Study of Effectiveness, Tolerability and Safety of Intravenous Iron Sucrose in Iron Deficiency Anaemia in Postnatal Women

INTRODUCTION: Anaemia is defined by a decrease in haemoglobin concentration with a consequent decrease in the hematocrit. It is the most common medical disorder in pregnancy. The two most common cause of anaemia are iron deficiency and acute blood loss. Depending on the severity of the blood loss anaemic postpartum patients can be at increased risk of morbidity and even mortality and anaemia due to heavy bleeding during delivery should be corrected without delay. Anaemia is defined by World Health Organisation as haemoglobin levels <11 g/dl. It is one of the most serious global public health problems, affecting 52% of pregnant women in developing and 23% of the developed countries. Iron is an essential component of haemoglobin in the blood. The pregnant woman needs 1000mg of iron all through her pregnancy i.e. 3-5 mg/day to maintain iron balance. This demand during later half of pregnancy and for several weeks after delivery increases to 6.7 mg/day. The absorption of iron from oral supplements is influenced by the dose; the patients iron stores and intake in relation to meal time. Parentral administration of iron, as an alternative provides a quick and certain correction of total iron deficit. AIM OF THE STUDY: 1. To determine the efficacy and tolerability of the intravenous iron sucrose in the treatment of iron deficiency anaemia in the postpartum period. 2. To determine the safety of iron sucrose in the treatment of iron deficiency anaemia in the postpartum period. MATERIALS AND METHODS: This study was conducted in Institute of Obstetrics and Gynaecology, Madras Medical College, Chennai. Fifty (50) postnatal patients both after vaginal and caesarean section with iron deficiency anaemia within the first 48 hours with haemoglobin percentage between 6 g/dl and 8g/dl were selected and included in this study. Inclusion Criteria: 1. Age > 18 years, 2. Diagnosis of postpartum anaemia with Hb% equal to or greater than 6 g/dl and less than 8 g/dl. Exclusion Criteria: 1. History of allergy to iron containing medications, 2. History of allergic conditions or bronchial asthma, 3. Thalassemia, 4. History of bleeding tendency, 5. Non iron deficient anaemia. Blood investigations were sent for the patients who looked clinically anaemic within the first 48 hours of either vaginal or caesarean delivery, which includes Hb%, PCV, MCV and tests to confirm iron deficiency anaemia by peripheral smear, serum iron and total iron binding capacity. Hb%, PCV, MCV were analysed by automatic cell counter and serum iron and total iron binding capacity were calculated using semi auto analyser ERBA CHEM 5 PLUS V2. Those patients with iron deficiency anaemia were included in this study. An informed consent was obtained, a detailed history taking and a complete general examination was done. METHOD OF THE STUDY: The dosage of iron required for each individual patient is calculated using the formula (Target Hb% - patient Hb %) in gm% * 2.4 *weight in kg Test dose is not needed. The patients were given 100 mg of elemental iron diluted in 100 ml of 0.9 % normal saline and infused over 15 minutes every alternate day (not more than 3 days in a week) until the required dosage is infused. SUMMARY: In our study fifty postnatal patients with iron deficiency anaemia were selected according to the inclusion and the exclusion criteria stated in the methodology. The iron required is calculated and given intravenously in the form of iron sucrose complex and followed up after 30 days and the following parameters were analysed. 1. Haemoglobin in g/dl. 2. Hematocrit. 3. Mean corpuscular volume. 4. Serum iron. 5. Total iron binding capacity. 6. Percent saturation. The results of the study are tabulated, analysed and summarised as follows; 1. Majority of the patients around 52% (26/50) belong to the age group between 21 – 25 years. 2. Almost three fourth (72%) of the patients were booked patients. 3. Majority of the patients (84%) belongs to the class V socio economic status. 4. Majority of the patients were multipara (68%) and among them para 2 is the major population (56%) 5. Mean raise in haemoglobin % after 30 days of treatment was 3.60 with a p value <0.05 which is statistically significant. 6. Average raise in the mean hematocrit was 8.73 after 30 days of treatment with a p value <0.05 which is statistically significant. 7. Mean raise in the Mean Corpuscular Haemoglobin was 13.55 fl with a p value of <0.05 which is statistically significant. 8. Mean raise in the serum iron value was 38.82 with a p value <0.05 which is statistically significant. 9. Mean change in the total iron binding capacity is 129.77 with a p value of <0.05 which is statistically significant 10. Mean change in the percent saturation was 22.26 with a p value <0.05 which is statistically significant. 11. The side effects were very minimal in our study group (12%). The side effects profile was also very mild which included headache in one patient, chills and rigors in three patients and thrombophlebitis in two patients. No anaphylactic reactions occurred. CONCLUSION: 1. Intravenous iron sucrose complex is highly efficacious in improving the haemoglobin %, hematocrit and the serum iron values in the treatment of iron deficiency anaemia in the postnatal women. 2. Iron sucrose infusion was well tolerated and safe, there were no major adverse reactions To conclude intravenous iron sucrose complex is safe, convenient and more effective mode of treatment of iron deficiency anaemia in postnatal women. It could be used to reduce the number of blood transfusions in the postnatal period in asymptomatic women with Hb% between 6 and 8 g/dl.