The Effects of an Intravenous Iron Infusion on Pre-Operative Haemoglobin Concentration in Iron Deficiency Anaemia: A Retrospective Observational Study. (Preprint)

2021 ◽  
Author(s):  
Guy Nicholls ◽  
Rajan Mehta ◽  
Karen Mcveagh ◽  
Matt Egan
Keyword(s):  
Iron Deficiency ◽  
Iron Deficiency Anaemia ◽  
Adverse Reactions ◽  
Haemoglobin Concentration ◽  
Intravenous Iron ◽  
Surgical Patients ◽  
Deficiency Anaemia ◽  
Post Infusion ◽  
Iv Iron ◽  
Iron Based

BACKGROUND An iron infusion pathway using Ferrinject®(ferric carboxymaltose) was implemented at Southend University Hospital for pre-operative surgical patients with iron deficiency anaemia undergoing major surgery. This was based on a treatment algorithm proposed by Munting et al, based on the international consensus statement on peri-operative management of anaemia and NICE guidelines. This states intravenous iron is indicated when oral iron is poorly tolerated, ineffective, there is insufficient time to surgery, or due to functional iron deficiency. OBJECTIVE Our objective was to study the degree of change in adult haemoglobin concentration (Hb g/L) after infusion at the time of surgery. METHODS Data was retrospectively collected on all surgical patients that received an iron infusion pre-operatively for iron deficiency anaemia from July 2019 to April 2020. Non-surgical patients, obstetrics, paediatrics and those without a post infusion haemoglobin level were excluded. Data collected included: pre and post infusion Hb, ferritin, and transferrin (post infusion results closest to surgery were collected), correct or incorrect dose of IV iron received (dose based on baseline Hb and weight) and any adverse reactions noted. RESULTS 32 surgical patients with iron deficiency anaemia received intravenous iron between July 2019 and April 2020 prior to surgery. The average pre and post iron infusion haemoglobin concentration across the cohort was 97 g/L and 114 g/L respectively (18% increase p= 0.001). 2 (6%) patients had a post transfusion Hb ≥ 130 g/L prior to surgery after infusion. 9 patients had both a pre and post infusion ferritin level recorded which showed an increase from 12 μg/L pre infusion to 94 μg/L (p=0.02) post infusion. 23 (72%) patients were did not receive the full dose of IV iron based on their Hb and weight. 75% of patients received an iron infusion >2 weeks prior to surgery with 25% < 2 weeks before their surgery. There was an average increase in Hb of 22% (21 g/L 95% CI 13-28) and 5% (5 g/L 95% CI 1-10) (p=0.03) respectively across the two groups. There were no documented adverse reactions to the infusion. CONCLUSIONS IV iron is an effective intervention to improve haemoglobin concentration in iron deficiency anaemia despite the majority of cases not receiving the full dose of IV iron based on their baseline Hb and weight. Increasing interval time between infusion and surgery was associated with a greater increase in Hb with only a minimal increase seen if given less than 2 weeks before.

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

2019 ◽  
Vol 8 (10) ◽  
pp. 2258
Author(s):  
K. P. Poojitha ◽  
B. S. B. Mallika ◽  
K. V. Siva Prasad
Keyword(s):  
Iron Deficiency ◽  
Iron Deficiency Anaemia ◽  
Haemoglobin Concentration ◽  
Intravenous Iron ◽  
Iron Sucrose ◽  
Efficacy And Safety ◽  
Deficiency Anaemia ◽  
Anaemia In Pregnancy ◽  
Moderate Anaemia ◽  
In Pregnancy

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.

scholarly journals Evaluation of efficacy of injection ferric carboxymaltose in pregnant women

2020 ◽  
Vol 9 (7) ◽  
pp. 2900
Author(s):  
Rupali M. Sabale ◽  
Reena J. Wani ◽  
Rashmi Jalvee
Keyword(s):  
Iron Deficiency ◽  
Pregnant Women ◽  
Iron Deficiency Anaemia ◽  
Oral Treatment ◽  
Intravenous Iron ◽  
Oral Iron ◽  
Ferric Carboxymaltose ◽  
Iron Group ◽  
Deficiency Anaemia ◽  
Iv Iron

Background: Iron deficiency anaemia (IDA) continues to be a very common problem in developing countries leading to a spectrum of adverse events in pregnant women. The objective of this study was to determine the efficacy, side effects and tolerance of ferric carboxymaltose as compared to available iron preparations for the prophylaxis and treatment of mild to moderate iron deficiency anaemia during pregnancy.Methods: One-year clinical study (from June 2017 to May 2018). A total 100 patients were enrolled after matching inclusion and exclusion criteria. The efficacy assessment was performed during 4, 8, and 12 weeks of starting therapy. If the patient is not responding to therapy in either arm as documented by no rise or fall in haemoglobin levels patients may be removed from study for other therapy. Treatment duration up to 12 weeks. Safety and efficacy follow-up visit at 4, 8 and 12 weeks. Institutional ethics committee permission was taken.Results: On intra-group comparisons there was significant increase in haemoglobin levels at 8 and 12 weeks in oral iron group as compared to day 1 haemoglobin levels while there was significant increase in haemoglobin levels at 4, 8 and 12 weeks in IV iron group as compared to day 1 haemoglobin levels. On intergroup comparisons between oral and IV iron group, there was significant increase in haemoglobin levels at 4, 8 and 12 weeks in IV iron group as compared oral iron group haemoglobin levels.Conclusions: Intravenous iron therapy with ferric carboxymaltose causes significant improvement in haemoglobin more quickly and more effective in correcting iron deficiency anaemia in pregnancy compared to oral treatment in terms of increase in haemoglobin levels at 4, 8 and 12 weeks. Intravenous ferric carboxymaltose is safe and effective option for pregnant women with iron deficiency anaemia.

A Prospective Randomised Trial of Intravenous Iron Therapy Versus Oral Iron for Iron Deficiency Anaemia in Pregnant Australian Women

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3750-3750 ◽  
Author(s):  
Alhossain A. Khalafallah ◽  
Amanda Dennis ◽  
Joan Bates ◽  
Gerald Bates ◽  
Lauern Smith ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Pregnant Women ◽  
Serum Ferritin ◽  
Iron Deficiency Anaemia ◽  
Intravenous Iron ◽  
Oral Iron ◽  
Iron Therapy ◽  
Deficiency Anaemia ◽  
Iv Iron ◽  
Intravenous Iron Therapy

Abstract To date, limited data is available regarding prevalence of iron deficiency during pregnancy in Australia. There is little if any data currently available regarding comparative efficacy of IV iron versus oral iron therapy in pregnant women. In Australia the prevalence of iron deficiency anaemia (IDA) is approximately 5% in the general population with higher rates in pregnant women. At a single site, the Launceston General Hospital (LGH), we prospectively investigated 200 pregnant women between January and July 2007 with FBC and iron studies at the first or second antenatal visit. Among those, 40 women (20%) had iron deficiency anaemia, and were recruited to a prospective randomised trial to determine whether intravenous iron therapy (iron polymaltose) is superior to oral iron (ferrous sulphate) for the management of IDA associated with pregnancy. The patients’ median age was 28 years old (range; 19–40) with a median gestational age at recruitment of 27 weeks (range; 13–29) and a median body weight of 74 kg (range; 47–130). At recruitment median Hb was 106 g/L (range; 90–114, normal range; 120–160 g/L), while median serum ferritin was 11.5 μg/L and mean ferritin was 19 μg/L normal range; 30–460). After four weeks of treatment the Hb level increased by a mean of 6g/L on oral iron and by 10.5 g/L after IV iron. Mean/Median serum ferritin did not increase significantly in women on oral iron, but increased to a median of 96.5 μg/L and a mean of 224 μg/L in those received IV iron. Multi-variate analysis using general linear modelling for continuous variables showed a significant increase in serum ferritin after treatment with IV iron versus oral iron (p=0.017). There was no statistically significant difference in terms of Hb increment, patients’ parity, weight, and date of last pregnancy between groups. Analysis of quality of life questionnaires to assess patients’ well-being, ability to perform activities, and symptoms of anaemia showed improvement in both groups of patients with a trend to greater and faster improvement after IV iron. Both treatments were well tolerated without major side effects. The preliminary data indicate IDA is a common finding during pregnancy in the LGH population, and intravenous iron therapy appears a safe and effective treatment in this cohort of patients. This research received a grant from the Clifford Craig Medical Research Trust, Tasmania, Australia.

scholarly journals Intravenous iron is non-inferior to oral iron regarding cell growth and iron metabolism in colorectal cancer associated with iron-deficiency anaemia

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hafid O. Al-Hassi ◽  
Oliver Ng ◽  
Rayko Evstatiev ◽  
Manel Mangalika ◽  
Natalie Worton ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Iron Deficiency ◽  
Iron Metabolism ◽  
Iron Deficiency Anaemia ◽  
Iron Transport ◽  
Intravenous Iron ◽  
Oral Iron ◽  
Iron Loading ◽  
Deficiency Anaemia ◽  
Iron Treatment

AbstractOral iron promotes intestinal tumourigenesis in animal models. In humans, expression of iron transport proteins are altered in colorectal cancer. This study examined whether the route of iron therapy alters iron transport and tumour growth. Colorectal adenocarcinoma patients with pre-operative iron deficiency anaemia received oral ferrous sulphate (n = 15), or intravenous ferric carboxymaltose (n = 15). Paired (normal and tumour tissues) samples were compared for expression of iron loading, iron transporters, proliferation, apoptosis and Wnt signalling using immunohistochemistry and RT-PCR. Iron loading was increased in tumour and distributed to the stroma in intravenous treatment and to the epithelium in oral treatment. Protein and mRNA expression of proliferation and iron transporters were increased in tumours compared to normal tissues but there were no significant differences between the treatment groups. However, intravenous iron treatment reduced ferritin mRNA levels in tumours and replenished body iron stores. Iron distribution to non-epithelial cells in intravenous iron suggests that iron is less bioavailable to tumour cells. Therefore, intravenous iron may be a better option in the treatment of colorectal cancer patients with iron deficiency anaemia due to its efficiency in replenishing iron levels while its effect on proliferation and iron metabolism is similar to that of oral iron treatment.

scholarly journals Study of outcome of the treatment with intravenous iron sucrose in moderately anaemic pregnant women

2019 ◽  
Vol 8 (9) ◽  
pp. 3480
Author(s):  
Kohila Kalimuthu ◽  
Vanusha Avudaithangam
Keyword(s):  
Standard Deviation ◽  
Iron Deficiency ◽  
Pregnant Women ◽  
Iron Deficiency Anaemia ◽  
Intravenous Iron ◽  
Iron Sucrose ◽  
P Value ◽  
Deficiency Anaemia ◽  
The Mean ◽  
The Difference

Background: Moderate anaemia seen in about 15-20% of pregnant women. Iron sucrose complex which is used intravenously for the correction of Iron deficiency anaemia. The drug has been able to raise the haemoglobin to satisfactory level when used in moderately anaemic iron deficient pregnant women. The objective of this study was to study the improvement of Hb% after treatment with intravenous Iron sucrose complex in moderately anaemic pregnant women belonging to 24-32 weeks of gestational age.Methods: 50 antenatal patients between gestational age 24-32 weeks with hemoglobin between 8-9.5g/dl were selected and included in this study. They were subjected to blood hemoglobin estimation, hematocrit and peripheral smear study. In each infusion, the maximum total dose administered was 200 mg iron sucrose in 100 ml of normal saline, slow IV infused over 30 minutes. Monitoring was done throughout the infusion to observe for any side effects.Results: Mean hemoglobin among the 50 patients before starting the therapy was 8.172g/dl and the mean hemoglobin at the end of one month of completing the therapy was 11.066g/dl. The rise in mean hemoglobin i.e. the difference in the mean hemoglobin before and after treatment was 2.894g/dl. The p value is 0.0001 which is statistically significant. The mean hematocrit of the 50 patients studied before starting the treatment was 26.772% with a standard deviation of 1.914. The mean hematocrit after completing the therapy was 33.872% with a standard deviation of 1.321. The difference in the mean hematocrit was 7.100% with a p value of 0.0001 which is statistically significant.Conclusions: Intravenous iron sucrose complex is well tolerated and highly efficacious in improving hemoglobin, hematocrit in the treatment of iron deficiency anaemia in antenatal women.

scholarly journals Impact of Intravenous Iron on Oxidative Stress and Mitochondrial Function in Experimental Chronic Kidney Disease

Antioxidants ◽  
2019 ◽  
Vol 8 (10) ◽  
pp. 498 ◽  
Author(s):  
Faisal Nuhu ◽  
Anne-Marie Seymour ◽  
Sunil Bhandari
Keyword(s):  
Oxidative Stress ◽  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Iron Deficiency ◽  
Glutathione Peroxidase ◽  
Mitochondrial Function ◽  
Iron Deficiency Anaemia ◽  
Deficiency Anaemia ◽  
Iv Iron

Background: Mitochondrial dysfunction is observed in chronic kidney disease (CKD). Iron deficiency anaemia (IDA), a common complication in CKD, is associated with poor clinical outcomes affecting mitochondrial function and exacerbating oxidative stress. Intravenous (iv) iron, that is used to treat anaemia, may lead to acute systemic oxidative stress. This study evaluated the impact of iv iron on mitochondrial function and oxidative stress. Methods: Uraemia was induced surgically in male Sprague-Dawley rats and studies were carried out 12 weeks later in two groups sham operated and uraemic (5/6 nephrectomy) rats not exposed to i.v. iron versus sham operated and uraemic rats with iv iron. Results: Induction of uraemia resulted in reduced iron availability (serum iron: 31.1 ± 1.8 versus 46.4 ± 1.4 µM), low total iron binding capacity (26.4 ± 0.7 versus 29.5 ± 0.8 µM), anaemia (haematocrit: 42.5 ± 3.0 versus 55.0 ± 3.0%), cardiac hypertrophy, reduced systemic glutathione peroxidase activity (1.12 ± 0.11 versus 1.48 ± 0.12 U/mL), tissue oxidative stress (oxidised glutathione: 0.50 ± 0.03 versus 0.36 ± 0.04 nmol/mg of tissue), renal mitochondrial dysfunction (proton/electron leak: 61.8 ± 8.0 versus 22.7 ± 5.77) and complex I respiration (134.6 ± 31.4 versus 267.6 ± 26.4 pmol/min/µg). Iron therapy had no effect on renal function and cardiac hypertrophy but improved anaemia and systemic glutathione peroxidase (GPx) activity. There was increased renal iron content and complex II and complex IV dysfunction. Conclusion: Iron therapy improved iron deficiency anaemia in CKD without significant impact on renal function or oxidant status.

scholarly journals Intravenous versus oral iron therapy in treatment of postpartum anaemia

2017 ◽  
Vol 6 (8) ◽  
pp. 3454
Author(s):  
Neelima Agarwal ◽  
Preeti Sharma
Keyword(s):  
Iron Deficiency ◽  
Iron Deficiency Anaemia ◽  
Ferrous Sulphate ◽  
Intravenous Iron ◽  
Hemoglobin Level ◽  
Oral Iron ◽  
Chi Square ◽  
Deficiency Anaemia ◽  
Significant Difference ◽  
Red Cell Indices

Background: Postpartum iron deficiency anaemia (IDA) is common in women. Most women are treated with either oral iron supplementation or blood transfusion. Hence, the aim of our study was to compare the effect of treatment with either oral ferrous sulphate or intravenous ferrous sucrose on postpartum IDA.Methods: 100 postpartum women with proven iron deficiency anaemia with hemoglobin <9gm/dl and serum ferritin <15 µgm/l were included in the study. They were randomized to receive either oral ferrous sulphate 200 mg twice daily for 6 weeks (group 1) or intravenous ferrous sucrose 200 mg, two to three doses given on alternate days (group 2). Total iron deficit was calculated using a standard formula. Target hemoglobin was 11 gm/dl. Results were analysed by the students t-test and chi-square test. Hemoglobin, hematocrit, red cell indices and ferritin were measured on day 2-3, 1-2 weeks and 6 weeks postpartumResults: By 1-2 weeks, hemoglobin level in women treated with intravenous iron had risen from 7.81±0.849 to 9.88±0.760 gm/dl which was more than those treated with oral iron (p<0.01); although by 6 weeks, there was no significant difference between the two groups. Ferritin levels rose rapidly in those treated with intravenous iron and remained significantly higher than in those treated with oral iron (p<0.01).Conclusions: Intravenous iron sucrose increases the hemoglobin level more rapidly than oral ferrous sulphate in women with postpartum IDA. It also replenishes iron stores more rapidly. 

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