Management of postpartum iron deficiency anemia: review of literature
Keywords:Iron deficiency, Intravenous iron, Oral iron, Postpartum anemia
Anemia is a condition in which either the number of circulating red blood cells or their hemoglobin concentration is decreased. As a result, there is decreased transport of oxygen from the lungs to peripheral tissues. The standard approach to treatment of postpartum iron deficiency anemia is oral iron supplementation, with blood transfusion reserved for more server or symptomatic cases. There are a number of hazards of allogenic blood transfusion including transfusion of the wrong blood, infection, anaphylaxis and lung injury, any of which will be devastating for a young mother. These hazards, together with the national shortage of blood products, mean that transfusion should be viewed as a last resort in otherwise young and healthy women. Currently, there are many iron preparations available containing different types of iron salts, including ferrous sulfate, ferrous fumarate, ferrous ascorbate but common adverse drug reactions found with these preparations are mainly gastrointestinal intolerance like nausea, vomiting, constipation, diarrhoea, abdominal pain, while ferrous bis-glycinate (fully reacted chelated amino acid form of iron) rarely make complication. Two types of intravenous (IV) preparations available are IV iron sucrose and IV ferric carboxymaltose. IV iron sucrose is safe, effective and economical. Reported incidence of adverse reactions with IV iron sucrose is less as compared to older iron preparations (Iron dextran, iron sorbitol), but it requires multiple doses and prolonged infusion time. Intramuscular iron sucrose complex is particularly contraindicated because of poor absorption. It was also stated that when iron dextran is given intravenously up to 30% of patients suffer from adverse effects which include arthritis, fever, urticaria and anaphylaxis.
Bodnar LM, Cogswell ME, Scanlon KS. Low income postpartum women are at risk of iron deficiency. J Nutr. 2002;132(8):2298-302.
World Health Organization (WHO) (1992): The Prevalence of Anaemia in Women: a tabulation of available information, Division of Family Health, Maternal Health and Safe Motherhood Programme, Division of Health Protection and Promotion, Nutrition Programme; WHO, 2nd ed. World Health Organization, Geneva, Switzerland.
Milman N, Bergholt T, Eriksen L, Byg KE, Graudal N, Pedersen P, et al. Iron prophylaxis during pregnancy-how much iron is needed? A randomized dose-response study of 20-80 mg ferrous iron daily in pregnant women. Acta Obstet Gynecol Scand. 2005;84(3):238-47.
Khalafallah A, Dennis A, Bates J, Bates G, Robertson IK, Smith L, et al. A prospective randomized, controlled trial of intravenous versus oral iron for moderate iron deficiency anaemia of pregnancy. J Int Med. 2010;268(3):286-95.
Anderson C, Aronson I, Jacobs P. Erythrocyte deformability is reduced and fragility increased by iron deficiency. Hematol. 1999;4(5):457-60.
Naigamwalla D, Webb J and Giger U. Iron deficiency anemia. Can Vet J. 2012;53:250-6.
Weiss G. Iron metabolism in the anemia of chronic disease. Biochimica Biophysica Acta (BBA)-General Subjects. 2009;1790(7):682-93.
Katodritou E, Zervas K, Terpos E, Brugnara C. Use of erythropoiesis stimulating agents and intravenous iron for cancer and treatment‐related anaemia: the need for predictors and indicators of effectiveness has not abated. Brit J Haematol. 2008;142(1):3-10.
Johnson-Wimbley TD, Graham DY. Diagnosis and management of iron deficiency anemia in the 21st century. Ther Adv Gastroenterol. 2011;4(3):177-84.
Bermejo F, García-López S. A guide to diagnosis of iron deficiency and iron deficiency anemia in digestive diseases. World J Gastroenterol: WJG. 2009;15(37):4638-43.
Clark S. Iron deficiency anemia: Diagnosis and management. Curr Opin Gastroenterol. 2009;25:122-8.
Conrad M and Umbreit J. Iron absorption the mucin-mobilferrinintegrin pathway. A competitive pathway for metal absorption. Am J Hematol. 1993;42:67-73.
Kumar A, Jain S, Singh N, Singh T. Oral versus high dose parenteral iron supplementation in pregnancy. Int J Gynecol Obstet. 2005;89(1):7-13.
Sharma N. Iron absorption: IPC therapy is superior to conventional iron salts. Obstet Gynecol. 2001:515-9.
Barton JC, Barton EH, Bertoli LF, Gothard CH, Sherrer JS. Intravenous iron dextran therapy in patients with iron deficiency and normal renal function who failed to respond to or did not tolerate oral iron supplementation. Am J Med. 2000;109(1):27-32.
Henry DH, Dahl NV, Auerbach M, Tchekmedyian S, Laufman LR. Intravenous ferric gluconate significantly improves response to epoetin alfa versus oral iron or no iron in anemic patients with cancer receiving chemotherapy. Oncol. 2007;12(2):231-42.
Auerbach M, Ballard H, Glaspy J. Clinical update: intravenous iron for anaemia. Lancet. 2007;369(9572):1502-4.
Rodgers GM, Auerbach M, Cella D, Chertow GM, Coyne DW, Glaspy JA, et al. High-molecular weight iron dextran: a wolf in sheep's clothing?. J American Soc Nephrol. 2008;19(5):833-4.
Gilreath JA, Sageser DS, Jorgenson JA, Rodgers GM. Establishing an anemia clinic for optimal erythropoietic-stimulating agent use in hematology-oncology patients. J Nat Comp Cancer Netw. 2008;6(6):577-84.
Mamula P, Piccoli DA, Peck SN, Markowitz JE, Baldassano RN. Total dose intravenous infusion of iron dextran for iron-deficiency anemia in children with inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2002;34(3):286-90.
Fletes R, Lazarus JM, Gage J, Chertow GM. Suspected iron dextran-related adverse drug events in hemodialysis patients. Am J Kidney Dis. 2001;37(4):743-9.
Eschbach JW, Egrie JC, Downing MR, Browne JK, Adamson JW. Correction of the anemia of end-stage renal disease with recombinant human erythropoietin. N Engl J Med. 1987;316(2):73-8.
Fishbane S, Ungureanu VD, Maesaka JK, Kaupke CJ, Lim V, Wish J. The safety of intravenous iron dextran in hemodialysis patients. Am J Kidney Dis. 1996;28(4):529-34.
Michael B, Coyne DW, Fishbane S, Folkert V, Lynn R, Nissenson AR, et al. Sodium ferric gluconate complex in hemodialysis patients: adverse reactions compared to placebo and iron dextran. Kidney Int. 2002;61(5):1830-9.
Kapoian T, O'Mara NB, Singh AK, Moran J, Rizkala AR, Geronemus R, et al. Ferric gluconate reduces epoetin requirements in hemodialysis patients with elevated ferritin. J Am Soc Nephrol. 2008;19(2):372-9.
Coyne DW, Kapoian T, Suki W, Singh AK, Moran JE, Dahl NV, et al. Ferric gluconate is highly efficacious in anemic hemodialysis patients with high serum ferritin and low transferrin saturation: results of the Dialysis Patients’ Response to IV Iron with Elevated Ferritin (DRIVE) Study. J Am Soc Nephrol. 2007;18(3):975-84.
Aronoff GR, Bennett WM, Blumenthal S, Charytan C, Pennell JP, Reed J, et al. Iron sucrose in hemodialysis patients: safety of replacement and maintenance regimens. Kidney Int. 2004;66(3):1193-8.
Van Wyck DB, Roppolo M, Martinez CO, Mazey RM, Mcmurray S. A randomized, controlled trial comparing IV iron sucrose to oral iron in anemic patients with nondialysis-dependent CKD. Kidney Int. 2005;68(6):2846-56.
Macdougall IC, Roche A. Administration of intravenous iron sucrose as a 2-minute push to CKD patients: a prospective evaluation of 2,297 injections. Am J Kidney Dis. 2005;46(2):283-9.
Anker SD, Comin Colet J, Filippatos G, Willenheimer R, Dickstein K, Drexler H, et al. Ferric carboxymaltose in patients with heart failure and iron deficiency. New Eng J Med. 2009;361(25):2436-48.
Singh A, Patel T, Hertel J, Bernardo M, Kausz A, Brenner L. Safety of ferumoxytol in patients with anemia and CKD. Am J Kidney Dis. 2008;52(5):907-15.
Wikstrom B, Bhandari S, Barany P, Kalra PA, Ladefoged S, Wilske J. Monofer, a novel intravenous iron oligosaccharide for treatment of iron deficiency in patients with chronic kidney disease (CKD). World Congress Nephrol Milan. 2009.