Intravenous iron therapy for fast and efficient preoperative preparation for uterine myomectomy

Abstract

Objective The aim of the study was to evaluate the therapeutic yield of intravenous iron for preoperative preparation of patients assigned for uterine myomectomy compared with oral iron therapy and to determine the value of supplemental erythropoietin therapy in resistant cases. Patients and methods Sixty women assigned for myomectomy were allocated into two groups: the intravenous group and the oral group. The intravenous group received intravenous iron sucrose therapy every other day to fulfill the calculated dose and the oral group received ferrous bis-glycine sulfate with folic acid yielding 100 mg elemental iron daily. Vitamin C effervescent tablets were given to group oral women to enhance iron absorption. Women who did not approach hemoglobin concentration (Hb conc.) of more than 10 g/dl (the surgical target concentration) within 4 weeks received weekly subcutaneous injection of epoetin-α up to a total dose of more than 600 IU/kg plus oral iron therapy. Venous blood samples were obtained at the time of enrollment and at 2, 4, and 6 weeks of intervention for estimation of Hb conc. and ELISA estimation of serum ferritin. Results Both groups showed a steady, progressive, significant increase of Hb conc. with concomitant significant decrease of concentration deficit. Patients in the intravenous group showed significantly higher Hb conc. at 2 weeks compared with the oral group, and the difference was higher at 4 weeks of therapy. Intravenous therapy led to a significantly lower frequency of patients requiring epoetin-α therapy compared with oral therapy. Both groups showed a steady, progressive, significant increase of serum ferritin levels, with significantly higher levels in the intravenous group compared with the oral group throughout the study period. At 2- and 4-week estimations, serum ferritin level was significantly higher compared with baseline level in both groups, with significantly higher levels at 4 weeks compared with 2 weeks. At week 6, serum ferritin level was significantly higher in the oral group but was nonsignificantly higher in the intravenous group compared with 4-week levels, despite the significantly higher levels in both groups compared with baseline and 2-week levels. Conclusion Intravenous iron sucrose therapy allowed rapid and efficient alleviation of anemia and spares the need and cost of erythropoietin therapy. Combination of oral iron and erythropoietin allowed resistant cases to approach the surgical target concentration.