Iron therapy in pregnant women with iron deficiency anemia: a meta-analysis

Background: Pregnancy significantly increases the need for iron. The prevalence of anemia in pregnant women is high, affecting 41.8% of all pregnant women worldwide. In patients with low tolerance to oral iron, it is recommended to start them on parenteral iron therapy but with variable degree of efficacy. Hence this meta-analysis was done with the following aim. This study aimed to assess the efficacy of various iron preparations in pregnant women with iron deficiency anemia (IDA).Methods: Randomised controlled trials (RCTs) (available as full free text) which included iron therapy in pregnant women with iron deficiency anemia were retrieved from electronic databases viz. PubMed, Google scholar and IndMed, with specific search terms. Qualities of RCTs were assessed using JADAD score and four RCTs with high score were included for analysis using RevMan 5.3 software. Outcome measures were change in hemoglobin levels and serum ferritin concentration after one month of therapy.Results: In the four RCTs included, a total of 267 patients were treated with oral iron and 267 patients were treated with parenteral iron therapy. Change in the hemoglobin levels between the 2 groups had a standard mean difference of 0.73, 95% CI (-0.05-1.52), with the p-value of 0.07. To assess the change in the serum ferritin concentration a total of 188 patients in oral iron and 197 patients in parenteral iron therapy were included. There was a standard mean difference of 0.88, 95% CI (0.60-1.66), with a p value of<0.00001.Conclusions: In the present meta-analysis we found that oral and parenteral iron therapy showed similar efficacy in improving the hemoglobin level in pregnant women.

Anemia sideropenica in età pediatrica: pillole di… ferro

Iron deficiency anemia is the most frequent haematological disorder in children. Although much is already known about the diagnostic-therapeutic approach, new frontiers regarding its diagnosis and therapeutic options emerge every day. An adequate intake with the diet is essential and can also be obtained in compliance with vegetarian-type diets. The use of glycinate or lysosomal preparations could positively affect the efficacy of therapy reducing the side effects associated with commonly used iron preparations. Parenteral iron therapy in pediatric age, which is currently limited to selected conditions, may evolve further, as a consequence of the production of molecules such as ferrocarboxymaltose, the use of which is not currently permitted under the age of 14. Further studies are therefore necessary in order to implement the knowledge and diagnostic-therapeutic interventions related to this widespread nosological entity.

Abstract 15912: Parenteral Iron Sucrose Improves Iron Biomarkers in Pediatric Heart Failure Patients With Iron Deficiency

Introduction: Iron deficiency (FeD) is common in adults with heart failure and is associated with worse outcomes. Parenteral iron therapy improves outcomes in this population, but this has not been described in the pediatric population. Methods: We conducted a prospective observational cohort study of heart failure patients with FeD, defined as ferritin <100 ng/mL or ferritin = 100-300 with iron saturation <20%, who received parenteral iron sucrose between 01/2007-12/2019. Iron dosing and frequency were based on initial and subsequent iron profiles using a standard replacement protocol. Monthly follow-up lab and clinical data up to 6 months were obtained and analyzed to characterize the effect on iron biomarkers and association with clinical outcomes (B-type natriuretic peptide (BNP), death, transplant, and mechanical circulatory support). Results: Among 61 patients who received parenteral iron therapy, 49% were male, with a median age of 23 months (IQR 7 - 117). 30 (49%) had primary cardiomyopathy; 31 (51%) had congenital heart disease with systolic dysfunction, 14 (45%) of which with cyanotic disease. 56 (92%) of the patients had a follow-up iron profile at timepoint 1 (TP 1) at a mean of 24 SD + 9 days. The interval between the 1st dose of iron and last follow-up (TP Last) was 61 + 50 days. The cumulative number of iron doses received was 3.5 + 1.5 at TP 1 and 4.1 + 2.4 at TP Last. Figure 1 shows the trend in iron biomarkers and BNP. There was a statistically significant increase in ferritin, iron saturation and serum iron levels, as well as a decrease in BNP over time. Clinical outcomes were examined by multivariable analysis. Only an increase in ferritin was associated with a decrease in BNP (p=0.012). Conclusions: Parenteral iron therapy for FeD under a standard protocol led to improvement in iron biomarkers in children with heart failure. Our study was limited by a small sample size and further study to assess clinical outcomes specifically related to iron therapy is warranted.