Peer Reviewed Articles on Treatment of Iron Deficiency Anemia
Turk J Obstet Gynecol. 2015 Sep; 12(3): 173–181.
Diagnosis and handling of iron deficiency anemia during pregnancy and the postpartum flow: Iron deficiency anemia working group consensus report
Olus Api
i Yeditepe University Hospital, Clinic of Gynecology and Obstetrics, İstanbul, Turkey
Christian Breyman
2 Zurich Academy Infirmary, Feto Maternal Hematology Unit of measurement, Zurich, Switzerland
Mustafa Çetiner
3 Koç Academy Faculty of Medicine American Infirmary, Department of Hematology, İstanbul, Turkey
Cansun Demir
4 Çukurova University Faculty of Medicine, Department of Gynecology and Obstetrics, Adana, Turkey
Tevfik Ecder
five İstanbul Bilim University Kinesthesia of Medicine, Department of Internal Medicine, Division of Nephrology, İstanbul, Turkey
Received 2015 Sep 3; Accepted 2015 Oct ii.
Abstract
According to the Globe Wellness Organization (WHO), anemia is the near common disease, affecting >ane.5 billion people worldwide. Furthermore, atomic number 26 deficiency anemia (IDA) accounts for 50% of cases of anemia. IDA is common during pregnancy and the postpartum period, and can lead to serious maternal and fetal complications. The aim of this study was to present the experiences of a multidisciplinary expert grouping, and to establish reference guidelines for the optimal diagnosis and treatment of IDA during pregnancy and the postpartum menstruum. Studies and guidelines on the diagnosis and treatment of IDA published in Turkish and international journals were reviewed. Conclusive recommendations were made by an skilful panel aiming for a scientific consensus. Measurement of serum ferritin has the highest sensitivity and specificity for diagnosis of IDA unless there is a concurrent inflammatory status. The lower threshold value for hemoglobin (Hb) in pregnant women is <xi 1000/dL during the 1st and 3rd trimesters, and <x.5 g/dL during the 2nd trimester. In postpartum period a Hb concentration <10 one thousand/dL indicates clinically pregnant anemia. Oral iron therapy is given as the showtime-line handling for IDA. Although current data are limited, intravenous (IV) iron therapy is an alternative therapeutic selection in patients who practise not respond to oral iron therapy, take adverse reactions, do non comply with oral fe treatment, accept a very depression Hb concentration, and require rapid fe repletion. Iv fe preparations can be safely used for the treatment of IDA during pregnancy and the postpartum menstruation, and are more beneficial than oral iron preparations in specific indications.
Keywords: Iron deficiency anemia, Pregnancy, postpartum period, intravenous iron therapy
INTRODUCTION
According to the World Wellness Organization (WHO), anemia affects approximately 1.5 billion people worldwide. The prevalence is very high in Africa, Asia, India, Latin America, Eastern Europe, and Cathay; however, it is also high in developed countries(1,ii).
Anemia has the highest prevalence in three groups: children aged <5 years (47%), pregnant women (42%), and women of reproductive age (30%). Atomic number 26 deficiency is seen in l% of cases and is the almost common cause of anemia(ane,2). No national epidemiologic study on the prevalence of anemia has been conducted in Turkey but some regional studies take been performed(iii,four,5,6,7,8,9,10). The WHO placed Turkey on the worldwide anemia map by extrapolating these data. Accordingly, Turkey is in the intermediate group, with a prevalence of anemia between 20% and 39.9% among women of reproductive age, and is in the severe group for meaning women, with a prevalence of 40%(1,ii).
Attention has focused on the culling use of intravenous (IV) fe preparations because oral iron therapy has some disadvantages(11,12,xiii). Many studies on Four iron sucrose and ferric carboxymaltose have been conducted. Data on other IV fe preparations such as atomic number 26 gluconate, iron sorbitol, iron polymaltose, atomic number 26 isomaltoside, and depression molecular weight fe dextran are very limited, and at that place are increasing safety concerns well-nigh high molecular weight fe dextran, which is no longer available in Europe due to a high rate of serious adverse events.
Recent guidelines published in England, Switzerland, Germany, and Asia-Pacific have included IV iron therapy, and the Network for Advancement of Transfusion Alternatives (NATA) besides published reports on the indications for IV atomic number 26 therapy(fourteen,fifteen,xvi,17,18).
| Recommendations |
| • Large-scale, multicenter studies should be performed to accurately collect population-based information on iron deficiency anemia in Turkey. |
MATERIALS AND METHODS
The members of the working group reviewed the studies and guidelines on the diagnosis and handling of iron deficiency anemia published in Turkish and international journals. Near 200 literature articles were screened. Search terms were atomic number 26 deficiency anemia, pregnancy, postpartum period, and parenteral iron therapy. Sources about atomic number 26 deficiency prophylaxis and oral iron therapy were excluded because the focus was iron deficiency anemia and parenteral iron therapy. The included sources were listed in references part. With the data from the reviewed literature and the working group's own experiences, conclusive recommendations were made as a scientific consensus.
What follows is a review of the diagnosis of iron deficiency anemia and intravenous iron therapy; prophylaxis and oral atomic number 26 therapy volition not exist discussed.
IRON DEFICIENCY ANEMIA DURING PREGNANCY
Diagnosis
The major signs and symptoms of atomic number 26 deficiency anemia can be summarized as fatigue, low physical and mental chapters, headache, vertigo, leg cramps, pagophagia, cold intolerance, koilonychias, mucosal paleness, and angular stomatitis. Iron deficiency anemia during pregnancy poses a number of maternal and fetal bug, including premature nativity, intrauterine developmental retardation, placental problems, a subtract in newborn iron storage, the hazard of a decrease in maternal blood reserves during nascency, and the need for transfusion in cases of heavy blood loss, cardiac stress, symptoms of anemia, prolonged hospital stay, decreased maternal chest milk production, and maternal depletion of iron stores during and subsequently the postpartum flow. As such, diagnosis and effective treatment of atomic number 26 deficiency anemia are of critical importance(19,20,21,22).
The nigh important factor in the diagnosis of iron deficiency anemia is laboratory testing. The classic laboratory findings of iron deficiency anemia include a decrease in the hemoglobin (Hb) level, serum fe concentration, serum transferrin saturation, and serum ferritin level, and an increase in total iron-binding capacity. In fact, information technology is adequate to written report the complete blood count and serum ferritin for diagnosis. A serum ferritin concentration <xxx μg/L together with an Hb concentration <11 g/dL during the 1st trimester, <10.5 yard/dL during the 2nd trimester, and <eleven g/dL during the 3rd trimester are diagnostic for anemia during pregnancy. Measurement of the serum ferritin concentration is the most accurate test in patients without underlying inflammation, and a serum ferritin level below the threshold value alone is adequate for diagnosis in the absence of other tests; however, physicians should exist enlightened that serum ferritin is likewise an acute phase reactant and may be normal, even elevated, under inflammatory conditions despite the presence of anemia, and in such cases confirmation of the diagnosis may require additional tests.
It is recommended to measure out serum ferritin at to the lowest degree one time early in pregnancy. If ferritin and hemoglobin indicate iron deficiency anemia, anemia treatment should be initiated (note that intravenous fe is not warranted for the use in commencement trimester); if ferritin and hemoglobin levels are normal, condom oral atomic number 26 therapy should be commenced. It is not necessary to measure serum ferritin once again afterward in pregnancy unless the symptoms of anemia occur. On the other hand, Hb should be measured in each trimester because the probability of an increase in the need for iron and evolution of iron deficiency is e'er possible, fifty-fifty if the baseline value is normal. Moreover, the Hb concentration during delivery is important because a depression maternal Hb can upshot in fetal bug, including bloodshed(1,17,23,24,25,26,27).
If serum ferritin is low (<30 μg/L), but the Hb is normal (≥11 g/dL during the 1st trimester, ≥10.5 g/dL during the iind trimester, and ≥11 g/dL during the 3rd trimester) the diagnosis is iron deficiency; however, if serum ferritin is depression (<30 μg/L) and Hb is likewise low (<xi g/dL during the 1st trimester, <ten.five g/dL during the iind trimester, and <11 g/dL during the iiird trimester), the diagnosis is fe deficiency anemia. When Hb is low (<11 g/dL during the 1st trimester, <ten.five g/dL during the 2nd trimester, and <xi g/dL during the 3rd trimester), just serum ferritin is normal (≥30 μg/L) additional tests, such as transferrin saturation, serum atomic number 26, total atomic number 26-binding capacity, and C-reactive poly peptide (CRP), are needed for diagnosis. When serum ferritin is normal (≥30 μg/L), just mean corpuscular volume (MCV) is low (<70 fL) in the absence of inflammation, the diagnosis might be thalassemia and further investigation is required (Figure ane).
Algorithm for the diagnosis and treatment of iron deficiency anemia during pregnancy
| Recommendations |
| • The serum ferritin level, which is the most sensitive exam at baseline, should be measured together with the Hb level to diagnose iron deficiency. A serum ferritin level <30 μg/L during pregnancy should prompt handling. Monitoring in further periods should be based on the Hb concentration, which should be measured in each trimester. |
Treatment
Every bit the need for iron increases during pregnancy, condom oral fe therapy is given to all pregnant women with normal laboratory values; however, the primary cause of morbidity is iron deficiency anemia. Data suggesting that anemia causes cardiovascular diseases in further stages of life are increasing. Oral atomic number 26 preparations tin be used throughout pregnancy, whereas Four atomic number 26 therapy is recommended during the 2nd and 3rd trimesters. There are some instances for which switching to an IV iron preparation is advantageous (Table i). Actually, IV atomic number 26 therapy should be the outset selection in the presence of severe anemia and risk factors, and in emergency situations, because 4 therapy is more effective and rapid than oral therapy for resolving anemia(i,17,26,28,29,30).
Tabular array 1
Conditions during pregnancy that require intravenous atomic number 26 therapy
Threshold values for Hb that signal oral or Iv iron therapy during pregnancy according to countries and guidelines:
| Pregnancy | Oral iron | Four iron |
| Switzerland | 9< Hb ≤10.5 m/dL | Hb ≤9 grand/dL |
| Federal republic of germany | 9< Hb ≤11.5 1000/dL | Hb ≤9 g/dL |
| Asia-Paci c | ten< Hb ≤10.5 chiliad/dL | Hb ≤10 yard/dL |
| NATA | Hb ≤11 thou/dL (2nd Trimester) | Hb ≤eleven g/dL (3rd Trimester) |
Hb threshold values tin can exist college in the presence of additional adventure factors, such as coagulation disorders and placenta previa. The reason that Hb threshold levels are higher in Asia-Pacific countries is that there the goal of reducing the need for blood transfusion is achieved via IV atomic number 26 therapy because blood transfusion cannot exist performed often(fourteen,fifteen,16,17,xviii).
| Recommendations |
| • IV iron therapy should exist considered from the 2nd trimester onwards in pregnant women with fe deficiency anemia that cannot tolerate or exercise not reply to oral iron therapy. |
| • With severe anemia (Hb ≤9 thousand/dL), the presence of risk factors (such as coagulation disorders, placenta previa) and weather condition that require prompt resolution of anemia (paleness, tachycardia, tachypnea, syncope, eye failure, respiratory failure, angina pectoris, and signs of cerebral hypoxia) are other potential indications for 4 atomic number 26 therapy. |
| • The 4 iron therapy dose should be individual patient based and bringing the Hb level up to at to the lowest degree xi g/dL should be the target of the therapy. |
| • Switching from oral to IV iron therapy or starting 4 therapy initially is contingent upon take a chance-do good assessment; however, such assessment should be performed on an individual patient basis and requirements should be evaluated advisedly. |
| Pregnancy | Oral atomic number 26 | IV iron |
| Turkey | ix<Hb≤xi g/dL (1st and threerd trimester) - 9<Hb≤x.5 m/dL (2nd trimester) | Hb≤ix g/dL |
Fe DEFICIENCY ANEMIA DURING THE POSTPARTUM Menstruation
Postpartum anemia occurs primarily due to inadequate iron intake before and during pregnancy, and blood loss during delivery. In other words, the combination of fe deficiency anemia and hemorrhagic anemia leads to postpartum anemia. Postpartum anemia has been associated with depression, stress, anxiety, cerebral damage, decreased mother-baby attachment, and infant developmental retardation. The Hb concentration must be checked in patients with excessive claret loss during delivery and/or in those with puerperal symptoms of anemia. A postpartum Hb concentration ≤10 k/dL indicates clinically pregnant anemia. Moderate-to-astringent anemia is considered when Hb is between 9-10 g/dL and an Hb concentration ≤9 g/dL is considered astringent anemia(17,18,27,31,32,33,34). Information technology is non meaningful to mensurate the serum level of ferritin, an astute phase reactant, because it tin can be normal or elevated during the first vi weeks post delivery (Effigy 2).
| Recommendations |
| • The Hb concentration must be checked within 24-48 h after delivery in cases of blood loss >500 mL during the postpartum period, untreated anemia during the antenatal menstruum, or symptoms of anemia during the postnatal period. |
Handling
Treatment is based on the severity of anemia and health status of the puerperal. Equally a rule, oral iron therapy is recommended in cases of mild anemia; yet, information technology can be switched to Iv iron therapy in patients with moderate and severe anemia or in those who cannot tolerate oral iron therapy. After achieving the target values, maintenance therapy can be administered using oral fe preparations. Many studies have reported that IV iron administration is more advantageous than oral assistants(12,thirteen,17,35,36,37). Heavy blood loss can occur in women who brainstorm delivery while anemic, and blood transfusion becomes necessary when the Hb concentration drops to 7 thousand/dL. One report reported that 18% of women who were hospitalized for anemia and postpartum bleeding received transfusion. Another reward of IV iron therapy is that information technology reduces the need for blood transfusion. Claret transfusion is in essence a blazon of transplantation and is associated with serious safety risks, loftier costs, and availability issues. Transfusion-induced sensitization is another risk for the future. Additionally, IV fe therapy is associated with a shorter duration of hospitalization(38,39,40,41,42).
Various Hb threshold values that indicate oral atomic number 26 and IV iron therapy during the postpartum period:
| Postpartum | Oral atomic number 26 | Four fe |
| Switzerland | x< Hb ≤11.5 g/dL | Hb ≤10 g/dL |
| Germany | 8< Hb≤ 10 1000/dL | Hb ≤8 m/dL |
| Asia-Pacific | 10< Hb≤ 10.v g/dL | Hb ≤ten yard/dL |
| NATA | - | Hb ≤10 k/dL |
In Deutschland, the Hb threshold is <viii m/dL, which is below the limit of astringent anemia. This value is extremely low and is probably related to economic reimbursement issues(xiv,fifteen,16,17,18).
Heavy menstrual bleeding is another status that can crave blood transfusion. Although a precise definition of this clinical status is defective, according to the National Institute for Health and Care Excellence (NICE) guidelines, it corresponds to a book of haemorrhage that causes wellness problems and social discomfort, roughly fourscore mL/per menstruation. Here as well, an indication for IV fe therapy can be mentioned because such patients face the risk of transfusion and this process is likely to progress to hysterectomy(43,44,45).
| Recommendations |
| • In patients with an Hb level ≤10 g/dL who are hemodynamically stable and asymptomatic or mildly symptomatic, oral iron 100-200 mg/day should continue for upwards to 3 months, and complete blood count and serum ferritin values should be checked at the cease of treatment. |
| • Iv iron therapy should exist considered in patients who cannot tolerate or do not respond to oral fe therapy, and have meaning symptoms or moderate-severe/severe anemia. |
| • The physician should start IV iron therapy whenever the Hb value is less than or equal to 9 because this is considered as severe anemia. |
| • The therapeutic iron dose should be determined on an individual patient basis and should achieve an Hb level ≥xi g/dL. |
| Postpartum | Oral iron | Four fe |
| Turkey | nine< Hb ≤11 g/dL | Hb ≤ix 1000/dL |
PARENTERAL Iron THERAPY OPTIONS
Worldwide, iron deficiency anemia is most commonly treated with oral iron preparations; nonetheless, oral preparations are associated with issues such equally intolerability, poor patient compliance, insufficient response to treatment, and prolonged treatment. Therefore physicians are increasingly interested in parenteral iron therapy options.
INTRAMUSCULAR IRON THERAPY
Some preparations such as iron sorbitex, loftier-molecular-weight fe dextran, and low-molecular-weight fe dextran can exist given intramuscularly (IM). Withal, IM injections have some pregnant drawbacks, therefore IM is generally not recommended. Intramuscular injection is painful, has a risk of permanent skin staining, and is associated with the development of sterile abscesses and gluteal sarcomas. Also, intramuscular assimilation of atomic number 26 is irksome, the use of iron given via this road is variable, and IM injections are not possible for patients who have reduced muscle mass. IM administration of iron is non safer or less toxic than the Iv route, so the about advisable parenteral road is Iv(46,47,48,49,50).
INTRAVENOUS IRON THERAPY
4 iron therapy is not associated with oral and IM fe therapy problems and is a more cost-effective option. Iv preparations are more expensive than oral preparations, but the full cost of oral treatment becomes equivalent to Four treatment considering repeated administrations are needed in oral treatment. Additionally, the patient has the initiative in oral administration and that makes it difficult to monitor how many doses the patient has actually received; if the patient is not receiving the tablets, the physician prescribes more and more oral preparations to treat the patient so the price increases and becomes even more than than IV treatment. The risk of premature nascency, the most serious take a chance associated with anemia during pregnancy, increases in patients with anemic who are not treated. The cost of care for a premature baby far exceeds that of IV iron treatment, which is why interest in IV iron therapy is gradually increasing(50,51,52,53).
Loftier-MOLECULAR-WEIGHT IRON DEXTRAN
Safety concerns that physicians have regarding parenteral fe preparations are related to serious adverse events (anaphylaxis, stupor, and death) reported in association with high-molecular-weight iron dextran, which has been removed from the market in Europe and replaced past newer preparations that have more favorable safe profiles(54,55,56,57,58,59).
Low-MOLECULAR-WEIGHT IRON DEXTRAN
At that place are a express number of studies on the use of low-molecular weight iron dextran during pregnancy and the postpartum period. No serious adverse events have been associated with its utilise, but mild adverse events have been observed in 5% of cases. It is contraindicated during the 1st trimester, and the Food and Drug Administration (FDA) pregnancy category is C for the 2northwardd and 3rd trimesters. Data on its utilize during the neonatal period is lacking and its outcome on lactation is unknown. It tin exist administered via IV injection or infusion. A examination dose is required before each IV assistants(xviii,60,61).
FERROUS GLUCONATE
Ferrous gluconate is not bachelor in Turkey. At that place few studies on its use during pregnancy and there are information concerning its use during the neonatal period. It is contraindicated during the anest trimester, and its pregnancy category is B for the 2nd and 3rd trimesters. No serious agin events have been associated with its apply. It can only be administered via the Iv route. The maximum single dose is 125 mg and a test dose is non required. Its molecular stability is low. Free fe release can occur and may cause liver necrosis(62,63).
Fe POLYMALTOSE
There are a express number of studies on the utilise of iron polymaltose during pregnancy and the neonatal period, only no serious adverse events have been reported. Its administration is express to the IM route(64,65,66,67).
IRON SORBITOL
Iron sorbitol is not bachelor in Turkey. At that place are few studies on its use during pregnancy and no data exists on its utilise during the neonatal period. It tin be administered only via the IM route. No serious adverse events have been reported in association with its use(68).
Atomic number 26 ISOMALTOSIDE
Fe isomaltoside is not available in Turkey. There are a express number of studies and inadequate information on its employ during pregnancy. Studies revealed adverse outcome in one% of patients. The risks associated with its use during lactation are unknown. It can exist administered via IV injection and infusion, a exam dose is not required(18,61,69,70,71).
Atomic number 26 SUCROSE
The use of atomic number 26 sucrose during pregnancy is approved beginning from the 2nd trimester and is FDA pregnancy category B. Numerous studies on its efficacy and safety, every bit compared with fe dextran and ferrous gluconate, reported that it was well tolerated; with the exception of urticarial, no hypersensitivity reactions were observed (anaphylaxis, angioedema) and no fatal events were observed. On the other hand, the need for erythropoietin decreases, but Hb, iron, transferrin saturation, serum ferritin, and MCV values increase. Moreover, IV therapy provides a higher serum ferritin value and anemia tin be controlled more effectively. The use of fe sucrose during pregnancy, the postpartum period, and the neonatal period has been studied extensively; amidst iron preparations it has the largest data prepare(18,twoscore,72,73,74,75,76).
Assistants OF Fe SUCROSE
Iron sucrose normally comes in the form of a 100 mg/5 mL ampoule. It is administered but via the Iv route as a wearisome injection or infusion. During injection, 1 ampoule should be administered over the course of ≥5 min and the dosage per minute should non exceed twenty mg. The maximum dose that tin can be administered as a unmarried 4 injection is 200 mg. In adults a test dose of twenty mg/1 mL should showtime exist administered, if an agin event is non observed inside 15 min the remaining dose should be administered in appropriate time. IV infusion is the preferred method of administration, which reduces the gamble of hypotension and paravenous injection. For Four infusion, a 100 mg/five mL ampoule should exist diluted with a maximum of 100 mL of physiologic serum. The administration time should be at least fifteen min for 100 mg, thirty min for 200 mg, and should non exceed a total dosage of 200 mg/day. Doses exceeding 200 mg/twenty-four hours are not recommended in pregnancy or the postpartum period because there is not enough safety data(77).
FERRIC CARBOXYMALTOSE
The use of ferric carboxymaltose in pregnant women has been approved from the 2nd trimester. Studies on IV versus oral fe therapies reported that ferric carboxymaltose was associated with a higher rate of patient tolerability, a college rate of patient compliance, and target value achievement at lower doses, and that was as safety every bit but more than effective than iron sucrose. With ferric carboxymaltose, a high dose of fe can be administered in a single administration in a short time; hence, problems associated with patient compliance and the additional cost of repeated administrations can be avoided. Ferric carboxymaltose has high molecular stability. Labile iron release or liver necrosis has not been observed in association with its apply. Data for and experience with ferric carboxymaltose (pregnancy, postpartum period, neonatal period) are gradually increasing(18,78,79,80,81,82,83,84,85,86).
ADMINISTRATION OF FERRIC CARBOXYMALTOSE
A 500 mg/ten mL vial of ferric carboxymaltose is administered only via the 4 route.
Criteria for determining the full dose of ferric carboxymaltose:
| Hb (g/dL) | Patient weight 35-70 kg | Patients weight >70 kg |
| <10 | 1500 mg | 2000 mg |
| ≥10 | 1000 mg | 1500 mg |
| The total dose should not exceed 500 mg in patients who counterbalance <35 kg. | ||
The maximum daily dose is thousand mg/twenty mL; because the minimum dose interval is 7 d, this likewise corresponds to the maximum weekly dose. While administering via injection, the rate of administration should be 100-500 mg/min. Administration fourth dimension is a minimum of 15 min for doses of 500-1000 mg.
Dilution schedule for administering as infusion:
| Volume | Iron | Maximum volume of physiologic serum | Minimum duration of administration |
| 2-4 mL | 100-200 mg | fifty mL | - |
| ≥4-10 mL | ≥200-500 mg | 100 mL | 6 min |
| ≥10-twenty mL | ≥500-yard mg | 250 ml | xv min |
A placental perfusion written report reported that ferric carboxymaltose did not pass to the the fetus via the placenta(87). The FDA canonical ferric carboxymaltose in Baronial 2013 and the preparation has since become available as Injectafer; however, to date there has not been a sufficient number of large-scale randomized studies on the utilise of ferric carboxymaltose during pregnancy and the FDA has specified the pregnancy (2nd and 3rd trimester) category of the drug every bit C. As such, physicians must carefully consider the risk-benefit ratio when using this drug(77,88).
With regard to international approaches to IV iron therapy, IV atomic number 26 therapy during pregnancy and the postpartum menstruum in patients with iron deficiency anemia is recommended in the United Kingdom, Frg, Switzerland, Scandinavia, Spain, Eastern Europe, Russia, Islamic republic of pakistan, India, Malaysia, Singapore, Republic of indonesia, China, Thailand, Peru, Argentina, Chile, and Australia. Clear expressions in favor of Four fe are coming from these countries; still, there are many generic drugs on the market, specially in China, and many studies report that generic iron preparations are less constructive and more toxic. Commonwealth of australia strongly recommends Four iron in several indications and is a leading source of publications and guidelines on reducing the need for blood transfusion. Articulate expressions nigh Iv iron therapy have not been obtained from the FDA and American Higher of Obstetricians and Gynecologists (ACOG) from the United States of America(fourteen,15,16,17,18).
| Recommendations |
| • Iv iron therapy should be included in iron deficiency anemia guidelines published past relevant medical organizations in Turkey, and the principles of iron therapy should be clearly described. |
CONCLUSION
Serious adverse events acquired by 4 iron preparations that were used in the early years, particularly iron dextran, resulted in concerns about the condom of IV iron therapy. More effective iron preparations have been developed in recent years that are associated with proficient patient compliance, tolerance, and safety profiles. These preparations are more beneficial than oral iron preparations in some specific indications such as intolerability, depression patient compliance, insufficient response to handling, and prolonged treatment duration. IV iron preparations can be safely used for the treatment of iron deficiency anemia during pregnancy and the postpartum period, particularly for rapid improvement of anemia and rapid replacement of iron storage.
Algorithm for the diagnosis and handling of iron deficiency anemia during the postpartum period
Footnotes
Peer-rewiev: Internal peer-reviewed.
Contributed past
Concept: Oluş Api, Christian Breymann, Mustafa Çetiner, Cansun Demir, Tevfik Ecder, Design: Oluş Api, Christian Breymann, Mustafa Çetiner, Cansun Demir, Tevfik Ecder, Data Acquisition or Processing: Oluş Api, Christian Breymann, Mustafa Çetiner, Cansun Demir, Tevfik Ecder, Analysis or Interpretation: Oluş Api, Christian Breymann, Mustafa Çetiner, Cansun Demir, Tevfik Ecder, Literature Search: Figen Yavuz, Writing: Oluş Api, Figen Yavuz.
Disharmonize of Interest: C Breymann is a medical advisor of Vifor International/Switzerland in the field of fe deficiency in Obstetrics and Gynecology. O Api, M Çetiner, C Demir, T Ecder, and F Yavuz declare that at that place are no conflicts of involvement.
Fiscal Disclosure: The authors declared that this study has received no financial support.
References
3. Beştepe G, Bilgin Due north. Afyon ili two ve 4 no'lu sağlık ocaklarındaki gebelerde anemi prevalansı ve anemiyi etkileyen bazı faktörlerin incelenmesi. Sağlık ve Toplum. 2002;12:45–53. [Google Scholar]
4. Mersin S, Kuş C, Yeşildal N, Mayda AS, Şerifi B. Konuralp Kamil Furtun Sağlık Ocağı bölgesi gebelerde anemi araştırması. Diyarbakır: eight. Ulusal Halk Sağlığı Kongresi Bildiri Kitabı; 2002. pp. 257–sixty. [Google Scholar]
5. Oruç O, Tuncer A, Apan Eastward. Adana Yenibaraj Sağlık Ocağı bölgesinde gebelerde anemi prevalansı. İstanbul: 5. Ulusal Halk Sağlığı Kongresi Bildiri Kitabı; 1996. pp. 374–eight. [Google Scholar]
6. Pekcan G, Karaağaoğlu N. State of nutrition in Turkey. Diet and Health. 2000;xiv:41–52. [PubMed] [Google Scholar]
7. Pirinçci E, Açık Y, Bostancı M, Eren S, Beritanlı H. Elazığ İl Merkezinde Yaşayan Gebelerde Anemi Prevalansı Fırat Üniversitesi Sağlık Bilimleri Tıp Dergisi. 2001;15:449–54. [Google Scholar]
viii. Toksöz P, Ilçin E, Özcan Thou. Diyarbakır Bağlar Sağlık Ocağı bölgesinde gebe kadınlarda anemi prevalansı Beslenme ve Diyet Dergisi. 1990;xix:61–9. [Google Scholar]
ix. Api O, Bayer F, Akıl A, Bektaş M, Api M, Dabak R, Ünal O. İstanbul'da bir eğitim ve araştırma hastanesine başvuran gebelerde anemi prevalansını etkileyen etyolojik ve demografik faktörler. Perinatoloji Dergisi. 2009;17:28–34. [Google Scholar]
10. Memişoğulları R, Ak Yıldırım H, Uçgun T, Erkan ME, Güneş C, Erbaş Thou, Güngör A, Yanık ME. Prevalence and etiology of anemias in the adult Turkish population. Turkish Journal of Medical Sciences. 2012;42:957–63. [Google Scholar]
11. Al RA, Unlubilgin E, Kandemir O, Yalvac Southward, Cakir L, Haberal A. Intravenous versus oral atomic number 26 for treatment of anemia in pregnancy: a randomized trial. Obstet Gynecol. 2005;106:1335–40. [PubMed] [Google Scholar]
12. Bhandal N, Russell R. Intravenous versus oral atomic number 26 therapy for postpartum anaemia. BJOG. 2006;113:1248. [PubMed] [Google Scholar]
13. Khalafallah AA, Dennis AE. Fe deficiency anaemia in pregnancy and postpartum: pathophysiology and effect of oral versus intravenous iron therapy. J Pregnancy. 2012;2012:630519. [PMC free article] [PubMed] [Google Scholar]
14. Bergmann R L, Dudenhausen J West, Ennen J C, et al. Diagnostik und Behandlung der Anämie und des Eisenmangels in der Schwangerschaft und im Wochenbett. Literaturüberblick und Empfehlungen. Geburtsh Frauenheilk. 2009;69:682–6. [Google Scholar]
15. Beris P, Maniatis A. NATA working group on intravenous iron therapy. Guidelines on intravenous iron supplementation in surgery and obstetrics/gynecology. Transfusion Alternatives in Transfusion Medicine. 2007;9:29. [Google Scholar]
16. Breymann C, Bian XM, Blanco-Capito LR, Chong C, Mahmud G, Rehman R. Expert recommendations for the diagnosis and treatment of iron-deficiency anemia during pregnancy and the postpartum menstruation in the Asia-Pacific region. J Perinat Med. 2011;39:113–21. [PubMed] [Google Scholar]
17. Breymann C, Honegger C, Holzgreve W, Surbek D. Diagnosis and treatment of iron-deficiency anaemia during pregnancy and postpartum. Curvation Gynecol Obstet. 2010;282:577–lxxx. [PubMed] [Google Scholar]
xviii. Sue Pavord, Bethan Myers, Susan Robinson, et al. Great britain guidelines on the direction of iron deficiency in pregnancy. British Journal of Haematology. 2012;156:588–600. [PubMed] [Google Scholar]
19. Breymann C. Iron supplementation during pregnancy. Fetal and Maternal Medicine Review. 2002;13:1–29. [Google Scholar]
20. Reveiz Fifty, Gyte GML, Cuervo LG. Treatments for iron-deficiency anaemia in pregnancy. The Cochrane Library; 2007. [PubMed] [Google Scholar]
21. Savajols Eastward, Burguet A, Grimaldi M, Godoy F, Sagot P, Semama DS. Maternal Haemoglobin and Short-Term Neonatal Outcome in Preterm Neonates. Plos 1; February 25, 2014. [PMC free article] [PubMed] [Google Scholar]
22. Erez Azulay C, Pariente M, Shoham-Vardi I, Kessous R, Sergienko R, Sheiner Eastward. Maternal anemia during pregnancy and subsequent risk for cardiovascular illness. J Matern Fetal Neonatal Med. 2014;29:ane–four. [PubMed] [Google Scholar]
23. American Higher of Obstetricians and Gynecologists. ACOG practice bulletin no. 95: anemia in pregnancy. Obstet Gynecol. 2008;112:201–vii. [PubMed] [Google Scholar]
24. Guyatt GH, Oxman AD, Ali Chiliad, Willan A, McIlroy W, Patterson C. Laboratory diagnosis of iron-deficiency anemia: an overview. J Gen Intern Med. 1992;seven:145–53. [PubMed] [Google Scholar]
25. Hercberg S, Galan p, Preziosi P. Consequences of iron deficiency in meaning women: Current issues. Clin Drug Invest. 2000;19:1–7. [Google Scholar]
26. No authors listed. Recommendations to preclude and control atomic number 26 deficiency in the United States. Centers for Affliction Control and Prevention. MMWR Recomm Rep. 1998;47:1–29. [PubMed] [Google Scholar]
27. National Found for Health and Clinical Excellence. Antenatal care: Routine Care for the Healthy Pregnant Adult female. Clinical Guideline. London: UK: National Found for Health and Clinical Excellence; 2008. [Google Scholar]
28. Bashiri A, Burstein Due east, Sheiner E, Mazor G. Anemia during pregnancy and treatment with intravenous fe: review of the literature. Eur J Obstet Gynecol Reprod Biol. 2003;110:2–7. [PubMed] [Google Scholar]
29. Khalafallah AA, Dennis AE, Ogden K, Robertson I, Charlton RH, Bellette JM, et al. Three-year follow-upwards of a randomised clinical trial of intravenous versus oral iron for anaemia in pregnancy. BMJ Open. 2012;2 [PMC free commodity] [PubMed] [Google Scholar]
30. Melamed N, Ben-Haroush A, Kaplan B, Yogev Y. Fe supplementation in pregnancy--does the grooming matter? Curvation Gynecol Obstet. 2007;276:601–4. [PubMed] [Google Scholar]
31. Bodnar LM, Cogswell ME, McDonald T. Take nosotros forgotten the significance of postpartum iron deficiency? Am J Obstet Gynecol. 2005;193:36–44. [PubMed] [Google Scholar]
32. Bruner AB, Joffe A, Duggan AK, Casella JF, Brandt J. Randomised study of cerebral furnishings of fe supplementation in not-anaemic iron-deficient adolescent girls. Lancet. 1996;348:992–vi. [PubMed] [Google Scholar]
33. Murray-Kolb LE. Iron condition and neuropsychological consequences in women of reproductive age: what do we know and where are we headed? The Journal of Nutrition. 2011;141:747S–55S. [PubMed] [Google Scholar]
34. Murray-Kolb LE, Beard JL. Iron treatment normalizes cerebral performance in immature women. The American Journal of Clinical Diet. 2007;85:778–87. [PubMed] [Google Scholar]
35. Breymann C, Gliga F, Bejenariu C, Strizhova N. Comparative efficacy and prophylactic of intravenous ferric carboxymaltose in the handling of postpartum atomic number 26 deficiency anemia. International Periodical of Gynecology and Obstetrics. 2008;101:67–73. [PubMed] [Google Scholar]
36. Froessler B, Cocchiaro C, Saadat-Gilani G, Hodyl Due north, Dekker G. Intravenous iron sucrose versus oral atomic number 26 ferrous sulfate for antenatal and postpartum atomic number 26 deficiency anemia: a randomized trial. J Matern Fetal Neonatal Med. 2013;26:654–9. [PubMed] [Google Scholar]
37. Van Wyck DB, Martens MG, Seid MH, Bakery JB, Mangione A. Intravenous ferric carboxymaltose compared with oral iron in the treatment of postpartum anemia: a randomized controlled trial. Obstet Gynecol. 2007;110:267–78. [PubMed] [Google Scholar]
38. Auerbach K, Goodnough LT, Picard D, Maniatis A. The role of intravenous atomic number 26 in anemia management and transfusion abstention. Transfusion. 2008;48:988. [PubMed] [Google Scholar]
39. Hallak M, Sharon Equally, Diukman R, Auslender R, Abramovici H. Supplementing iron intravenously in pregnancy. A way to avert blood transfusions. J Reprod Med. 1997;42:99–103. [PubMed] [Google Scholar]
40. Peebles G, Fenwick South. Intravenous atomic number 26 administration in a short-stay hospital setting. Nurs Stand. 2008;22:35–41. [PubMed] [Google Scholar]
41. Seid MH, Derman RJ, Bakery JB, Banach W, Goldberg C, Rogers R. Ferric carboxymaltose injection in the handling of postpartum iron deficiency anemia: a randomized controlled clinical trial. Am J Obstet Gynecol. 2008;199:435.e1–7. [PubMed] [Google Scholar]
42. Silverman JA, Barrett J, Callum JL. The appropriateness of red blood cell transfusions in the peripartum patient. Obstet Gynecol. 2004;104:chiliad–iv. [PubMed] [Google Scholar]
44. Van Wyck DB, Mangione A, Morrison J, Hadley PE, Jehle JA, Goodnough LT. Large-dose intravenous ferric carboxymaltose injection for iron deficiency anemia in heavy uterine bleeding: a randomized controlled trial. Transfusion. 2009;49:2719–28. [PubMed] [Google Scholar]
45. Gordon S, Hadley PE, Van Wyck DB, Mangione A. Atomic number 26 Carboxymaltose, A New Intravenous Iron Agent for Iron Deficiency in Heavy Uterine Bleeding. Obstet Gynecol. 2007;109:1–127. [Google Scholar]
46. Pasricha S, Flecknoe-Brown S, Allen G. Diagnosis and management of iron deficiency anaemia: a clinical update. Med J Aust. 2010;193:525–32. [PubMed] [Google Scholar]
47. Solomons NW, Schumann Thousand. Intramuscular administration of iron dextran is inappropriate for treatment of moderate pregnancy anaemia, both in intervention research on underprivileged women and in routine prenatal care provided by public wellness services. Am J Clin Nutr. 2004;79:ane–3. [PubMed] [Google Scholar]
fifty. Auerbach K, Ballard H, Glaspy J. Clinical update: intravenous iron for anaemia. Lancet. 2007;369:1502–four. [PubMed] [Google Scholar]
51. Auerbach M, Ballard H. Clinical utilize of intravenous atomic number 26: administration, efficacy, and safety. Hematology Am Soc Hematol Educ Program. 2010;2010:338–47. [PubMed] [Google Scholar]
52. Bhandari Due south. Across efficacy and rubber-the need for user-friendly and cost-constructive fe therapy in wellness care. NDT Plus. 2011;four:i14–i19. [PMC free article] [PubMed] [Google Scholar]
53. Szucs TD, et al. The costs of iv atomic number 26 preparations. Haematologica. 2009;94:52. [Google Scholar]
54. Bailie GR, Clark JA, Lane CE, Lane PL. Hypersensitivity reactions and deaths associated with intravenous iron preparations. Nephrol Dial Transplant. 2005;xx:1443–9. [PubMed] [Google Scholar]
55. Chertow GM, Bricklayer PD, Vaage-Nilsen O, Ahlmén J. Update on adverse drug events associated with parenteral iron. Nephrol Dial Transplant. 2006;21:378–82. [PubMed] [Google Scholar]
56. Chertow GM, Winkelmayer WC. On the relative safety of intravenous iron formulations: new answers, new questions. Am J Hematol. 2010;85:643–iv. [PubMed] [Google Scholar]
57. Macdougall IC, Bock A, Carrera F, Eckardt KU, Gaillard C, Van Wyck D, et al. The FIND-CKD written report-a randomized controlled trial of intravenous iron versus oral iron in non-dialysis chronic kidney disease patients: groundwork and rationale. Nephrol Dial Transplant. 2014;29:843–50. [PMC free article] [PubMed] [Google Scholar]
58. Rampton D, Folkersen J, Fishbane S, Hedenus M, Howaldt S, Locatelli F, et al. Hypersensitivity reactions to intravenous iron: guidance for gamble minimization and direction. Haematologica. 2014;99:1671–half dozen. [PMC gratuitous article] [PubMed] [Google Scholar]
59. Wysowski DK, Swartz 50, Borders-Hemphill BV, Goulding MR, Dormitzer C. Employ of parenteral iron products and serious anaphylactic-blazon reactions. Am J Hematol. 2010;85:650–4. [PubMed] [Google Scholar]
lx. Auerbach M, Pappadakis JA, Bahrain H, Auerbach SA, Ballard H, Dahl NV. Safe and efficacy of quickly administered (1 60 minutes) one gram of depression molecular weight iron dextran (INFeD) for the handling of iron deficient anemia. Am J Hematol. 2011;86:860–2. [PubMed] [Google Scholar]
61. Gozzard D. When is high-dose intravenous iron repletion needed? Assessing new treatment options. Drug Des Devel Ther. 2011;5:51–threescore. [PMC free article] [PubMed] [Google Scholar]
62. Faich G, Strobos J. Sodium ferric gluconate complex in sucrose: safer intravenous atomic number 26 therapy than fe dextrans. Am J Kidney Dis. 1999;33:464. [PubMed] [Google Scholar]
63. Miller HJ, Hu J, Valentine JK, Gable PS. Efficacy and tolerability of intravenous ferric gluconate in the handling of iron deficiency anemia in patients without kidney disease. Arch Intern Med. 2007;167:1327. [PubMed] [Google Scholar]
64. Geisser P. Safe and efficacy of fe(3)-hydroxide polymaltose complex / a review of over 25 years experience. Arzneimittelforschung. 2007;57:439–52. [PubMed] [Google Scholar]
65. Ortiz R, Toblli JE, Romero JD, Monterrosa B, Frer C, Macagno E, Breymann C. Efficacy and safety of oral iron(III) polymaltose complex versus ferrous sulfate in pregnant women with fe-deficiency anemia: a multicenter, randomized, controlled study. J Matern Fetal Neonatal Med. 2011;24:1347–52. [PubMed] [Google Scholar]
66. Singh 1000, Fong YF, Kuperan P. A comparison between intravenous iron polymaltose complex (Ferrum Hausmann) and oral ferrous fumarate in the treatment of iron deficiency anaemia in pregnancy. Eur J Haematol. 1998;sixty:119–24. [PubMed] [Google Scholar]
67. Toblli JE, Brignoli R. (2007). Atomic number 26(Iii)-hydroxide polymaltose complex in fe deficiency anemia / review and meta-analysis. Arzneimittelforschung. 2007;57:431–8. [PubMed] [Google Scholar]
68. Wali A, Mushtaq A. Comparative study-efficacy, safe and compliance of intravenous iron sucrose and intramuscular atomic number 26 sorbitol in iron deficiency anemia of pregnancy. J Pak Med Assoc. 2002;52:392–5. [PubMed] [Google Scholar]
69. Holm C, Thomsen LL, Norgaard A, Langhoff-Roos J. Intravenous iron isomaltoside 1000 administered past high single-dose infusions or standard medical treat the handling of fatigue in women afterwards postpartum bleeding: report protocol for a randomised controlled trial. Trials. 2015;16:5. [PMC free commodity] [PubMed] [Google Scholar]
seventy. Reinisch W, Staun G, Tandon RK, Altorjay I, Thillainayagam AV, Gratzer C, et al. A randomized, open-label, non-inferiority study of intravenous iron isomaltoside 1,000 (Monofer) compared with oral iron for treatment of anemia in IBD (PROCEED) Am J Gastroenterol. 2013;108:1877–88. [PMC free article] [PubMed] [Google Scholar]
71. Wikström B, Bhandari S, Barany P, Kalra PA, Ladefoged S, Wilske J, et al. Fe isomaltoside chiliad: a new intravenous iron for treating iron deficiency in chronic kidney disease. J Nephrol. 2011;24:589–96. [PubMed] [Google Scholar]
72. Breymann C. The Apply of Iron Sucrose Circuitous for Anemia in Pregnancy and the Postpartum Menstruation. Seminars in Hematology. 2006;43:S28–31. [Google Scholar]
73. Krafft A, Bencaiova G, Breymann C. Selective use of recombinant man erythropoietin in meaning patients with astringent anemia or nonresponsive to atomic number 26 sucrose lonely. Fetal Diagn Ther. 2009;25:239–45. [PubMed] [Google Scholar]
74. Krafft A, Breymann C. Iron sucrose with and without recombinant erythropoietin for the treatment of severe postpartum anemia: a prospective, randomized, open up-characterization written report. J Obstet Gynaecol Res. 2011;37:119–24. [PubMed] [Google Scholar]
75. Van Wyck DB, Cavallo G, Spinowitz BS, Adhikarla R, Gagnon Southward, Charytan C, et al. Prophylactic and efficacy of iron sucrose in patients sensitive to fe dextran: North American clinical trial. Am J Kidney Dis. 2000;36:88–97. [PubMed] [Google Scholar]
76. Westad S, Backe B, Salvesen KA, Nakling J. A 12-week randomised report comparing intravenous iron sucrose versus oral ferrous sulphate for treatment of postpartum anemia. Acta Obstet Gynecol Scand. 2008;87:916–23. [PubMed] [Google Scholar]
78. Barish CF, Koch T, Butcher A, Morris D, Bregman DB. Safety and Efficacy of Intravenous Ferric Carboxymaltose (750 mg) in the Treatment of Iron Deficiency Anemia: Ii Randomized, Controlled Trials. Anemia. 2012;2012:172104. [PMC costless article] [PubMed] [Google Scholar]
79. Christoph P, Schuller C, Studer H, Irion O, De Tejada BM, Surbek D. Intravenous atomic number 26 treatment in pregnancy: comparison of loftier-dose ferric carboxymaltose vs. fe sucrose. J Perinat Med. 2012;forty:469–74. [PubMed] [Google Scholar]
fourscore. Froessler B, Collingwood J, Hodyl NA, Dekker G. Intravenous ferric carboxymaltose for anaemia in Pregnancy. BMC Pregnancy and Childbirth. 2014;14:115. [PMC complimentary commodity] [PubMed] [Google Scholar]
81. Hussain I, Bhoyroo J, Butcher A, Koch TA, He A, Bregman DB. Direct Comparison of the Safe and Efficacy of Ferric Carboxymaltose versus Iron Dextran in Patients with Iron Deficiency Anemia. Anemia. 2013;2013:169107. [PMC gratis commodity] [PubMed] [Google Scholar]
82. Kulnigg S, Stoinov Southward, Simanenkov V, Dudar LV, Karnafel W, Garcia LC, et al. A novel intravenous atomic number 26 conception for treatment of anemia in inflammatory bowel disease: the ferric carboxymaltose (FERINJECT) randomized controlled trial. Am J Gastroenterol. 2007;102:1–11. [PubMed] [Google Scholar]
83. Lynseng-Williamson KA, Keating GM. Ferric Carboxymaltose. A review of its utilize in Iron-deficiency Anemia. Drugs. 2009;69:739–56. [PubMed] [Google Scholar]
84. Moore RA, Gaskell H, Rose P, Allan J. Meta-analysis of efficacy and safety of intravenous ferric carboxymaltose (Ferinject) from clinical trial reports and published trial data. BMC Blood Disorders. 2011;11:iv. [PMC free commodity] [PubMed] [Google Scholar]
85. Geisser P. The pharmacology and safety profile of ferric carboxymaltose (Ferinject®): construction/reactivity relationships of iron preparations. Port J Nephrol Hypert. 2009;23:xi–six. [Google Scholar]
86. Pfenniger A, Schuller C, Christoph P, Surbek D. Safety and efficacy of highdose intravenous fe carboxymaltose vs. iron sucrose for treatment of postpartum anemia. J Perinat Med. 2012;xl:397–402. [PubMed] [Google Scholar]
87. Malek A. In vitro studies of ferric carboxymaltose on placental permeability using the dual perfusion model of human placenta. Arzneimittelforschung. 2010;60:354–61. [PubMed] [Google Scholar]
Articles from Turkish Periodical of Obstetrics and Gynecology are provided hither courtesy of Turkish Society of Obstetrics and Gynecology
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5558393/
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