Efficacy of Intravenous Iron for Treating Postpartum Anemia in Low-Resource African Countries: A Pilot Study in Malawi

Abstract

Postpartum hemorrhage may lead to maternal morbidity and mortality, increases risks of transfusion, and incurs costs. We report on the feasibility and efficacy of in-hospital intravenous (IV) iron for treating postoperative anemia at Mtengo wa Nthenga, Malawi. Twenty-eight consecutive women undergoing surgery for complicated pregnancy or complicated childbirth entered the study. Patients with hemoglobin (Hb) <10 g/dL on postoperative day 1 (n = 14) received IV iron sucrose (200 mg/day, 3 consecutive days), and those with Hb ≥10 g/dL (n = 14) received oral iron (ferrous sulfate, 256 mg/day). In-hospital postoperative Hb increase and blood transfusion were recorded. Mean changes in Hb from postoperative day 1 to postoperative day 7 were -0.6 ± 1.2 g/dL and 2.1 ± 1.7 g/dL, for the oral and IV iron groups, respectively (p = 0.001). No side effect was seen with IV iron. Only 1 of 4 women receiving allogeneic blood was transfused after the initiation of IV iron treatment. Our results suggest that IV iron sucrose is an effective drug for treating puerperal anemia, leading to a rapid recovery of Hb levels. The current availability of generic iron sucrose preparations, with considerably lower acquisition costs, may facilitate in-hospital access to this treatment option in low-resource countries.