Iron Sucrose Therapy Research Articles

Exploring Risk Factors and Assessing the Effectiveness of Intravenous Iron Sucrose versus Oral Ferrous Fumarate for Pregnancy-Related Anemia

Background: Anemia associated to pregnancy, which is defined by low hemoglobin levels or inadequate red blood cells, is a serious worldwide health issue that affects the prognosis of both mothers and fetuses. Due to food habits, healthcare access issues, and socioeconomic differences, anemia during pregnancy is very common in Pakistan. Objective: The aim of the study was to identify risk variables linked to anemia in expectant mothers and assess the effectiveness of intravenous iron sucrose against oral ferrous fumarate in the management of iron deficient anemia during pregnancy. Methodology: This prospective cross-sectional study was conducted from November 2022 to October 2023 at the Department of Obstetrics and Gynecology, Liaqat Memorial Hospital, Kohat, Pakistan. 120 pregnant women made up the final cohort, which was split evenly between Group B (intravenous) and Group A (oral). Group B had intravenous iron sucrose therapy, whereas Group A got oral ferrous fumarate. Serum ferritin and hemoglobin levels were assessed during the course of the 4-week follow-up assessments. The statistical analysis was performed using SPSS version 27, which showed continuous variables as mean and standard deviation and categorical data as frequency and percentage. A P value of less than 0.05 was considered noteworthy. Results: Group A's mean hemoglobin rose from 86.49 g/dL to 102.97 g/dL (T-Value: 4.45, P-Value: 0.017), and serum ferritin increased from 8.19 ng/ml to 56.62 ng/ml (T-Value: 11.05, P-Value: 0.029). Similarly, Group B showed significant improvements, with hemoglobin increasing from 82.87 g/dL to 118.41 g/dL (T-Value: 5.26, P-Value: 0.001) and serum ferritin surging from 9.84 ng/ml to 109.85 ng/ml (T-Value: 7.37, P-Value: 0.001). Significant risk factors identified included poor nutrition (51.67%, n=62), multi-parity (59.17%, n=71), lack of antenatal care (67.50%, n=81), and lower socio-economic status (57.50%, n=69). Conclusion: Intravenous iron sucrose is more effective than oral ferrous fumarate in increasing maternal iron stores, with a notable advantage in terms of fewer side effects.

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.

Role of parenteral iron sucrose in the treatment of iron-deficiency anemia in pregnant women of gestational age 20–34 weeks

Background: Anemia is responsible directly or indirectly for 40%–60% of maternal deaths from cardiac failure, hemorrhage, infection, and preeclampsia. It also increases perinatal mortality and morbidity rates consequent to preterm deliveries, intrauterine growth restriction, low iron stores, iron-deficiency anemia, and cognitive and affective dysfunction in the infant. Objective: The objective of this study is to study the efficacy of intravenous iron sucrose in terms of hemoglobin rise and side effects. Materials and Methods: Single-center, hospital-based comparative prospective study was conducted among 60 patients admitted with anemia in pregnancy with a hemoglobin concentration of 7.5–9 g/dl. Blood samples were sent for evaluation of hemoglobin, packed cell volume (PCV), and serum ferritin levels at baseline, at 4, and 8 weeks. Results: Mean age was 29.08 ± 5.74 years. About 51.7% belonged to the middle social class. Most were gravida III (36.7%). About 46.7% had 20–24 weeks of gestations. Seventy-five percent had microcytic hypochromic anemia. Hemoglobin improved significantly (P < 0.05) from 8.76 ± 0.54 g% at baseline to 11.47 ± 0.85 g% at 4 weeks, and to 12.68 ± 1.04 g% at 8 weeks; PCV also improved significantly (P < 0.05) from 26.78 ± 3.11% to 34.64 ± 3.73% at 4 weeks and again improved to 42.50 ± 4.67% at 8 weeks; serum ferritin also improved significantly (P < 0.05) from 23.06 ± 7.96 μg/l to 28.86 ± 9.79 μg/l at 4 weeks and again improved to 36.31 ± 12.53 at 8 weeks after parenteral iron sucrose therapy. Only one pregnant woman complained of vomiting and only four women complained of pain at the site of injection after giving parenteral iron sucrose therapy. About 91.6% of the women had no complaints. Conclusion: Parenteral iron sucrose therapy in pregnant women with a gestational age of 20–34 weeks with iron-deficiency anemia was found effective in improving the hemoglobin, PCV, and serum ferritin with negligible side effects.

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.

S2793 Adrenal Crisis in a Patient With Crohn’s Disease: A Legacy of the Corticosteroid Treatment Era

Introduction: Before the era of biologic agents, corticosteroids were the most effective therapy available for inflammatory bowel disease (IBD) as well as other inflammatory and immune-mediated disorders, and treatment often was prolonged. As a result, many patients developed secondary adrenal insufficiency, in which the normal circadian rhythm of cortisol secretion was maintained but a defect in the cortisol response to stress persisted, as was the risk of adrenal crisis in response to severe physiologic stress. As corticosteroids are no longer used chronically in IBD, adrenal crisis has become a rare complication, and many gastroenterologists have no personal experience with it. We recently saw such a case which we are presenting as a reminder of its continued existence. Case Description/Methods: A 73-year-old female with Crohn’s disease diagnosed at the age of 18, complicated by short bowel syndrome and esophageal involvement, who had been steroid dependent for 15 years though stable on ustekinumab and no steroids for more than 8 years, presented to the emergency department with an acute onset of abdominal pain, diarrhea with incontinence, profound weakness, disorientation, and possible syncope, one hour after IV iron sucrose therapy. Initial physical exam was notable for pallor and edema of hands and feet. Laboratory exams showed hemoconcentration, leukocytosis, hyponatremia, plus elevated serum lactate concentration and anion gap. Because of the severity of this response, the possibility of adrenal crisis was raised: serum cortisol was 15.5 ug/dL (nl 6.2-29) despite the stressful situation and the patient responded clinically to 100 mg of hydrocortisone IV. She was discharged within 24 hours and all laboratory abnormalities reversed within 72 hours. Discussion: Adrenal crisis can present with a wide variety of nonspecific symptoms and should be in the differential diagnosis when a patient presents after a significant physiologic stress and has a history of chronic oral corticosteroid use. Electrolyte disturbances are less common in secondary adrenal insufficiency as the zona glomerulosa of the adrenal gland is not affected. Secondary adrenal insufficiency may persist for many years after chronic steroid use and may be permanent. In patients with secondary adrenal insufficiency. Important hints are the patient’s age and GI history, which includes extent of exposure to corticosteroids. Effective diagnosis requires maintaining a high index of suspicion.

Study of Compliance, Pattern of Treatment Interruption and Adverse Events Reported by Anaemic Pregnant Women Receiving the Parenteral Iron Sucrose Therapy

Background: In spite of many efforts by the government since independence anaemia in pregnant women has shown resistance to improvement. Aim: The main aim was to study the compliance of parenteral iron sucrose therapy in pregnant woman along with an additional objective which was to study the pattern of treatment interruption and adverse events observed by them. Methods: This study was conducted by the Department of Community Medicine in the rural and urban field practice area of district Nuh. A list of three hundred and eighty four anaemic pregnant females put on IVIS therapy, fetched from the health centre and relevant details were documented. Result: Out of total of 384 study participants, 291 (75.8%) were compliant with IVIS therapy i.e., they received all four doses. Out of total 93 either non-compliant or partially compliant subjects, most of them (51.6%, n=48) missed 3 doses whereas 22 participants (23.7%) missed 2 doses of the IVIS therapy. Ten study participants (10.7%) showed non-compliance to the therapy. Multigravida subjects were either non or partial compliant compared to primigravida. The three most common adverse events recorded at the time of infusion of 1st dose of IVIS therapy were swelling at injection site, pruritus, and muscle pain or joint pain experienced by 32 (8.3%), 17 (4.4%) and 16 (4.2%) study participants respectively. Conclusion: IVIS therapy is relatively safe therapy and well tolerated by anaemic pregnant females when given as slow infusion. Multigravida subjects were either non or partial compliant compared to primigravida females for IVIS therapy.

Efficacy of Oral Versus Injectable Iron in Patients With Chronic Kidney Disease: A Two-Year Cross-Sectional Study Conducted at a Rural Teaching Hospital.

AimAnaemia (particularly iron deficiency) is of important concern in patients with chronic kidney disease (CKD) as it reflects the outcome of the disease. Current recommendations for the use of intravenous iron (IV) therapy in the management of anaemia in such patients are limited. This study highlights the comparison of oral to intravenous iron in patients with chronic kidney disease.Materials and methodsThis is a prospective case-control study comparing intravenous iron to oral iron in chronic kidney disease patients admitted to the Medicine Department of Acharya Vinoba Bhave Rural Hospital, in central India from October 2018 to October 2020. A total of 150 patients were divided into two groups of 75 each, one receiving oral iron (ferrous sulfate 325 mg tablets) and the other intravenous iron (IV iron sucrose).ResultsSerum iron, serum ferritin, and transferrin saturation (TS) showed increased levels in the IV iron group than in the oral iron group. In the IV group, a statistically significant increase was found in haemoglobin levels after therapy among all stages of kidney disease (p<0.05) while the same was not reported in the oral iron group.ConclusionIV iron sucrose therapy had been found to be effective, well-tolerated, and more successful than oral iron treatment in chronic kidney disease patients as far as the parameter of iron deficiency anaemia is concerned.

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.

Iron Sucrose Induced Near Fatal Anaphylaxis in a Postnatal Mother

Iron deficiency anemia in pregnancy can lead to significant adverse effects on the mother and fetus. Patients with iron deficiency anemia are treated with parenteral iron therapy when oral iron therapy is ineffective or in case of non-compliance due to side effects. Parenteral iron preparations such as iron dextran and sodium ferric gluconate complex can cause side effects including life-threatening anaphylactic reactions. However, parenteral iron sucrose has a favorable safety profile and anaphylactic reactions are extremely rare. We report a rare case of near-fatal anaphylaxis following intravenous iron sucrose therapy in a postnatal mother with iron deficiency anemia.

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.

Efficacy and Cost Effectiveness of Intravenous Ferric Carboxymaltose Versus Iron Sucrose in Adult Patients with Iron Deficiency Anemia

Abstract: Objectives: Iron deficiency anemia (IDA) is a major health issues and common type of nutritional deficiency worldwide. For IDA treatment, IV iron is a useful therapy. Many intravenous (IV) iron preparations are used for treatment of iron-deficiency anemia (IDA). The purpose of this study is to evaluate the efficacy of ferric carboxymaltose (FCM) in comparison to iron sucrose (IS) in treatment of IDA adult patients; considering cost-effectiveness (CE) for IDA patients from Qatar healthcare system perspective. We evaluated both treatments considering their response outcomes at 12 months period as well their respective acquisition costs. Methods: This was a cross sectional study with retrospective data performed on 764 IDA adult patients who were treated either with FCM or IS for IDA linking clinical efficacy (defined as improvement in hemoglobin (HB), ferritin and transferrin saturation levels) utility, and CE evaluation, including Incremental Cost-Effectiveness Ratio (ICER) over a 12-months period. The response to treatment was the primary outcomes. As the clinical laboratory data were collected before and after the first injection of the medications. The cost i.e. resources consumed were also the main outcome in our study. The cost effectiveness of FCM and IS was the secondary outcome. Direct healthcare costs were derived from the national healthcare payer system. Both descriptive and differential statistics were applied for data analysis. Alpha = 0.05. Results: Patients in the IS group used significantly higher number of injections, ampoules of medication, NS 0.9% bags and visits to the IV suite compared to FCM group. There were significant changes of laboratory tests between the FCM and IS groups. Further analysis in the change of effectiveness, indicated that the changes of hemoglobin and MCH levels in the IS group were significantly higher than the FCM group. The overall cost of IS therapy was significantly slightly higher than FCM. The medication cost for FCM was approximately 6.5 times higher than IS but cheaper in terms of bed cost and nursing cost. CE ratio illustrated that FCM and IS were significantly different in terms of HB, ferritin and MCH levels. Further, ICER indicated that further justifications and decisions need to be made for FCM when using HB, iron, transferrin saturation, MCH and MCV levels as the surrogate outcomes. Conclusions: 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 HB, iron, transferrin saturation, MCH and MCV levels as the surrogate outcomes. Limitations and strengths: Limited data is available with respect to comparison of safety and adverse effects of FCM and IS. The data is reliable as it was collected and documented before and after the treatment. Patients were monitored 30 min after the infusion to ensure keen observation and maximum safety. Disclosures No relevant conflicts of interest to declare.

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.

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.