Parenteral Iron Research Articles

ABSTRACT Iron deficiency anemia (IDA) is a common nutritional disorder in mammals, particularly affecting neonates and neonatal piglets. Parenteral iron supplementation is widely used but carries toxicity risks at high doses. Due to rapid growth and low iron stores at birth, piglets serve as an ideal model for investigating early life iron supplementation and its impact on gut health. In this study, neonatal piglets were assigned to three groups: control (CON, no iron supplementation), moderate‐dose (MI, two low doses), and high‐dose (HI, a single high dose), all administered via intramuscular iron dextran. We found that both iron supplementation protocols significantly increased hemoglobin levels ( p < 0.01) and effectively alleviated IDA. However, the HI group exhibited significant adverse effects, including elevated aspartate aminotransferase (AST) ( p < 0.01), suppressed anti‐inflammatory cytokines (IL‐10, p < 0.01), and increased tissue iron accumulation, whereas the MI group showed no such adverse effects. Gut microbiota analysis revealed that the HI group disrupted the gut microbiota, with a greater impact on fungal diversity than bacterial diversity, as indicated by α‐diversity metrics ( p < 0.05), and also altered the intestinal metabolite profiles. Protein–protein interaction network analysis identified key genera and metabolites, including Fusarium , Geotrichum , Parabacteroides , Candida , and cholest‐4‐en‐3‐one, associated with duodenal iron accumulation. This study demonstrates that although high‐dose parenteral iron effectively corrects IDA, it causes liver dysfunction, immune suppression, systemic iron overload, and altered gut microbiota. Our findings highlight the importance of appropriate iron dosing and reveal broader roles of trace elements in shaping gut microbiota.

We describe four cases of iron extravasation injuries presenting to a dermatology clinic, where compression applied post-infusion appeared to reduce or prevent cutaneous siderosis. In each case, distinct patterns of hyperpigmentation were observed, with areas of compression from bandages or dressings showing reduced staining. Iron extravasation, a complication of intravenous iron therapy, can cause permanent cosmetic damage and distress. Current treatment options for reversing staining are limited, costly and require multiple sessions. This case series suggests that compression may be a simple, safe and effective measure to minimise cutaneous siderosis and improve patient outcomes.

Abstract Background It is well established that perioperative anaemia is associated with poor outcomes, including prolonged recovery period and increased post-operative mortality. This is especially true for orthogeriatric patients, with iron deficiency being a major cause of anaemia within this patient cohort. Objectives To improve 1) the diagnostic testing for iron-deficiency anaemia (IDA) with full iron studies and 2) the usage of intravenous iron to treat iron deficiency in perioperative orthogeriatric patients in a tertiary hospital. Methodology Baseline inpatient data for geriatric hip and femur fractures from October to December 2023 were audited against the perioperative anaemia guideline by Centre for Perioperative Care, analysing the proportion of full iron studies tested and intravenous iron usage. Two ‘clusters’ of interventions were introduced; cluster 1: introduction of a local guideline and increasing ward availability of parenteral iron; cluster 2: introduction of a dedicated ‘Silver Trauma’ team and wider communication of the local guideline, including two sessions of departmental teaching. PDSA cycles were conducted following each intervention cluster. Results Initial audit showed 25.8% of patients with anaemia were tested for full iron studies, which improved to 57.9% and 78.9% after each intervention cluster. 62.5% of patients with IDA in the initial audit were given intravenous iron, which improved to 73.3% and 79.2% after each cluster. Conclusion There are significant improvements in both objectives following the interventions, which will have an impact in improving patient outcomes. Further strategies are currently being discussed to increase sustainability of the new pathway. All efforts have been undertaken to ensure compliance with established ethical standards for this work.

Background and Objectives: Iron deficiency anemia (IDA) is the most common cause of anemia in pregnant women and can adversely affect both maternal and fetal health. This study aimed to compare pregnancy outcomes between women with and without IDA in Northern Thailand, a region with a high prevalence of anemia. Methods: A retrospective cohort study was conducted on all singleton pregnancies attending antenatal care (ANC) and/or delivering at Maharaj Nakorn Chiang Mai Hospital between 2003 and 2024. The study group consisted of women diagnosed with IDA in the first half of pregnancy, while the control group comprised women with low-risk pregnancies during the same study period. Results: Of the 38,979 pregnancies, after applying exclusion criteria, 634 pregnancies (2.2%) with laboratory-confirmed IDA and 28,132 controls remained available for analysis. Women with IDA had significantly higher parity, lower socioeconomic status, and lower hemoglobin levels throughout pregnancy. Multivariate regression analysis revealed that IDA was significantly associated with increased risks of preterm birth (adjusted odds ratio; aOR 1.04; 95% CI: 1.01–1.07), fetal growth restriction (FGR) (aOR 1.02; 95% CI: 1.00–1.04), and low birth weight (aOR 1.05; 95% CI: 1.03–1.08). Conclusions: IDA, even with treatment, may still slightly increase the risk of adverse pregnancy outcomes, particularly preterm birth, fetal growth restriction, and low birth weight. The residual risk likely reflects incomplete correction of anemia. Optimizing management requires strict compliance, judicious use of parenteral iron, and attention to coexisting nutritional deficiencies, underscoring the need for closer monitoring and improved care strategies.

277 Background: Few studies have identified the prevalence of iron deficiency/iron deficiency anemia in the population of luminal gastrointestinal (GI) malignancies. The objective of this retrospective study was to assess the prevalence of iron deficiency (ID) and iron deficiency anemia (IDA) in GI cancer patients treated at Mount Sinai Hospital (MSH) in Toronto, Canada. Methods: Between January 2009 and December 2022, 533 luminal GI cancer patient charts were retrospectively reviewed at MSH. Details extracted included demographics, history of IDA, previous IDA therapies, and cancer history. Hemoglobin, mean corpuscular volume and hematocrit were collected at five time points. Transferrin saturation, ferritin, iron serum and iron saturation were collected at pre- and post-chemotherapy initiation. Anemia was defined as having a hemoglobin (Hb) value < 110g/dL in women and < 132g/dL in men. Results: The patient population included 54 gastric, 267 colon, 62 recto-sigmoid, and 150 rectal cancer patients, 75.4% (402/533) of which were anemic at some point during the study period. At pre-chemotherapy initiation, 219 (41.1%) patients were anemic, 65 (12.2%) patients had ferritin and transferrin saturation values assessed; 31 (47.7%) had ID and 25 (38.5%) had IDA. After chemotherapy initiation, 83 (15.6%) patients were assessed for ID; 27 (32.5%) had ID and 19 (22.9%) had IDA. Anemia was treated by parenteral, oral iron or red blood cell transfusion, at least once during or prior to chemotherapy treatment for 186 patients. Conclusions: Despite anemia being prevalent in GI cancer patients where initial diagnoses is often prompted by onset of anemia, only 65 (12.2%) patients were assessed for ID pre-chemotherapy and 34.9% of patients were provided with any form of treatment for anemia during oncologic treatment. Proper repletion needs to occur if ID or IDA is identified, most notably with rapid parenteral iron, especially if embarking on myelosuppressive systemic chemotherapy. Guidelines are essential to ensure proper diagnosis and management of ID and IDA in this cancer patient population.

The influence of iron deficiency anemia and iron treatments on the gut microbiome was evaluated in young rhesus monkeys. First, the hindgut bacterial profiles of 12 iron-deficient anemic infants were compared to those of 9 iron-sufficient infants at 6 months of age, a time when the risk of anemia is high due to rapid growth. After this screening, the anemic monkeys were treated with either parenteral or enteral iron. Seven monkeys were injected intramuscularly with iron dextran, the typical weekly treatment used in veterinary practice. Four other anemic infants were treated with a novel oral supplement daily: yeast genetically modified to express ferritin. Fecal specimens were analyzed using 16S ribosomal RNA (rRNA) gene amplicon sequencing. Bacterial species richness in anemic infants was not different from that of iron-sufficient infants, but beta diversity and LEfSe analyses of bacterial composition indicated that the microbiota profiles were associated with iron status. Both systemic and oral iron increased alpha and beta diversity metrics. The relative abundance of Ruminococcaceae and other Firmicutes shifted in the direction of an iron-sufficient host, but many different bacteria, including Mollicutes, Tenericutes, and Archaea, were also enriched. Collectively, the findings affirm the important influence of the host’s iron status on commensal bacteria in the gut and concur with clinical concerns about the possibility of adverse consequences after iron supplementation in low-resource settings where children may be carriers of iron-responsive bacterial pathogens.

Background and Objectives: Iron deficiency anaemia (IDA) is a common consequence of bariatric and metabolic surgery (BMS). Women are at higher risk, and some patients cannot tolerate oral iron. This study aimed to report the demographics of patients with IDA that required iron infusion post-BMS and to investigate risk factors including gynaecological dysfunction. Materials and Methods: The medical records for all patients (n = 383) post-BMS at a large tertiary centre from January 2017 to December 2024 were reviewed, and those who received intravenous iron infusion (n = 32) for IDA were included. The criteria for iron infusion were ferritin < 50 µg/L or intolerance to oral iron. Demographic information including co-morbidities—gynaecological and other—age, pre-operative weight, body mass index (BMI), and ferritin levels were collected to investigate possible risk factors for IDA. Results: Thirty-two patients, all female, received one or more parenteral iron infusions. Eighteen had surgery locally; 14 had surgery elsewhere. Operations varied and included 14 Roux-en-Y gastric bypasses, 14 sleeve gastrectomy’s, and 4 gastric bands or other procedures. Eleven patients had a history of gynaecological disorders. Pre-infusion ferritin levels in the cohort with gynaecological disorders versus the cohort without were lower (median 11.0 vs. 14.5 µg/L), with a shorter time to presentation (median 6.9 vs. 10.2 years), and more patients requiring >2 infusions for resolution of symptoms (36.4% vs. 9.5%). Conclusions: Locally, 95% of our patients did not require iron infusion post-BMS. Eighty percent of those who did require iron infusion responded to ≤2 infusions. Women with a history of gynaecological disorder who underwent BMS required a significantly higher number of iron infusions and presented with symptoms sooner post-operatively vs. those without gynaecological disorders, particularly following Roux-en-Y gastric bypass. This is an important observation to consider both pre- and post-operatively for patients undergoing bariatric surgery, and additional well-designed studies that investigate this further are needed.

Abstract IntroductionIron‐deficiency anemia is a common finding in pregnancy; however, current obstetric practice lacks standardized recommendations for its diagnosis and treatment during pregnancy, and data are limited regarding the effectiveness of diagnosis and treatment strategies toward improving pregnancy outcomes.MethodsWe conducted a retrospective study to examine the impact of a standardized protocol for the diagnosis and management of iron‐deficiency anemia in pregnancy implemented in June 2018 across all 61 prenatal care facilities in an integrated healthcare delivery system. Our primary aim was to compare the prevalence of anemia at the time of delivery among pregnant patients who received prenatal care before protocol implementation with those who received care after protocol implementation. Secondary outcomes included receipt of iron infusions and peripartum red blood cell transfusions. Relative risks for each outcome were adjusted (aRR) for potential confounders.ResultsDuring the specified pre‐protocol study period, there were 16,151 eligible pregnancies with iron‐deficiency anemia (prevalence 19.5%); during the post‐protocol period, 8604 pregnancies were identified with iron‐deficiency anemia (prevalence 23.3%). Patients with iron‐deficiency anemia receiving prenatal care post‐protocol had 21% lower risk of anemia at the time of delivery compared with those receiving care pre‐protocol (aRR 0.79, 95% confidence interval, CI 0.76–0.83). In stratified analyses, post‐protocol (vs. pre‐protocol) prenatal care was also associated with lower risk of anemia at delivery in each racial and ethnic subgroup. Parenteral iron therapy utilization was more than twofold higher in the post‐protocol cohort (aRR 2.25, 95% CI 2.09–2.42). While not statistically significant, a modest reduction in risk of peripartum blood transfusion was also observed in the post‐protocol cohort (aRR 0.89, 95% CI 0.78–1.02).ConclusionImplementation of a standardized protocol for the diagnosis and management of iron‐deficiency anemia during pregnancy was associated with uniformly lower risk of anemia at delivery. Maternal care in the post‐protocol time frame was associated with greater utilization of iron infusions for management of iron‐deficiency anemia and reduced peripartum red blood cell transfusion.

Objective: To determine the efficacy of parenteral iron carboxy-maltose (FCM) versus iron sucrose complex (ISC) for the treatment of postpartum iron-deficiency anemia (IDA).Methods: A randomized controlled trial was conducted among postpartum women with IDA. Primary outcome was to compare the efficacy of FCM versus ISC in the improvement of hemoglobin (Hb), RBC indices (mean corpuscular Hb (MCH), mean corpuscular volume (MCV), mean corpuscular Hb concentration (MCHC)), and iron stores (serum iron, serum ferritin, percentage saturation of iron, and total iron binding capacity). Secondary outcomes were side-effect profile and maternal complications. At enrolment, 500 women were randomized to two groups. Demographic and clinical data were collected at enrolment and four weeks later.Results: Women receiving FCM had statistically significantly higher Hb levels (g/dl) (11.4 (10.3-12.5) vs. 11 (9.1-12.9), p<0.001), better RBC indices (MCV (fl); 96.5 (87.5-105) vs. 92 (77-107), p<0.001, MCH (pg/cell); 32 (27-37) vs. 30 (25-35), p<0.001, MCHC (g/dl); 36 (31-41) vs. 34 (30-38), p=0.001) and better iron stores (serum ferritin (µg/l); 290 (273-307) vs. 229 (213-245), p<0.001, and percentage saturation of iron (%); 24.5 (16.5-32.5) vs. 21 (16-26), p<0.001). However, there was no difference regarding serum iron (p=0.513) and total iron binding capacity (p=0.298). ISC had poor compliance as 23 (9.2%) women did not come for repeated doses. Secondary outcomes (side-effect profile (p=0.797) and maternal complications (p=0.176)) were comparable among women.Conclusion: Ferric carboxymaltose has better efficacy and compliance for the treatment of postpartum iron-deficiency anemia as compared to iron-sucrose complex, with a similar side effect profile. We recommend that women with postpartum iron deficiency anemia (Hb 7-11 g%) receive at least a single parenteral FCM (1000 mg) before discharge from the hospital as a standard policy, especially in low- and middle-income countries.

Anemia in pregnancy is a critical public health concern, affecting millions of women globally, particularly in low-resource settings. Defined by hemoglobin levels below 11 g/dL, this condition is primarily caused by nutritional deficiencies, chronic diseases, and genetic disorders, leading to severe maternal and fetal complications. This review provides an updated and comprehensive overview of the complications of anemia in pregnancy, highlighting the importance of early detection, effective management, and preventive strategies to mitigate its adverse outcomes. Maternal complications of anemia during pregnancy include an increased risk of mortality, susceptibility to infections, preterm labor, postpartum hemorrhage, and cardiac issues. Fetal complications are equally concerning, with risks of intrauterine growth restriction, preterm birth, perinatal mortality, and long-term neurodevelopmental impairments. Understanding these complications underscores the necessity for routine screening, accurate diagnosis, and timely intervention to improve health outcomes for both mother and child. Effective management of anemia in pregnancy involves a multifaceted approach, including nutritional supplementation, dietary modifications, and medical interventions such as parenteral iron therapy and blood transfusions. Prevention through regular antenatal care, health education, and public health initiatives is essential. By equipping healthcare professionals with the knowledge and tools to address anemia in pregnancy, this review aims to enhance maternal and fetal health outcomes, ultimately reducing the global burden of this condition.

Abstract Introduction: Anemia is a global health issue that predominantly affects women of reproductive age. The World Health Organization has implemented an iron supplementation program that various countries, including India, have adopted. Despite numerous anemia prevention strategies, the incidence of anemia remains high. This study aims to assess pregnant women’s compliance with iron and folic acid supplementation and identify the factors influencing this compliance. Methodology: This cross-sectional study was conducted among pregnant women at a rural medical college. The study utilized a questionnaire based on the Morisky Medication Adherence Scale to categorize the participants into compliant and noncompliant groups. Both groups were interviewed using a standardized questionnaire to gather information on their sociodemographic profiles, obstetric history, anemia awareness, iron supplementation during pregnancy, and healthcare needs. The data were organized in Microsoft Excel and analyzed using appropriate statistical methods. Results: The study sample comprised 460 participants, with 182 women (39.56%) classified as compliant. The compliant group demonstrated significantly better educational and a higher socioeconomic status than the noncompliant group. In terms of obstetric factors, women in the compliant group had substantially more antenatal care visits, earlier registration in the first trimester, longer interconception intervals, and higher contraceptive use rates. Moreover, the compliant group showed greater knowledge and awareness of iron supplementation, anemia prevention, and healthcare needs during pregnancy. Conclusion: This study highlights that compliance with iron and folic acid supplementation among rural pregnant women remains low, with women’s education and awareness being key factors influencing adherence. In addition to ongoing efforts in the Anemia Mukt Bharat Programme, introducing prophylactic parenteral iron supplementation may enhance compliance and reduce anemia.

Background/Objectives: Pica, the compulsive ingestion of non-nutritive substances, has long been observed in patients with iron deficiency anemia (IDA). This behavior is particularly noted in adults, including pregnant women, and poses both diagnostic and management challenges. We conducted a review of studies from the past decade to evaluate the epidemiology and nature of pica in adult IDA patients and the outcome of various treatment strategies on anemia and pica behaviors. Methods: We searched PubMed, Scopus, and Cochrane Library for peer-reviewed articles (including observational studies, clinical trials, and reviews) published in English between 2015 and 2025. Inclusion criteria targeted studies of adult populations with IDA that reported on pica prevalence, characteristics, or treatment outcomes. We also reviewed clinical guidelines and meta-analyses on IDA treatment in adults for recommended management approaches. Results: Pica was found to be a prevalent symptom among individuals with IDA, but was readily treatable with appropriate iron deficiency treatment. Among treatment options, both oral and parenteral iron supplementation were found to be effective in resolving iron deficiency and pica. Choice of treatment depends on tolerance to oral iron, speed of resolution required, and comorbid conditions. Conclusions: Pica is closely intertwined with IDA; our review highlighted the prevalence of pica among individuals with IDA, which serves as both a clinical clue to underlying anemia and a potential source of complications. Crucially, the treatment of IDA is also effective for pica. We recommend oral iron therapy on alternate-day dosing as first-line therapy to minimize side effects, alongside dietary optimization. If IDA and pica are resistant to oral iron supplementation or oral iron cannot be tolerated, parenteral iron therapy can be considered.

Objective: To compare the mean rise in hemoglobin with ferric carboxymaltose versus iron sucrose for treating iron deficiency anaemia in pregnant women Methodology: This randomized controlled trial study was conducted at Department of Obstetrics &amp; Gynaecology, Combined Military Hospital Multan from February 2024 to July 2024. Sixty pregnant women (20-45 years, 28-34 weeks gestation) with iron deficiency anemia (Hb &lt;10 gm%, ferritin &lt;30 ng/ml) were randomized via lottery method to intravenous ferrous carboxymaltose (FCM; 1000 mg/sitting) or iron sucrose complex (ISC; 300 mg twice weekly). Both groups received anthelminthic therapy and folic acid. Total iron dose was calculated as (2.4×weight×Hb deficit) +500 mg. Hemoglobin, ferritin, and demographics were recorded. Post-treatment outcomes were assessed at 3 weeks. Descriptive statistics were run using SPSS version 23. The mean rise in hemoglobin between the groups was compared through independent t-tests at 5% significance level. Results: Participants’ mean age was 31.4±3.9 years. Baseline Hb and ferritin were 8.8±0.5 g/dL and 31.6±12.8 ng/mL respectively. Post-treatment, FCM demonstrated higher mean Hb (10.7±0.4 vs.10.4±0.3 g/dL), ferritin (370.9±47.6 vs.261.1±34.2 ng/mL), and Hb rise (2.0±0.3 vs.1.4±0.2 g/dL) compared to ISC (p&lt;0.001). Educational status, socioeconomic class, and baseline Hb differed significantly between groups. Stratified analysis confirmed sustained superiority of FCM across demographics (p&lt;0.001). Conclusion: Intravenous ferrous carboxymaltose outperformed iron sucrose in correcting haemoglobin and levels of ferritin in iron-deficient pregnant women, despite baseline disparities. FCM offers a more efficacious parenteral iron therapy option in this population.

More than 18% of the global population suffers from osteoporosis and its associated fracture risk each year. Among the many factors implicated in osteoporosis development, high iron levels have been implicated in bone loss in mice and patients. Here, we performed a comparative analysis of the effect of iron overload induced via diet, injections, or genetic factors, on overall bone health and mechanical bone strength. We used female mice, given the higher risk of osteoporosis and associated fractures in women than in men. We show that dietary iron overload induced trabecular remodeling in the spine but not in the femur, with potentially pre-pathogenic structural changes. By contrast, iron injections caused severe bone deficits across all sites measured. Interestingly, the loss of cortical bone emerged as a common hallmark of secondary iron overload and was associated with decreased mechanical strength in mice. However, no bone anomalies were observed in mice with genetic iron overload, demonstrating that iron overload per se does not suffice to induce bone loss in genetic hemochromatosis. Collectively, our study shows that iron overload-induced by diet and injections, but not genetically, induces selective and specific bone deficits, which are associated with decreased bone mechanical strength in mice.

Iron deficiency anemia has medical and social consequences worldwide, so the treatment of iron deficiency is an important goal. Oral iron therapy may not be optimal in some clinical situations requiring rapid replenishment of iron stores or due to possible ineffectiveness or intolerance. Intravenous iron therapy is an effective method for the treatment of iron deficiency anemia. So far, the use of intravenous iron preparations in pediatric patients has been limited, despite extensive experience of their use in adults and the results of studies conducted with children that have also demonstrated the efficacy and safety of this therapeutic option in pediatric patients. First of all, it is due to concerns about a risk of severe allergic reactions which was quite high in the era of first-generation intravenous iron medicines. The emergence of a new generation of more effective and safer intravenous iron preparations, including high-dose parenteral iron products, makes this type of therapy a promising means of treatment for iron deficiency in children and adolescents.

Background: The current study aimed to determine the frequency of restless leg syndrome (RLS) in patients with iron deficiency anemia (IDA) presenting to Khyber Teaching Hospital (KTH) and Khushal Medical Center (KMC) Peshawar and to see the effect of parenteral iron therapy on RLS with IDA. Methods: This prospective cohort study enrolled 110 patients of either gender with IDA from September 2022 to December 2023. All patients were interviewed and data was recorded for restless leg syndrome as per operational definition. The diagnosed RLS patients were given 500mg iron carboxymaltose in 100ml normal saline (NS) over a period of 15 minutes stats and 500mg after two weeks and treatment response was assessed four weeks after the treatment. Clinical symptoms including pain, fatigue and sleep quality were recorded before and after the iron therapy. All the data were analyzed using SPSS version 22.0. Results: RLS was observed in 35.5% patients with IDA. The mean age was 48.70±8.0 years. Male gender was 54.5% while female gender was 45.5% in our study. The levels of hemoglobin (Hb) were significantly improved with iron carboxymaltose (p-value &lt;0.001). The symptoms related to RLS including pain, fatigue and quality of sleep were 90.1% improved after iron therapy. T-test reveals significant improvement in pain, fatigue and sleep quality before and after iron therapy with p-value &lt;0.001. There was no statistical significant association between gender and improvement of symptoms related to RLS (p-value &gt;0.05). Conclusion: RLS was highly prevalent in patients with IDA in our population. Management of IDA with parenteral iron carboxymaltose not only improves the levels of Hb but provide immediate relief of symptoms related to RLS.

OBJECTIVE The goal of this study is to assess the effectiveness of parenteral iron sucrose therapy vs oral iron supplements in the treatment of iron deficiency anaemia (IDA) in the postpartum period. METHODOLOGY: This study is conducted in the OBS and Gynae department of PAF Hospital Islamabad. This is a randomized control trial (RCT). A total of 130 women, 65 in each group were recruited who were diagnosed with iron deficiency anaemia (as per operational definition ), 48hrs after delivery. In group A females were prescribed intravenous iron sucrose therapy according to post-delivery hemoglobin level by using the formula (2.4 × (target Hb-actual Hb) × post-pregnancy weight (kg)) + 1000 mg every alternate day. In group B females were prescribed daily oral iron supplements along with folic acid. Follow-up of both groups was done after 4 weeks in OPD. RESULTS: The mean age was 29 years ± 2.688 in group A, while in group B it was 30 years with SD ±2.422. In group A (Intravenous iron sucrose therapy) mean ferritin level was 140.94 ± 3.292 and the mean hemoglobin level was 11.11 ± 0.710. In group B (Oral iron supplements) mean serum ferritin level was 125.34 ± 6.551 and the mean Hemoglobin level was 10.65 ± 0.623 after treatment. CONCLUSION Our study concludes that there is no significant difference in treatment between intravenous iron sucrose therapy and oral iron supplements for iron deficiency anaemia in the post-partum period.

Background: Iron deficiency anemia is common in pregnancy and is of great concern with regards to maternal health as well as increasing the risk of complication such as primary postpartum hemorrhage. Parenteral iron administration is one option that has become available for anemia but its role in preventing postpartum hemorrhage in pregnant women with mild to moderate anemia is an area that is in need of further investigation. Objective: To determine the efficacy of parenteral iron in prevention of primary postpartum hemorrhage in mild to moderate anemic patients. Study Design: Quasi-experimental study. Duration and Place of Study: The study was conducted between August 2024 and February 2025 at the Department of Obstetrics and Gynaecology, Saidu Group of Teaching Hospitals, Swat. Methodology: A total of 139 women with singleton pregnancy in the 18–40 years range with anemia with an Hb of 8-12 g/dL were included in the recruitment. The subjects received intravenous iron sucrose 600 mg that was given in three consecutive days starting from 28 weeks' gestational age. The absence of immediate postpartum hemorrhage in the form of blood loss of ≥1000 ml with cesarean section or ≥500 ml with vaginal delivery was the primary outcome. Results: The subjects' mean age was 29.30 ± 4.42 years while the level of hemoglobin was 9.13 ± 1.02 g/dL upon enrollment. The parenteral iron therapy had an efficacy of 92.8% with no correlations of significance between demographic variables like age, BMI, or mode of delivery with efficacy. Of interest was that there was an inverse correlation of significance between hemoglobin level and efficacy such that those with the lowest baseline hemoglobin levels had the best response to the therapy. Conclusion: Parenteral iron sucrose is an effective and well-tolerated treatment for preventing primary postpartum hemorrhage in anemic pregnant women, with high efficacy across various demographic groups.

Background: Iron deficiency anemia (IDA) is a public health concern with this major global health concern seeming to be affecting the child population more, since it can prove detrimental to growth, cognitive functioning, and immune function. Though iron supplementation is the primary intervention for IDA treatment, its effects on gut microbiota and immune function are still not fully understood. Different forms of supplementation might have different effects on the gut microbiome and immunity. Methods: This systematic review examined studies published between 2014 and 2024 using electronic databases including PubMed, Scopus, and Cochrane Library. This review, abiding by the guidelines of PRISMA and following the PICOS construction, deals with children of ages comprising 0-12 years, diagnosed with IDA, investigating the various modes of delivering iron such as nano-iron, fortified foods, oral or parenteral iron, and their influence on gut microbiota composition and immune function. Results: Studies report variable responses of iron supplementation on gut microbiota and immunity based on formulation, dosage, and concurrent nutrient administration. Some studies show that there is no considerable change to the gut microbiota profiles resulting from synbiotic additions; however, they have also linked IDA with microbial dysbiosis. High-dose iron interventions tend to disrupt the gut microbiota and significantly increase the chances of infection, especially in settings with poor hygiene. On the other hand, even prebiotics have been tried to alleviate this side effect besides continuing iron therapies. Conclusion: Iron supplementation is necessary for treating IDA in children, and the effect on gut microbiota and immunity depend on various factors. The administration of prebiotics or adjusting doses could minimize side effects and benefit treatment. Future studies should be conducted with a focus on personalized intervention considering diet, environment, and microbiological factors to better manage IDA and alleviate adverse effects.

Hypocalcaemia and hypophosphataemia are recognised complications of concurrent denosumab and parenteral iron therapy, typically occurring within weeks of administration. We report a case of delayed-onset hypocalcaemia and hypophosphataemia following an iron infusion 5 months post denosumab administration in a postmenopausal woman with chronic kidney disease. This interaction induced profound hypocalcaemia and hypophosphataemia, despite normal preinfusion electrolyte and hormone levels. Clinicians should be aware of the potential for late-onset electrolyte disturbances in patients on denosumab, particularly when administering treatments that could interact with bone metabolism. Timely recognition is essential for effective management.