Intravenous Iron Sucrose Therapy Research Articles

Cost-effectiveness analysis of parenteral iron therapy compared to oral iron supplements in managing iron deficiency anemia among pregnant women.

This study compared the clinical efficacy and cost-effectiveness of parenteral iron, using intravenous iron sucrose (IVIS) therapy against the standard regimen of oral iron (OI) therapy for managing iron-deficiency anemia (IDA) among pregnant women in a natural primary care setting in Gujarat. A prospective cost-effectiveness study was conducted in natural programme setting wherein 188 pregnant women in their 14 to 18weeks with moderate and severe anemia women enrolled from two districts of Gujarat, and 142 were followed up until the post-partum phase. The intervention group comprised of 82 participants who were administered IVIS, while the comparison group comprised of 106 participants who were put on OI therapy. Hemoglobin (Hb) levels were measured at periodic intervals, first during enrollment and then during each month of pregnancy period and finally on the 42nd day of the post-natal period. Change in mean Hb level from baseline was the primary outcome, while the incidence of morbidity and mortality was a secondary outcome measure. The intervention group showed a significant incremental mean change in Hb level from 8.2g/dl to 11.45g/dl at the fourth follow-up, while the control group's mean Hb level reduced from 9.99g/dl to 9.55g/dl. The discounted cost per beneficiary for IVIS was US$ 87, while that for OI was US$ 49. The incremental cost-effectiveness ratio (ICER) was US$ 9.84, which is 0.049% of India's per capita GDP. IVIS therapy was more clinically effective and cost-effective than OI therapy among pregnant women for management of moderate and severe anemia.

Abstract 13670: Prevalence and Long-Term Outcomes of Intravenous Iron Sucrose Therapy in Heart Failure With Reduced Ejection Fraction: A Single Institution Retrospective Cohort Study

Background: Iron deficiency (ID) is prevalent in heart failure with reduced ejection fraction (HFrEF) defined as left ventricular ejection fraction (LVEF) ≤ 40%. Most trials used in the 2022 AHA/ACC guidelines studied iron carboxymaltose; most had a short follow-up and evaluated heart failure readmissions. We explored the prevalence of iron use, long-term therapeutic benefits, and impact on all-cause readmission for patients with HFrEF. Methods: In this retrospective cohort study, we analyzed electronic medical record data from a university hospital from 2016 to 2021 with an ICD-10 code of systolic heart failure (LVEF < 50%) and ID, or iron deficiency anemia (IDA) (n=619). Intravenous (IV) iron sucrose group was matched to a control group (n = 43) by propensity score matching for age and sex. Conditional logistic regression was utilized to estimate unadjusted odds ratios (uOR) with 95% confidence interval (CI), while Mann-Whitney test was utilized to compare median values of nonparametric estimates. Statistical analysis was done in SAS version 9.4. Results: 66.7% of the studied population were male and 61.1% were ≥ 65 years. The common comorbid conditions were ischemic cardiomyopathy (39.6%), chronic kidney disease (CKD) (26.2%), and gastrointestinal (GI) bleeding (12.3%). ID was present in 115 (18.6%); IDA in 95 (15.4%) and 43 (6.9%) received IV iron sucrose. IV iron administration was significantly associated with LVEF 41-49% (uOR = 2.65, 95% CI: 1.10 - 6.43), GI bleeding (uOR = 16.00, 95% CI: 2.12 - 120.65), chronic kidney disease (uOR = 3.67, 95% CI: 1.49 - 9.04), iron deficiency (uOR = 26.00, 95% CI: 3.53 - 191.60]) and iron deficiency anemia (uOR = 24.00, 95% CI: 3.23 - 177.41). LVEF ≤40% was non-significantly associated with all-cause mortality (uOR = 1.50, 95% CI: 0.61 - 3.67). The IV iron group had a higher median rate of 6-year readmissions (8 [IQR:8] vs.1 [2]; p<0.001), and blood transfusions (11 [24] vs. 3.5 [2]; p=0.05). Conclusions: Patients with HFrEF were less likely to receive IV iron sucrose and more likely to die. Those with frequent blood transfusions, GI hemorrhage, and CKD were more likely to receive IV iron. The study indicates the impact of disease severity and comorbidities on management. Larger studies are needed to investigate this postulation.

Comparative study on intravenous iron sucrose versus intravenous ferric carboxymaltose in the management of iron deficiency anaemia in pregnancy in a tertiary care hospital, Bengaluru

Background: Iron deficiency is the most common nutritional deficiency worldwide; it affects 1.6 billion people Iron deficiency (ID) and iron deficiency anemia (IDA) are often encountered in the general population, particularly among children and women with abnormal uterine bleeding (AUB) and during pregnancy as well as postpartum period Intravenous (IV) iron replacement can deliver the total amount of required iron over a short period. Currently, the most commonly used IV iron formulations are iron sucrose (IS) and ferric carboxymaltose (FCM) [4-6]. Iron sucrose does not require test dose and is safe. Ferric carboxymaltose (FCM) is the latest I.V. iron formulation which can be used at high doses and allows rapid administration (up to 1000 mg in a single dose infused in 15 minutes) The present study was a comparative study of parenteral iron therapy (intravenous iron sucrose versus intravenous ferric carboxymaltose in the management of iron deficiency anaemia in pregnancy.Methods: In the present study, 50 pregnant women with IDA were randomly distributed into two groups of 25 each. Group - A: 25 receiving intravenous iron sucrose therapy; Group - B: 25 receiving intravenous ferric carboxymaltose therapy.Results: Majority of the study participants in Group A had gestational age between 20–25 weeks (48%). The mean age of the study participants in Group A was found to be 22.86+4.42 weeks. Majority of the study participants in Group B had gestational age between 20-25 weeks (36%). The mean age of the study participants was found to be 23.01+3.01 weeks. Majority of the study participants in Group A had nil parity (40%). 36% of the study participants in Group B had nil parity. 60% of the study participants in group A had Mild degree of anaemia with 52% in group B having mild degree of anaemia. 40% and 44% of the study participants in group A and group B had Moderate degree of anaemia respectively. The association was found to be statistically significant between the mean Hb and Ferritin values pre-treatment, 3rd and 6th week follow-up post treatment and the 2 groups of study participants. The adverse effects were comparatively lower among Group B (IV ferric carboxymaltose) than Group A (IV iron sucrose) of the study participants.Conclusions: IV ferric carboxymaltose administration increases the hemoglobin level more rapidly as compared to iron sucrose in women with iron deficiency anemia in the pregnancy. It also stores iron more rapidly. No serious adverse effects were recorded. Ferric carboxymaltose is well tolerated, safe and effective alternative to iron sucrose in iron deficiency anemia of pregnancy. FCM has the advantage of a large dose administration per sitting and early rise in hemoglobin level.

A Preliminary Study on Parenteral Intravenous Iron Sucrose (IVIS) Therapy in Managing Anaemia among Pregnant Women in Primary Care Setting of Rural Haryana

Background: Intravenous iron sucrose (IVIS) therapy is a newly introduced service component for combating moderate anaemia in pregnant women by the Haryana state as a public health measure from the year 2014. Aim: The aim of this study was to ascertain the effect of IVIS therapy on pregnant females having anaemia who were receiving this therapy in a primary care setting. Method: This prospective study was conducted at a randomly selected rural Primary Health Centre (PHC) in the Nuh district. 138 moderately anaemic females were given the standard form of IVIS therapy. The study subjects were requested to repeat haemoglobin levels after 2 weeks and 4 weeks of receipt of the last dose of therapy. Results: Of the total 154 anaemic pregnant women, 138 (89.6%) were diagnosed to have moderate anaemia. The number of study subjects with moderate anaemia reduced from 138 to 54, (54.54% reduction) when haemoglobin level was measured at the end of 4 weeks (endline). The mean rise in haemoglobin level among moderately anaemic pregnant females was 1.62 g/dL. At the end of 4 weeks (endline), 73.75% of the study subjects achieved normal levels of haemoglobin (from a total of 80 moderately anaemic women measurement). Conclusion: The mean rise in haemoglobin level in moderately anaemic pregnant females was 1.62 g/dL among participants who received IVIS therapy in a primary care setting in an underprivileged area in Haryana state. The women having severe anaemia achieved a better rise in Hb levels.

Effectiveness of Intravenous Iron Sucrose Therapy in Routine Antenatal Care for the Treatment of Moderate to Severe Anemia Among Pregnant Women Attending a Secondary Care Hospital in North India: A Retrospective Analysis.

Introduction: Anemia during pregnancy is an important public health problem and is associated with a number of maternal and fetal complications. Intravenous iron sucrose (IVIS) has been reported to be safe and efficacious in raising the hemoglobin (Hb) level among pregnant women. However, most of the studies were conducted in controlled research settings, and there is a paucity of data on the effectiveness when IVIS is given as routine therapy in public health facilities. The objective of this study was to estimate the change in mean Hb level four weeks after the last dose of IVIS infusion in pregnant women with moderate to severe anemia in a public healthcare setting.Methods: Records of pregnant women having moderate anemia (Hb level: 7.0-9.9 gm/dL), who received IVIS in calculated dose during routine antenatal care between 1 January 2018 and 31 July 2018, were reviewed. Data were analyzed using STATA version 13 software (StataCorp LLC, College Station, TX). Hb levels before the start of the therapy (baseline) and four weeks after the last infusion (endline) were compared. A value of p < 0.05 was considered statistically significant.Results: The mean (±SD) Hb level increased from 8.5 (±0.88) gm/dL at baseline to 10.3 (±1.24) gm/dL four weeks after the last dose of IVIS infusion. The mean (±SD) increase in Hb level was 1.7 (±1.29) gm/dL (95% CI: 1.57, 1.87). The change from moderate and severe anemia to normal Hb levels was observed in 28.4% and 28.6% of women, respectively.Conclusion: IVIS therapy is effective in improving Hb levels when given as routine therapy in a secondary level public healthcare facility.

Effectiveness and Safety of Intravenous Iron Sucrose Therapy in Children with Iron Deficiency Anemia

Background: Iron deficiency anemia is linked with growth retardation, cognition impairment, reduced interest in daily activities and has been shown to contribute to infant mortality. Objectives: To evaluate the effectiveness and safety of intravenous iron sucrose treatment in children with iron deficiency anemia. Methodology: A quasi-experimental study was conducted at the Lady Reading Hospital, Peshawar from November 2020 to April 2021. Patients younger than 18 years with iron deficiency who were refractory to conventional therapy were included and patients who were non-compliant with the oral iron therapy prescribed before the study were excluded. Patients were administered iron sucrose complex intravenously as per standard protocol. The patient's demographics, hemoglobin, ferritin levels, and other related variables were recorded. Results: A total of 152 patients were enrolled in the study with a mean age of 4.26 ± 3.21 years. At baseline, the mean hemoglobin was 7.01 ± 0.69 g/dL which increased to 12.35 ± 0.71 g/dL (p&lt;0.001). The mean corpuscular volume (MCV) before treatment was 66.35 ± 3.56 fL which was raised significantly to 88.42 ± 6.87 fL by day 30 (p&lt;0.001). The greatest pre-and post-treatment difference was observed in ferritin levels (6.95 ± 4.37 μg/L versus 49.67 ± 4.82 μg/L, p&lt;0.001). Conclusion: The current study revealed that iron sucrose therapy is very effective and considered safe for children between the ages of 1 and 17 years with no serious adverse effects.

A COMPARATIVE STUDY OF INTRAVENOUS IRON SUCROSE VERSUS ORAL IRON THERAPY IN IRON DEFICIENCY ANEMIA DURING POSTPARTUM PERIOD

Introduction: Anemia is the commonest major contributing factor in maternal mortality and morbidity in developing countries and according to World Health Organization (WHO) criteria, it contributes to 20% of maternal deaths. Anemia in pregnancy defined as hemoglobin level &lt;11 gm/dl (7.45 mmol/L) and hematocrit less than 33% (WHO).&#x0D; Aim: To compare the efficacy of oral iron ferrous sulphate therapy with intravenous iron sucrose therapy in the treatment of iron deficiency anemia during postpartum period.&#x0D; Material &amp; Methods: This was a prospective randomized comparative clinical trial single center study conducted on 200 postpartum women aged &gt;18 years (after normal delivery or LSCS) within 10 days of delivery with Hb level more or equal to 6 gm/dl but less than 10 gm/dl were included in the study. This was a one year study conducted during 1st December 2018 to 30th November 2019.&#x0D; Results : There was a significant increase in the hemoglobin level in both the groups i.e. in IV iron group, from 8.26 ±1.03gm/dl on day 1 to 11.62±0.94gm/dl on day 45 as compared to oral iron group, from 8.24±1.09gm/dl on day 1 to 11.07±1.14gm/dl on day 45; and serum ferritin level from 41.69±40.45ng/ml on day 1 to 77.34±41.60ng/ml on day 45 in IV iron group as compared to the oral iron group from 22.20±8.82ng/ml on day 1 to 31.72±9.72 ng/ml on day 45. So, there was a rapid increase in both hemoglobin and serum ferritin levels in IV iron group as compared to the oral iron group.&#x0D; Conclusion: Intravenous iron sucrose administration increases the hemoglobin level and serum ferritin more rapidly in compare to the oral intake of ferrous sulphate in women with iron deficiency anemia in postpartum women in our study.&#x0D; Keywords: Iron deficiency anemia, Intravenous iron sucrose, Serum ferritin, Maternal mortality.

Effect of oral iron and intravenous iron sucrose on pregnancy related outcome among pregnant females with iron deficiency anemia

Introduction: Intravenous iron sucrose and oral iron therapy are the primary therapeutic modalities for management of iron deficiency anaemia during pregnancy, but its efficacy during pregnancy is still a matter of argument among healthcare personnel. Therefore the objective of this study is to compare the effect of oral iron and intravenous iron sucrose on pregnancy related outcome among pregnant females with iron deficiency anemia. Materials and Methods: Randomized clinical trial was conducted among females between 14 to 36 weeks gestation with iron deficiency anemia who were managed either with oral ferrous sulphate or intravenous iron sucrose therapy. Chi-square test was used for statistical analysis with p Results: About 11.25% of the study subjects had the complication of abruption/ Post-Partum hemorrhage or had the need of blood transfusion in oral group. No significant difference in respect to maternal complications as well as mode of delivery was observed in between the two groups. In intravenous group proportion of appropriate for gestational age newborns (AGA) were significantly higher than the oral group (p Conclusions: Intravenous iron sucrose use for treatment of iron deficiency anaemia could reduce morbidities from iron deficiency and have better foetal outcome in terms of appropriate for gestational age in newborns. Keywords: Anaemia, Haemoglobin, Iron sucrose.

Intravenous Iron Sucrose Therapy in Anemia with Pregnancy

Anemia of pregnancy is most common medical disorder in the developing country, affecting 2 billion population worldwide. In India prevalence is 49.7% of pregnancy contributing to 80% of maternal mortality. Parental iron therapy produces rapid, complete correction of iron deficiency including iron stores. Intravenous iron sucrose therapy has become gold standard in management. It has many advantages over other iron preparations in correction of anemia. AIMS AND OBJECTIVE: Evaluation of hemoglobin improvement, time required, and patient’s compliance after iron sucrose therapy. MATERIAL AND METHODS: Retrospective analysis was done of 264 pregnant women with anemia who were admitted in AL-Zahra Teaching Hospital from May 2015 to August 2019, and were diagnosed as iron deficiency anemia and had received intravenous iron sucrose 200 mg weekly till targeted hemoglobin 10gm was reached. RESULTS: majority of women (54.2%) were in age group of 21-29 years. 66.3% were resident of rural area. Anemia was more common (69.7%) in women with vegetarian diet. 83% 0f patients were multigravida. 48.9% cases were of mild, 44.7% of moderate, and 6.4% of severe anemia. There was initial rise in Hb within a week and rise of 1-2gm Hb per week attaining a targeted Hb. CONCLUSION: Iron sucrose is the best tolerated drug, gives mean Hb rise by 600 mg in all grades of anemia and in maximum periods of 4 weeks. Looking at the patient’s compliance and feasibility this drug has replaced strategy of unnecessary blood transfusions. Keywords : Anemia of pregnancy, Pareneteral therapy, Iron sucrose therapy. DOI: 10.7176/JHMN/81-07 Publication date: October 31 st 2020

Intravenous iron sucrose in malnourished children with iron deficiency anemia.

Objectives: To compare the mean hemoglobin level before and six weeks after giving intravenous iron sucrose therapy in malnourished children having iron deficiency anemia. Study Design: Quasi Experimental Study. Setting: Nutritional Stabilization Centre, Children Hospital and Institute of Child Health, Multan. Period: From July 2018 to December 2018. Material &amp; Methods: A total of 80 patients were enrolled in the study. Hemoglobin level at baseline was recorded. IV iron sucrose therapy was divided into 3 equal doses and administered on 3 consecutive days. After 6 weeks of administration of iron sucrose, hemoglobin level was noted. Independent sample T-test was applied to compare Hb level before and after therapy with p-value≤0.05 as significant. Results: Overall, mean age was 13.39±6.11months. There were 54 (67.5%) males and 28 (32.5%) females. The mean weight of patients was 5.06±1.45kg and mean height was 64.59±8.72cm. The weight for height ratio was &lt;-3SD in all patients (100%). The mean hemoglobin level of patients at baseline was 7.37±0.44g/dl, which was improved to 9.47±0.47g/dl after 6 weeks treatment. This was significant improvement (p&lt;0.05). Conclusion: Thus intravenous iron sucrose therapy can significantly improve the condition of child and rectify the IDA.

English

English

CLINICAL EVALUATION OF INTRAVENOUS IRON SUCROSE IN PREGNANT ANEMIC FEMALES

The standard treatment in majority of the institutions is oral iron (OI), with blood transfusion reserved for severe or emergency cases. However, it is unreliable in the treatment of severe anemia. Blood transfusion has its own hazards, including transfusion of wrong blood and deadly infections like HIV, CMV, hepatitis and anaphylaxis. Thus, there is a need for a safe and effective alternative to OI or blood transfusion in the treatment of anemia. Iron dextran, the first parenteral iron used, lost its popularity due to anaphylaxis. Iron sucrose was then discovered as a parenteral iron that could be safe and effective. Hence based on above findings the present study was planned for Clinical Evaluation of Intravenous Iron Sucrose in Pregnant Anaemic Females.&#x0D; The present study was planned in Department of Obstetrics and Gynaecology, Madhubani Medical College and Hospital, Madhubani, Bihar. In the present study 50 females presenting in antenatal clinic with haemoglobin between 5-9 g% were enrolled in the present study. Iron sucrose (Injection Orofer S, Emcure Pharmacueticals Limited, India) was given in a dose of 200 mg intravenously twice weekly in 200 ml normal saline over a period of 15-20 min. First dose was given in the ward where equipment for cardiopulmonary resuscitation was available. The following doses were given on outpatient basis. Patients were observed for side effects or anaphylactic reactions. Any minor or major side effects were documented. All parameters were repeated at 2 wk interval till 8 wk.&#x0D; The data generated from the present study concludes that intravenous iron sucrose therapy was effective to treat moderate anaemia in pregnant women. Intramuscular preparations are known to be associated with local side-effects. Iron sucrose complex iv therapy was with negligible side effects. It caused rapid rise in haemoglobin level and the replacement of stores was faster.&#x0D; Keywords: Intravenous, Iron Sucrose, Pregnant, Anemic Females, etc.

Intravenous Iron sucrose and change in hemoglobin, ferritin, and oxidative stress markers among moderately anemic pregnant women attending a secondary care level Hospital in Northern India.

Intravenous iron is associated with oxidative stress, and very few studies have assessed change in oxidative stress markers post infusion. The study aimed to measure the change in levels of hemoglobin (Hb), serum ferritin, and select oxidative stress markers (malondialdehyde [MDA], superoxide dismutase [SOD], and ferric reducing ability of plasma [FRAP]) 4 weeks following the administration of intravenous iron sucrose (IVIS) among moderately anemic pregnant women who were attending a secondary-level health-care facility, Haryana, North India. An observational study was conducted (May 2016 to Jan 2018) among pregnant women receiving intravenous iron sucrose i.e., IVIS (300 mg per dose) diluted in 300 mL of normal saline over 20-45 min and were followed up for a period of 4 weeks after the last dose of IVIS (end line). The study outcomes were measured in the levels of Hb, serum ferritin, MDA, SOD, and FRAP from the baseline to the end line. The mean (95% confidence interval) change in the Hb and serum ferritin level 4 weeks after the last dose of IVIS was an increase of 2.5 (2.1-3.0) g/dL (P < 0.001) and 63.0 (44.7-81.3) ng/mL (P < 0.001), respectively. There were no significant changes (baseline to end line) in mean (standard deviation [SD]) MDA level and mean (SD) FRAP level. The mean (SD) SOD level declined significantly (2.2 [0.4] U/mL to 1.6 [0.5] U/mL [P < 0.001]). No life-threatening adverse events were encountered during the study. IVIS was well tolerated and effective in treating moderate anemia in pregnancy. Body iron store was replenished following IVIS administration. There was no increase in oxidative stress following IVIS therapy.

Evaluation of safety and efficacy of intravenous iron sucrose therapy for moderate anaemia in antenatal women

Background: Prevalence of iron deficiency anaemia is high in developing countries like India. Treatment of iron deficiency anaemia in pregnancy is very important to bring down maternal mortality rate as blood loss during delivery can lead to death of the patient. The aim and objective of our study is to evaluate the efficacy and safety of intravenous iron sucrose infusions in antenatal women admitted in hospital suffering from moderate iron deficiency anaemia. Special emphasis was given to observe adverse drug effects.Methods: This was a prospective observational study conducted in Obstetrics and Gynaecology department, Government General Hospital, Rangaraya Medical College, Kakinada, Andhra Pradesh. Study period was two months and study population included antenatal women with gestational age less than 37 weeks with moderate iron deficiency anaemia. Peripheral smear was examined for microcytic hypochromic anaemia and they were treated with intravenous infusion of iron sucrose. Haemoglobin levels were checked before and 5 weeks after iron infusions. Monitoring was done for adverse reactions.Results: Out of 322 admissions, 95% were found to be anaemic. 72 patients were suffering from moderate anaemia from which 25 have been included and treated with intravenous iron sucrose infusions. They were observed for efficacy and safety parameters. Two minor adverse events were reported (fever with chills and angioedema of lips) and they were excluded from study. Mean haemoglobin concentration was found to be raised from 7.08±0.73 (SD) to 11.33±0.48 (SD) within 5 weeks for 23 patients.Conclusions: Iron sucrose infusion is safe and effective for anaemia in pregnancy.

Efficacy and safety of intravenous iron sucrose therapy in a pregnant women with iron deficiency anaemia in pregnancy

Efficacy and safety of intravenous iron sucrose therapy in a pregnant women with iron deficiency anaemia in pregnancy

Efficacy of intravenous iron sucrose therapy for iron deficiency anaemia in pregnancy

Efficacy of intravenous iron sucrose therapy for iron deficiency anaemia in pregnancy

Comparison of Effect of Oral Iron Ascorbate Therapy versus Intravenous Iron Sucrose Therapy on Maternal and Fetal Outcomes in Anaemic Pregnant Women: A RCT

Comparison of Effect of Oral Iron Ascorbate Therapy versus Intravenous Iron Sucrose Therapy on Maternal and Fetal Outcomes in Anaemic Pregnant Women: A RCT

Parenteral Iron Sucrose Therapy for Moderate and Severe Iron-Deficiency Anemia in Pregnancy

Objective: Parenteral iron therapy for iron deficiency anemia is gaining popularity due to its fast and impressing action. However, effectiveness and safety of iron sucrose in pregnant patient population is less clear. In this study, we aimed to review our intravenous iron sucrose use in pregnant patients.Study Design: The medical records of all anemic pregnant patients hospitalized for parenteral iron sucrose therapy were reviewed retrospectively.Results: The results of 117 pregnant women were available. Thirty-one (26.5%) and 86 (73.5%) of the patients were in the 2nd and 3rd trimester of the pregnancy, respectively. Four (%3.4) of the patients had severe and 113 (%96.6) of the patients had moderate anemia. The median gestational age for iron sucrose administration was 31.1 weeks (26.8-34.3). The mean hemoglobin, hematocrit and ferritin levels before and after delivery were 10.8±1.3 gr/l; 9.9±1.3 gr/l, 33.5±4.0; 30.8±4.0 and 89.6±0.7 μg/L; 98.1±0.9 μg/L, respectively. All but 2 (1.8%) patients had elevated hemoglobin levels after iron sucrose therapy. When hemoglobin and hematocrit levels were compared between before iron sucrose therapy and before delivery, there was a 2.8 g/l and 7.8 % increase in the mean hemoglobin and hematocrit levels, respectively and the difference was statistically significant (p= 0.001 and p=0.001, respectively). Five patients (4.3%) reported mild hypersensitivity reaction to intravenous iron in the form of mild itching at the infusion site. No severe or life-threatening hypersensitivity reaction was reported.Conclusion: In this study, we found out that intravenous iron sucrose therapy for iron deficiency anemia is feasible, effective and has a good safety profile.

O-022 Intravenous Iron Sucrose for Treatment of Iron Deficiency Anemia in Pediatric Inflammatory Bowel Disease

Iron deficiency anemia (IDA) is a common complication of pediatric inflammatory bowel disease (IBD). The effectiveness of oral iron supplementation in the treatment of IDA is limited by its slow onset of action, daily dosing, gastrointestinal side effects, and potential for exacerbation of intestinal inflammation. Intravenous iron sucrose (IS) is an effective and safe alternative treatment for IDA in adults with IBD, but its role in the treatment of IDA in pediatric IBD is unclear. The primary aim of this study was to evaluate the use of IS in pediatric IBD patients with IDA and determine the clinical response measured by improvement in hemoglobin. Secondary aim was to describe adverse events associated with IS use in this population. A retrospective chart review of all pediatric IBD patients receiving IS infusions for IDA at The Children's Hospital of Philadelphia between January 2011 and August 2015 was performed. The diagnosis of IDA was based on low hemoglobin for age and sex, although serum concentrations of iron, ferritin, mean corpuscular volume, total iron-binding capacity, and red blood cell distribution width were also referenced to confirm the diagnosis. Patients who had a transfusion of blood products within 2 months of an IS infusion or who had no follow-up laboratory evaluation within 2 months of the last IS infusion were excluded from the efficacy analysis. Adverse events were reported descriptively. Repeated measures ANOVA was used to evaluate paired continuous variables with post-hoc testing performed using Tukey's test. Seventy-five patients (57 with Crohn disease, 10 with ulcerative colitis, and 8 with indeterminate colitis) received a total of 280 IS infusions with 4 patients receiving multiple treatment courses. Patients were administered 200 mg per dose, 2 mg/kg per dose, or dosing calculated based on total iron deficit. The mean treatment course (±SD) was 3.5 ± 1.6 doses. Fifty-two patients qualified for analysis. The mean age (±SD) was 14.6 ± 3.1 years. There was a statistically significant increase in hemoglobin over the treatment course, with mean hemoglobin increasing from 9.6 ± 1.2 g/dL at baseline to 12.0 ± 1.3 g/dL after IS treatment (P < 0.0001). Post-hoc analysis revealed that change in hemoglobin was greatest after 4 infusions with subsequent dosing having no increased benefit. There were no statistically significant differences in change in hemoglobin between the 3 different IS doses. Twenty-two adverse events were reported in 15 patients (7.9% of the total number of infusions), including blood pressure (8/22) and pulse fluctuations (6/22), pain at IV site (6/22), chills (1/22), and IV infiltration (1/22). No anaphylaxis reactions occurred. The patient with IV infiltration required IS infusion discontinuation. Otherwise, none of the adverse events resulted in IS discontinuation and none were life-threatening, required treatment, or hospitalization. This is one of the first reported studies on IS therapy in a cohort of children with IBD and suggests that IS is a safe and potentially efficacious treatment for IDA in pediatric IBD.

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

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.