Anemia in obstetrics and gynecology: An evaluation of therapy with parenteral iron

Abstract

A survey of the causes for a lowered hemoglobin concentration in obstetric and gynecologic patients indicated that the leading causes were acute blood loss, chronic blood loss, frequent pregnancies with iron depletion, or some combination of these. A not uncommon cause of apparent lowered concentration was error by the service laboratory.Obstetric patients who received supplementary iron during the antepartum period came to delivery with a higher hemoglobin level than did patients who had received no iron. When the iron requirements of pregnancy were routinely supplied intramuscularly with iron-dextran, the hematologic improvement was not significantly greater than when ferrous gluconate was given orally. The intramuscular route of administration, however, seemed of considerable value for treating the severely iron-deficient patient to insure maximal response late in pregnancy and subsequently to correct promptly and completely depleted iron stores. While the use of saccharated iron oxide given intravenously was frequently associated with distressing reactions, iron-dextran given intramuscularly produced only transient local soreness.In gynecologic patients with severe iron deficiency anemia as the result of chronic hypermenorrhea, therapy with iron-dextran resulted in rapid correction of the deficit in circulating hemoglobin so that operation usually could be safely performed at the end of 3 weeks without prior transfusion therapy. Similar prompt hematologic improvement was obtained during the puerperium in patients who were anemic as the result of hemorrhage.The calculation of dosage and the method of injection of iron-dextran have been discussed, as have been the indications for blood transfusions and for iron replacement therapy.Since this study was started the use of blood for transfusions but not the amount of blood cross-matched has dropped markedly. In spite of this sharp decrease occasional severe transfusion reactions have not been entirely avoided.