Intravenous iron sucrose vs. blood transfusion in the management of moderate postpartum iron deficiency anemia: A non-randomized quasi-experimental study

Iron-deficiency anemia (IDA) is a global health concern in pregnancy associated with adverse fetal and maternal outcomes. The present study aimed to evaluate and compare the therapeutic response and tolerability of intravenous (IV) iron sucrose and ferric carboxymaltose (FCM) administered to pregnant women with IDA. The present prospective observational study was conducted among 334 pregnant women who were in the second or third trimester of pregnancy with moderate to severe IDA and who were treated with IV iron sucrose or FCM at a large tertiary care center between April, 2018 and March, 2024. The therapeutic response was assessed by analyzing the increase in hemoglobin (Hb) and serum ferritin levels at 3 and 6 weeks following the first dose of IV iron treatment. Tolerability was assessed by analyzing the adverse events to drug administration. A statistically significant increase in the mean Hb and serum ferritin levels was observed in both the iron sucrose and FCM groups at 3 and 6 weeks post-infusion (P<0.0001 for all); however, the increase in the FCM group was significantly higher (P<0.0001) than that in the iron sucrose group. Minor temporary adverse drug reactions were comparable (P=0.232) between the both treatment groups, with no major serious adverse events observed in any group. IV iron sucrose and FCM both were efficacious and well tolerated in pregnant women with moderate to severe IDA during the second and third trimester. However, there was an improved overall response to FCM as it caused a greater increase in the Hb and serum ferritin levels than iron sucrose. Therefore, FCM is recommended as an effective and safe alternative to iron sucrose for the treatment of IDA during pregnancy.

Intravenous Iron Sucrose for Children with Iron Deficiency and/or Gastrointestinal Hemorrhage.

Iron Sucrose and Blood Pressure Patterns During Hemodialysis

Objectives:The objective of the present study is to compare the safety and efficacy of ferric carboxymaltose (FCM), intravenous (IV) iron sucrose and oral iron in the treatment of post = partum anemia (PPA).Materials and Methods:A total of 366 women admitted to SCB Medical College, Cuttack between September 2010 and August 2012 suffering from PPA hemoglobin (Hb) <10 g/dL were randomly assigned to receive either oral iron or IV FCM or iron sucrose. FCM, IV iron sucrose, and oral iron were given as per the protocol. Changes in hemoglobin (Hb) and serum ferritin levels at 2 and 6 weeks after treatment were measured and analyzed using ANOVA. Adverse effects to drug administration were also recorded.Results:A statistically significant increase in Hb and serum ferritin level were observed in all three groups, but the increase in FCM group was significantly higher (P < 0.0001) than conventional iron sucrose and oral iron group. The mean increase in Hb after 2 weeks was 0.8, 2.4, and 3.2 g/dL and 2.1, 3.4, and 4.4 g/dL at 6 weeks in oral iron, iron sucrose and FCM groups, respectively. The mean increase in serum ferritin levels after 2 weeks was 2.5, 193.1, and 307.1 and 14.2, 64, and 106.7 ng/mL after 6 weeks in oral iron, iron sucrose and FCM groups, respectively. Adverse drug reactions were significantly less (P < 0.001) in FCM group when compared with other two groups.Conclusion:Ferric carboxymaltose elevates Hb level and restores iron stores faster than IV iron sucrose and oral iron, without any severe adverse reactions. There was better overall satisfaction reported by the patients who received FCM treatment.

Iron deficiency anaemia (IDA) is a major health issues and common type of nutritional deficiency worldwide. For IDA treatment, intravenous (IV) iron is a useful therapy. To determine the efficacy and cost-effectiveness (CE) of intravenous (IV) Ferric Carboxymaltose (FCM) versus IV Iron Sucrose (IS) in treating IDA. Electronic medical record i.e. Cerner® system. Adults patients with iron deficiency anaemia. A 12-month period (01/01/2018-31/12/2018). Hamad Medical Corporation (HMC, a public hospital). IV Ferric Carboxymaltose versus IV Iron Sucrose. With regard to responses to treatment i.e., efficacy of treatment with FCM & IS in IDA patients, hemoglobin (Hgb), ferritin, and transferrin saturation (TSAT) levels were the primary outcomes. Additionally, the researchers also collected levels of iron, platelet, white blood cell (WBC), red blood cell (RBC), mean corpuscular hemoglobin (MCH), and mean corpuscular volume (MCV). The costs i.e. resources consumed (obtained from NCCCR-HMC) and the CE of FCM versus IS were the secondary outcomes. There was a significant improvement in Hgb, RBC and MCH levels in the IS group than the FCM group. The overall cost of IS therapy was significantly higher than FCM. The medication cost for FCM was approximately 6.5 times higher than IS, nonetheless, it is cheaper in terms of bed cost and nursing cost. The cost effectiveness (CE) ratio illustrated that FCM and IS were significantly different in terms of Hgb, ferritin and MCH levels. Further, Incremental Cost Effectiveness Ratio (ICER) indicated that further justifications and decisions need to be made for FCM when using Hgb, iron, TSAT, MCH and MCV levels as surrogate outcomes. Not applicable. The study did not consider the clinical or humanistic outcome. The higher cost of FCM versus IS can be offset by savings in healthcare personnel time and bed space. ICER indicated that further justifications and decisions need to be made for FCM when using Hgb, iron, TSAT, MCH and MCV levels as surrogate outcomes.

BackgroundIron deficiency anaemia (IDA) is a major health issues and common type of nutritional deficiency worldwide. For IDA treatment, intravenous (IV) iron is a useful therapy.ObjectiveTo determine the efficacy and cost-effectiveness (CE) of intravenous (IV) Ferric Carboxymaltose (FCM) versus IV Iron Sucrose (IS) in treating IDA.Data sourcesElectronic medical record i.e. Cerner® system.Target populationAdults patients with iron deficiency anaemia.Time horizonA 12-month period (01/01/2018–31/12/2018).PerspectiveHamad Medical Corporation (HMC, a public hospital).InterventionIV Ferric Carboxymaltose versus IV Iron Sucrose.Outcome measuresWith regard to responses to treatment i.e., efficacy of treatment with FCM & IS in IDA patients, hemoglobin (Hgb), ferritin, and transferrin saturation (TSAT) levels were the primary outcomes. Additionally, the researchers also collected levels of iron, platelet, white blood cell (WBC), red blood cell (RBC), mean corpuscular hemoglobin (MCH), and mean corpuscular volume (MCV). The costs i.e. resources consumed (obtained from NCCCR-HMC) and the CE of FCM versus IS were the secondary outcomes.Results of base-case analysisThere was a significant improvement in Hgb, RBC and MCH levels in the IS group than the FCM group. The overall cost of IS therapy was significantly higher than FCM. The medication cost for FCM was approximately 6.5 times higher than IS, nonetheless, it is cheaper in terms of bed cost and nursing cost. The cost effectiveness (CE) ratio illustrated that FCM and IS were significantly different in terms of Hgb, ferritin and MCH levels. Further, Incremental Cost Effectiveness Ratio (ICER) indicated that further justifications and decisions need to be made for FCM when using Hgb, iron, TSAT, MCH and MCV levels as surrogate outcomes.Results of sensitivity analysisNot applicable.LimitationsThe study did not consider the clinical or humanistic outcome.ConclusionsThe higher cost of FCM versus IS can be offset by savings in healthcare personnel time and bed space. ICER indicated that further justifications and decisions need to be made for FCM when using Hgb, iron, TSAT, MCH and MCV levels as surrogate outcomes.

To explore the safety and efficacy of intravenous (IV) iron sucrose in maintenance peritoneal dialysis (PD). Randomized, controlled, parallel-group single-center trial. Blood Purification Center of Chaoyang, Beijing Capital University of Medical Science, China. 46 patients on PD were involved in this trial. 26 patients received IV iron sucrose (200 mg iron) once per week for 4 weeks then once every other week for a further 4 weeks. The other 20 patients received oral ferrous succinate, 200 mg three times per day, for 8 weeks. Hemoglobin, hematocrit, serum ferritin (SF) level, and transferrin saturation (TSAT) were assessed at baseline and then again after 2, 4, and 8 weeks of treatment. There were no differences between the IV and oral groups in terms of sex, age, duration of PD, mean dialysate dosage per day, erythropoietin dosage per week, or hematological parameters at baseline. After 4 and 8 weeks of treatment, mean Hb and Hct were significantly increased in the IV group and were also significantly higher than those in the oral group. Levels of SF and TSAT were also significantly increased in the IV group, and significantly higher than in the oral group. After 8 weeks, the response rate in the IV group was 94.8%, which was significantly higher than that in the oral group. The mean erythropoietin dose was significantly lower in the IV group than in the oral group. Hb, Hct, SF, and TSAT levels were maintained between 4 and 8 weeks in the IV group despite the decrease in dose frequency. There were no adverse events with IV iron. Eight patients in the oral group had adverse gastrointestinal effects. IV iron sucrose is safe in PD patients. It increases Hb levels and serum iron parameters more effectively than oral iron; it is well tolerated and can permit reductions in the required dose of erythropoietin.

Iron deficiency anemia in children is a public health problem. Although oral iron treatment is the first choice, common side effects and compliance problems can cause the treatment to be interrupted. This study retrospectively evaluated children treated with intravenous (IV) iron sucrose or ferric carboxymaltose (FCM) and compared the treatment processes and efficacy. The demographic characteristics and treatment details of the 44 children with iron deficiency anemia were retrospectively evaluated. Iron sucrose was administered to 25 patients and FCM was administered to 19 patients. The IV iron infusion was applied to 64% of the patients because of unresponsiveness to oral treatment, 25% of the patients because of compliance problems, and 11% of the patients because of severe anemia. IV iron therapy increased hemoglobin, mean corpuscular volume, mean corpuscular hemoglobin, red-cell distribution width, and serum ferritin levels and decreased platelet count. The mean number of infusions per patient in the FCM group was lower, and the total treatment time was shorter. In conclusion, IV iron sucrose or FCM can be used in children with nonadherence to oral therapy and severe anemia in addition to specific indications.

Iron deficiency is the most common cause of anaemia worldwide and is associated with significant maternal and fetal morbidity. Current options for treatment include oral iron supplementation which can be ineffective and poorly tolerated, intravenous iron which can be used in patients who are intolerant to or unresponsive to oral iron and red blood cell transfusions which carry an inherent risk because of which it should be avoided. Intravenous iron therapy may reduce the requirement for allogenic blood transfusion. Ferric carboxymaltose is a new intravenous iron formulation promising to be more effective and as safe as iron sucrose. It may even have a better compliance as it offers the administration of a much higher iron dosage at a time.The study was designed to compare the efficacy and safety of IV ferric carboxymaltose versus iron sucrose in the treatment of iron deficiency anaemia of pregnant women with moderate anaemia in the second and third trimester.A hospital based randomized prospective study was done from July 2013 to June 2015 in the department of Obstetrics and Gynaecology, A.J. Institute of Medical Sciences, Mangalore. Baseline haemoglobin, peripheral smear and serum ferritin levels were measured to diagnose iron deficiency anaemia. 60 pregnant women who met the inclusion criteria and who formed the study subjects were randomly allocated into two groups comprising of 30 in Group C (Received ferric carboxymaltose) and 30 in Group S (Received iron sucrose). Outcome was assessed by measuring haemoglobin 3 weeks after treatment and a comparison of the safety and efficacy between the two groups was made. In the present study the commonest age group was 21 to 30 years: 80% in group C and 73.3% in group S and mean age of the study population in group C and S was comparable (25.2±3.54 vs 24.8±4.58 years). The socio demographic characteristics, obstetric history, vitals and pretreatment haemoglobin were comparable in both the groups (p&amp;#62;0.050). The post treatment haemoglobin levels in 63.3% of the women in group C compared to 46.7% in group S were found to be 11 or more and mean post treatment haemoglobin levels were comparable in group C and group S (11.016±0.789 vs 10.73±0.821 gm%; p=0.174). In the present study, post treatment mean increase in haemoglobin levels was noted between 2.0 to 2.5 gm% in 43.3% of the women in group C compared to 50.0% in group S. Ferric carboxymaltose administration in pregnant women in the second and third trimesters is well tolerated and is not associated with any clinical safety concerns. Both ferric carboxymaltose and iron sucrose have a comparable safety profile even when ferric carboxymaltose was administered in a much higher dosage compared to iron sucrose. Ferric carboxymaltose should be considered as the drug of choice, if i.v. iron treatment becomes necessary in the second or third trimester of pregnancy.

Worldwide Iron deficiency anemia (IDA) affects 25% population and in India it affects 80% of pregnant. Prospective interventional study was conducted to know the efficacy of intravenous (IV) iron sucrose in the management of IDA in pregnant women. Pregnant women with singleton pregnancy with gestational age more than 20 weeks and IDA (Hemoglobin <10 gm % and serum ferritin <15ng/dl) were enrolled in the study. Women divided in two treatment groups using lottery system division. Among these two groups, one group received oral iron treatment and another group received IV iron sucrose according to a predesigned standard treatment protocol. Hemoglobin and serum ferritin levels were studied one months after completion of treatment it was observed that in IV iron sucrose treatment group there is statistically significant improvement in Hb and serum ferritin on day 30 after completion of treatment (p value < 0.0001).

Aim: The aim of the study is to know whether intravenous iron sucrose can be a better alternative in terms of safety and efficacy over blood transfusion in the treatment of anaemia in post-partum. Materials and methods: This are prospective study is conducted in obstetrics and gynaecology Department . All these women are randomly assigned (50 women total , 25 in each group) to receive either 2 doses of intravenous iron sucrose(Group A) or blood transfusion (Group B). Haemoglobin, hemocrit, mean corpuscular volume and serum ferritin estimation is done before treatment and after 1 wk. of correction in both groups to note the improvement in values and monitored for adverse reactions. Results: There is statically significant rise in haemoglobin , hemocrit , mean corpuscular volume , and serum ferritin levels when compared to baseline after 1 week of treatment in both groups. Statistically insignificant rise in mean Hb,Hct was observed when iron sucrose group is compared to blood transfusion group. Conclusion: Intravenous iron sucrose is safe , efficacious and cost-effective treatment for post-partum anaemia. It may be an attractive to blood transfusion which may be associated with minor and major reactions.

Phlebitis after Parenteral Iron Sucrose Administration in Postpartum Women

To explore the safety and efficacy of intravenous iron sucrose in maintenance dialysis and to establish the optimal administration frequency and dose. One hundred and ninety-four patients on maintenance dialysis with the hemoglobin (Hb) level of 60 - 100 g/L and hematocrit (Hct) of 18% - 30% were randomly divided into 2 sex, age, duration of dialysis, weekly erythropoietin dosage, and hematological parameters-matched groups: intravenous iron sucrose group (n = 102) and oral medication group (n = 92). The intravenous iron sucrose group were sub-divided into 2 subgroups: (1) hemodialysis (HD) subgroup receiving intravenous iron sucrose 200 mg once a week for 4 weeks and then 100 mg once a week for a further 8 weeks, and (2) peritoneal dialysis (PD) subgroup receiving intravenous iron sucrose 200 mg once a week for 4 weeks and then 200 mg once every other week for a further 8 weeks. The oral medication group received ferrous succinate 200 mg tid for 12 weeks. The levels of serum ferritin (SF), transferrin saturation (TSAT), Hb, and Hct were examined before treatment and 4, 8, and 12 weeks after treatment. (1) Compared with baseline levels, the levels of Hb, Hct, SF, and TSAT significantly increased 2 weeks after treatment in the intravenous iron sucrose group, and 4 weeks after treatment in the oral medication group (all P < 0.05). (2) The Hb, Hct, SF, and TSAT levels 4, 6, 8, and 12 weeks after treatment of the 2 intravenous iron sucrose subgroups were all significantly higher than those of the oral medication group (all P < 0.05). (3) The Hb, Hct, SF, and TSAT levels 12 weeks after treatment 6, 8, and 12 weeks after treatment were not significantly different from those 4 weeks after treatment in the intravenous iron sucrose group (all P > 0.05). (4) The response rate of the intravenous iron sucrose group was 95.09%, significantly higher than that of the oral medication group (55.44%, P < 0.05). (5) The mean EPO doses 6, 8 and 12 weeks after treatment of the intravenous iron sucrose group were significantly lower than that before treatment and those of the oral medication group (all P < 0.05). (6) The Hb, Hct, SF, and TSAT levels maintained stable during the period 6, 8, and 12 weeks after treatment in the intravenous iron sucrose group despite the decrease in dose and frequency. (7) The Hb, Hct, SF, and TSAT levels were significantly higher in the intravenous PD subgroup than in the intravenous HD subgroup. (8) No adverse event was found in the intravenous iron sucrose group, and adverse gastrointestinal effects occurred in 12 patients of the oral medication group. (9) After 12 weeks, the cost of EPO + intravenous iron sucrose was significantly higher than that of EPO + ferrous succinate. Intravenous iron sucrose effectively increases the serum iron parameters and hemoglobin levels during maintenance peritoneal dialysis and is well tolerated. Infusing intravenous iron sucrose 200 mg every two weeks can maintain the serum iron parameters and hemoglobin level in maintenance peritoneal dialysis patients and n permits reduction of the required dose of EPO. However, the total cost of intravenous iron treatment is relatively high.

Background: Iron deficiency anemia (IDA) is one of the most frequent nutritional deficiency leading to morbidity and mortality in whole world. Oral iron therapy as well as intravenous (IV) iron therapy can be given to treat the IDA patients.&#x0D; Objective: To compare the efficacy and hematological changes of Oral and IV iron preparation in patients with uncomplicated iron deficiency anemia.&#x0D; Method: An interventional, prospective study in patients with uncomplicated IDA anemia receiving IV iron sucrose and Oral iron ferrous sulfate were included. Clinical history, baseline hemoglobin, anemia indices data were recorded in a case record form. A total number of 80 patients were enrolled in this study. 40 patients (Group A) were treated with IV iron sucrose and another 40 patients (Group B) were treated with oral iron ferrous sulfate. After therapy Hemoglobin level, RBC indices and adverse drug reactions (ADRs) were observed.&#x0D; Place and period of Study: Study was carried out in the Department of Hematology at Dhaka Medical College Hospital (DMCH), from July 2015 to June 2016.&#x0D; Results: The mean age of total participants was 35.77 ± 16.08 (range of 13 – 75 years). In this study female (72.5%) is predominant than male (27.5%). Oral and IV iron preparations significantly (P&lt;0.0001) improved mean hemoglobin, anemia indices at the end of study. However, mean increase in hemoglobin were significant (P&lt;0.0001) with IV iron sucrose (7.6 ± 2.9) gm/dl, as compared to Oral ferrous sulfate (6.4± 2.2)gm/dl, after 2 months of therapy. In this study Hemoglobin increases in group A (IV iron arm) almost 1mg/kg/week and in group B (oral iron arm) 0.8 mg/dl/week).Surprisingly, ADRs were more in patients treated with oral ferrous sulfate (38%) compared to iron sucrose (26%).&#x0D; Conclusion: IV iron sucrose improves hemoglobin, anemia indices and replenish iron stores rapidly and is well tolerated than oral iron preparations.&#x0D; J Dhaka Medical College, Vol. 27, No.2, October, 2018, Page 175-181

Anaemia in pregnancy is a public health concern because it is strongly associated with maternal and perinatal morbidity and mortality. An open label randomized controlled trial (RCT) was conducted in India across four government medical colleges, comparing intravenous (IV) iron sucrose and oral iron for the treatment of anaemia in pregnancy. This RCT failed to demonstrate superiority of IV iron sucrose compared with oral iron therapy in reducing adverse clinical (maternal and foetal/neonatal) outcomes in moderate-to-severe anaemia in pregnancy. However, IV iron sucrose seemed to reduce the need for blood transfusion among women with severe anaemia. The study objective was to conduct a cost-effectiveness analysis of IV iron sucrose over oral therapy for treatment of severe anaemia in pregnancy, alongside the RCT, to inform policy. The outcome of interest in our study was a 'safe delivery' defined by the absence of composite maternal and foetal/neonatal adverse clinical outcomes. Incremental cost-effectiveness ratio (ICER) was calculated from a limited societal perspective. IV iron sucrose was found to be more costly but more effective than the oral therapy for treatment of severe anaemia. The ICER was calculated at INR 31951 (USD 445.2) per safe delivery. We considered a threshold of half the gross national income for decision-making. Considering this threshold of India (INR 57230, USD 797.4), IV iron-sucrose remained cost-effective in 67% of the iterations in the model. At the current ICER, for every 32 severely anaemic pregnant woman treated with IV iron sucrose one additional pregnant woman will have a safe delivery. Such analyses can complement the national strategy to support evidence-based action.