To evaluate the efficacy and safety of single dose intravenous iron carboxymaltose verses multidose iron sucrose in post-partum cases of severe iron deficiency anemia

Urvashi Verma, Saroj Singh, Mukul Chandra, Mukesh Chandra, Ruchika Garg, Shikha Singh, Renu Rajvansh


Background: Iron deficiency is the most common nutritional deficiency worldwide. Anemia is the most common treatable, direct/indirect cause of maternal and neonatal morbidity and mortality in developing countries like India.

Methods: 100 cases with iron deficiency anemia in post-partum patient were selected from postpartum wards and assigned in two groups of 50 each. In group A iron carboxymaltose injection administered by intravenous infusion up to a maximum single dose of 20 ml of iron carboxymaltose injection (1000 mg of iron). In group B Iron sucrose was given as 200mg elemental iron (2 ampules of 5 ml) in 100ml of 0.9% normal saline infusion over 1 5 min alternate days up to 5 days. All patients were monitored for rise in hemoglobin level and any adverse effect at 2 weeks, 4 weeks, 8 weeks and 12 weeks of iron therapy.

Results: In group A mean Hemoglobin level rise is 3.95 g/dl and in group B it is 3.32 g/dl at 4 weeks of initial therapy. In group A 100% cases achieved target hemoglobin at 12 weeks after therapy while in group B 98% cases achieved target hemoglobin at 12 weeks after therapy. In group A 12% cases have grade 1 adverse reaction while in group B 20% cases have adverse reaction.

Conclusions: Administration of intravenous iron has a good clinical result, with minimum adverse reactions. Thus we can conclude that intravenous ferric carboxymaltose therapy is safe, convenient, more effective and faster acting than intravenous iron sucrose for treatment of severe iron deficiency anemia in postpartum patient.


Ferric carboxymaltose, Iron sucrose, Iron deficiency anemia, Hemoglobin

Full Text:



Morrison J, Patel ST, Watson W, Zaidi QR, Mangione A, Goss TF. Assessment of the prevalence and impact of anaemia on women hospitalized for gynaecology condition associated with heavy uterine bleeding. J Repord Med. 2008;53:323-30.

Bodnar LM, Cogswell ME, McDonald T. Have we forgotten the significance of postpartum iron deficiency anaemia? Am J Obstet Gynecol. 2005;193:36-44.

Broche DE, Gay C, Armand-Branger S, Grangeasse L, Terzibachian JJ. Acute postpartum anaemia. Clinical practice Leberecht a Haberlin F, Eberhard J. anaemia in puerperium; parenteral iron substitution renders erythropoietin therapy dispensable. Geburtshilfe Frauenheilkd.1995;55:167-70.

Prewusny KG, Huck R, Huck A, Breymann C. Parenteral iron sucrose complex. Br J Nutr. 2002;88:3-10, and interest of intravenous iron. Gynecol Obstet Fertil. 2004;32:613-9.

Al-Momen AK, Al-Meshari A, Al-Nuaim L, Saddique A, Abutalin Z, Khashogi T, et al. Intravenous iron sucrose complex in the treatment of iron deficiency anaemia during pregnancy. Eur J Obstet Gynecol Reprod Biol. 1996;69:121-4.

Bayoumeu F, Subiran-Cusset C, Baka NE, Eegagneur H, Monnier-Barbarino P, Laxenaire MC. Iron therapy in iron deficiency anaemia in pregnancy: intravenous route versus oral route. Am J Obstet Gynecol. 2002;186:518-22.

Umbreit IH, Conrad, Moore EG, Latocer LF. Iron absorption and cellular transport. Mobi (Ferrin/Paraferic) Paradigm Semin Hematol. 1998;35:13-26.

Willianmson C, Love S, Love EM, Conen H, Soldem K, Mclelland DB, et al. Serious hazards of transfusion initiative: analysis of the first two annual reports. BMJ. 1999;319:16-9.

Catling S. Blood conservation techniques in obstetrics: a UK perspective. Int J Obstet Anesth. 2007;6(3):241-9.

Ferraris VA, Davenport DL, Saha SP, Austin PC, Zwischenberger JB. Surgical outcomes and transfusion of minimal amounts of blood in the operating room. Arch Surg. 2012;147(1):49-55.

Greinacher A, Fendrich K, Brzenska R, Kiefel V, Hoffmann W. Implications of demographics on future blood supply: a population-based cross-sectional study. Transfusion. 2011;51(4):702-9.

Pfenniger A, Schuller C, Christoph P, Surbek D. Safety and efficacy of high-dose intravenous iron carboxymaltose vs. iron sucrose for treatment of postpartum anemia. J Perinat Med. 2012;40(4):397-402.

World Health Organization. Pregnancy, childbirth, postpartum and newborn care: a guide for essential practice. In: WHO, eds. WHO Guide. Geneva: World Health Organization; 2006. Funk F, Ryle P, Canclini C, Neiser S, Geisser P. The new generation of intravenous iron: chemistry, pharmacology and toxicology of ferric carboxymaltose. Arzneimittel Forsching. 2010;60(6a):345-53.

Bhandari S. efficacy and safety - the need for convenient and cost effective iron therapy in health care. NDT Plus. 2011;4(Suppl 1):i14-9.

Bhandari S. Update of a comparative analysis of cost minimization following the introduction of newly available iron therapies in hospital practice. Therapeut Clin Risk Manag. 2011;7:501-9(b).

Evestatiev R, Marteau P, Iqbal T, Khalif IL, Stein J, Bokemeyer B, et al. FERGIcor, a randomized controlled trial on ferric carboxymaltose for iron deficiency anaemia in inflammatory bowel disease. Gastroenterology. 2011 Sep;141(3)846-853.e1-2.

Breymann C, Gliga F, Bejenariu C, Stirzhova N. Comparative efficacy and safety of intravenous ferric carboxymaltose in the treatment of iron deficiency anaemia. Int J Gynaecol Obstet. 2008;101:67-73.

Seid MH, Derman RJ, Baker JB, Banach W, Goldberg C, Rogers R. Ferric carboxymaltose injection in the treatment of postpartum iron deficiency anaemia: a randomized controlled clinical trial. Am J Obstet Gynaecol. 2008;199:435-7.

Van Wyck DB, Martens MG, Seid MH, Baker JB, Mangione A. Intravenous ferric carboxymaltose compared with oral iron in the treatment of postpartum anaemia: a randomized controlled trial. Obstet Gynecol. 2007;110:267-78.