Role of Parenteral Iron Therapy in Gynaecologic Malignancies: A Review of Literature and Recommendations for Practice in a Cancer Centre in a Developing Country

Anaemia causes morbidity and mortality in cancer patients with negative impact on treatment outcome and prognosis. It has been a common practice to offer blood transfusion which comes with its own disadvantages. Therefore, alternative strategies are required to obviate the recurrent need for blood transfusion. Currently, the best treatment decisions for anaemia might be based on measurements of serum ferritin (SF), transferrin saturation (TSAT), soluble transferrin receptor (sTfR), ferritin index (FI = sTfR/log SF), hypochromic reticulocytes (CHR) and C-reactive protein (CRP). Parenteral iron therapy has advantages over oral route as compliance is the limiting factor in oral iron therapy and gastro-intestinal side effects are increased by oral route. A patient’s total body iron deficit can be calculated using the Ganzoni formula. Options for use of parenteral iron are iron dextran, iron sucrose and ferric gluconate. There are numerous trials which evaluate parenteral iron in cancer patients, but only a few evaluate them in gynaecologic malignancies. These trials conclude that usage leads to decreased transfusion rate and slow, steady and sustained rise in Hb level. Certain recommendations include safe and effective use of parenteral iron. Lowest Hb level for injectable iron should be 10 gm/dl. Post-surgical patients should be haemodynamically stable. Preparations can be given according to individual availability, cost and feasibility. Parenteral iron therapies improve time to target haemoglobin levels. They decrease need of blood transfusion. We recommend the use of intravenous iron therapy under supervision wherever feasible.