treatment of iron deficiency anemia in gravidas and neonates.

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“…4 Consider intravenous iron for women with confirmed IDA who fail to respond to or are intolerant of oral iron [37]. …”

Section: Resultsmentioning

confidence: 99%

Perinatal Iron Deficiency: Implications for Mothers and Infants

Juul¹,

Derman²,

Auerbach³

2019

Neonatology

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“…Ironically, despite shortfall in provision of blood, inappropriate transfusion and overtransfusion is not uncommon, and likely stems from relatively little education in transfusion medicine, coupled with a lack of standardization of transfusion practices as reflected by nonadherence to evidence‐based guidelines . Pertinent to the obstetric population, the Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis in collaboration with the International Federation of Gynaecology and Obstetrics and the European Board and College of Obstetrics and Gynaecology have published recommendations on prenatal iron therapy that could mitigate risk of transfusion . These and other guidelines on patient blood management were developed during or after the index study …”

Section: Discussionmentioning

confidence: 99%

“…Ironically, despite shortfall in provision of blood, inappropriate transfusion and overtransfusion is not uncommon, 24 and likely stems from relatively little education in transfusion medicine, coupled with a lack of standardization of transfusion practices as reflected by nonadherence to evidence-based guidelines. 25 26 These and other guidelines on patient blood management were developed during or after the index study. 27 There were limitations to the study.…”

Section: Discussionmentioning

confidence: 99%

Antenatal blood transfusion in South Africa: indications and practice in a high‐HIV‐prevalence setting

et al. 2020

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BACKGROUND Globally, data on antenatal blood transfusion practices are scarce. We sought to characterize the epidemiology of antenatal transfusion in South Africa. STUDY DESIGN AND METHODS A cross‐sectional study was conducted of women who were transfused during pregnancy (>48 hr before anticipated delivery) at two hospitals in Durban and Soweto in 2014 to 2015. Medical record data on demographics, obstetric history, anemia, HIV status, and indications for blood transfusion were abstracted. RESULTS The records on a total of 560 transfused pregnant women were evaluated; mean age was 28 years, 98% were of black African ethnicity, and 28% were HIV positive. At time of transfusion, one‐half were in the first trimester. Hemorrhage was noted in 76% of women, most of which was associated with abortion (67%) or ectopic pregnancy (27%). Most women were transfused with red blood cells (RBCs; median, 2 units); 14% of women were transfused with plasma and 2% with platelets. Median pre‐ and posttransfusion hemoglobin levels were 6.9 g/dL and 9.2 g/dL, respectively; the latter differed by hospital (8.7 g/dL vs. 9.5 g/dL; p < 0.01). Hemorrhage was associated with missing HIV status, lower gestational age, and transfusion of 3 or more RBC units (all p < 0.01). In contrast, diagnoses of anemia (Soweto only) were associated with HIV infection, later gestational age, and lower (<3 units) RBC dose (all p < 0.01). CONCLUSION Abortion and ectopic pregnancy with associated hemorrhage were the leading indications for antenatal transfusion and were concentrated in early gestation. By contrast, anemia was associated with HIV infection and transfusion in the third trimester.

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“…The symptoms associated with IDA include fatigue, palpitations, dyspnoea, headache, lack of concentration, dizziness, leg cramps, insomnia and pica . Treatment of IDA has been shown to improve energy, activity, quality of life (QOL), work capacity, cardiac function, sexual function, cognition and outcome in a variety of clinical settings …”

Section: Introductionmentioning

confidence: 99%

“…sexual function, cognition and outcome in a variety of clinical settings. [3][4][5][6][7] Oral iron is generally accepted as the treatment of choice for the majority of patients due to ease of administration, low cost and perceived effectiveness, but the incidence of side effects is considerable, thus, limiting adherence with long-term therapy. 8,9 A recent Cochrane Review raised doubts regarding the therapeutic value of oral iron for correcting postpartum anaemia.…”

mentioning

confidence: 99%

Pharmacokinetics of ferric bepectate—a new intravenous iron drug for treating iron deficiency

Múñoz

Olsen

Petersen

et al. 2019

Basic Clin Pharma Tox

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IV iron is indicated in clinical conditions, where rapid anaemia alleviation and repletion of iron stores are required. The acute toxicity of IV iron is ascribed to the presence of labile iron in plasma. Thus, shorter plasma residence time might improve the safety profile, even for compounds holding‐on the iron tightly. In this single‐centre, open‐label, single‐dose escalation study, we evaluated the elimination kinetics of ferric bepectate (FBP) compared to those of ferric carboxymaltose (FCM). Thirty‐three iron‐depleted anaemic patients who had undergone cardiac surgery were included and received 200, 500 or 1500 mg FBP or 500 mg FCM. Plasma drug curves were subjected to model‐free analysis. Because saturation kinetics was found, a compartmental model with limited elimination capacity was applied. Urinary iron excretion was also analysed. The initial non‐compartmental analysis revealed an increasing AUC/dose ratio for FBP. For both drugs, the central distribution compartment corresponded to plasma volume, and elimination followed Michaelis‐Menten saturation kinetics. Maximal elimination rates (Vmax) were 224 mg/h and 81 mg/h for FBP 500 mg and FCM 500 mg, respectively; drug concentrations at half Vmax (Km), 99 mg/L and 212 mg/L, respectively; and terminal plasma half‐life (T½), 3.05 h and 8.96 h, respectively. Both drugs were equally effective in eliciting an early ferritin rise. Urinary iron excretion was measurable in all patients receiving FCM but not in those receiving FBP, which was well tolerated. Intravenous iron drugs are subject to capacity‐limited elimination with different saturation thresholds. Urinary iron excretion can be used as a surrogate for labile plasma iron.

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Patient blood management in obstetrics: management of anaemia and haematinic deficiencies in pregnancy and in the post‐partum period: NATA consensus statement

Cited by 173 publications

References 113 publications

Perinatal Iron Deficiency: Implications for Mothers and Infants

Perinatal Iron Deficiency: Implications for Mothers and Infants

Antenatal blood transfusion in South Africa: indications and practice in a high‐HIV‐prevalence setting

Pharmacokinetics of ferric bepectate—a new intravenous iron drug for treating iron deficiency

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