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Parenteral iron therapy in obstetrics: 8 years experience with iron–sucrose complex

Published online by Cambridge University Press:  09 March 2007

G. Perewusnyk
Affiliation:
Perinatal Physiology Unit, Department of Obstetrics, Zurich University Hospital, Switzerland
R. Huch
Affiliation:
Perinatal Physiology Unit, Department of Obstetrics, Zurich University Hospital, Switzerland
A. Huch
Affiliation:
Perinatal Physiology Unit, Department of Obstetrics, Zurich University Hospital, Switzerland
C. Breymann*
Affiliation:
Perinatal Physiology Unit, Department of Obstetrics, Zurich University Hospital, Switzerland
*
*Corresponding author: Dr C. Breymann, fax +41 1 255 4430, email christian.breymann@fhk.usz.ch
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Abstract

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Fe is an essential component of haem in myoglobin and accounts for 70 % of haemoglobin. The balance of Fe, unlike that of other metals such as Na or Ca, is regulated solely by gastrointestinal absorption, which itself depends on the bioavailability of Fe in food, i.e. the chemical Fe species. Factors that maintain Fe homeostasis by modulating Fe transfer through the intestinal mucosa are found at the luminal, mucosal and systemic levels. Fe deficiency and its consequence, Fe-deficiency anaemia, form the commonest nutritional pathology in pregnant women. The current gold standard to detect Fe deficiency remains the serum ferritin value. Previously there was general consensus against parenteral Fe administration, i.e. parenteral Fe was only recommended for special conditions such as unresponsiveness to oral Fe, intolerance to oral Fe, severe anaemia, lack of time for therapy etc. However, especially in hospital settings, clinicians regularly face these conditions but are still worried about reactions that were described using Fe preparations such as Fe–dextrans. A widely used and safe alternative is the Fe–sucrose complex, which has become of major interest to prevent functional Fe deficiency after use of recombinant erythropoietin Numerous reports show the effectiveness and safety of the Fe–sucrose complex. Good tolerance to this Fe formulation is partly due to the low allergenic effect of the sucrose complex, partly due to slow release of elementary Fe from the complex. Accumulation of Fe–sucrose in parenchyma of organs is low compared with Fe–dextrans or Fe–gluconate, while incorporation into the bone marrow for erythropoiesis is considerably faster. Oral Fe is only started if haemoglobin levels are below 110 g/l. If levels fall below 100 g/l or are below 100 g/l at time of diagnosis, parenteral Fe–sucrose is used primarily. In cases of severe anaemia (haemoglobin <90 g/l) or non-response to parenteral Fe after 2 weeks, recombinant erythropoietin is considered in combination. By using parenteral Fe–sucrose in cases of severe Fe deficiency, anaemia during pregnancy is treated efficiently and safely according to our results and rate of blood transfusion could be reduced considerably to below 1 % of patients per year.

Type
Review article
Copyright
Copyright © The Nutrition Society 2002

References

Allen, LH (1997) Pregnancy and iron deficiency: unresolved issue. Nutrition Reviews 55, 91101.CrossRefGoogle Scholar
al-Momem, AK, al-Meshari, A, al-Nuaim, L, Saddique, A, Abotalib, Z, Khashogji, T & Abbas, M (1996) Intravenous iron sucrose complex in the treatment of iron deficiency anemia during pregnancy. European Journal of Obstetrics, Gynecology and Reproductive Biology 69, 12124.Google Scholar
Baynes, R (1994) Iron deficiency. In Iron metabolism in Health and Disease, pp. 190210 [Brock, J, Halliday, J, Pippard, M and Powell, L, editors]. London: W.B. Saunders & Company.Google Scholar
Beard, JL, Borel, MJ & Derr, J (1990a) Impaired thermoregulation and thyroid function in iron-deficiency anemia. American Journal of Clinical Nutrition 52, 813819.CrossRefGoogle ScholarPubMed
Beard, JL, Tobin, BW & Smith, SM (1990b) Effects of iron repletion and correction of anemia on norepinephrine turnover and thyroid metabolism in iron deficiency. Proceedings of the Society for Experimental Biology and Medicine 193, 306312.CrossRefGoogle ScholarPubMed
Breymann, C (1998) Modern therapy concepts for severe in pregnancy and post partum. In Prevention and Management of Anaemia in Pregnancy and Postpartum Haemorrhage, pp. 107122 [Huch, A, Huch, R and Breymann, C, editors]. Zurich: Schellenberg.Google Scholar
Breymann, C (2000) Assessment and differential diagnosis of iron-deficiency anaemia during pregnancy. Clinical Drug Investigation 19 Suppl. 1, 2127.Google Scholar
Breymann, C, Richter, R, Hüttner, C, Huch, R & Huch, A (2000) Effectiveness of rhEPO and iron sucrose vs iron therapy only, in patients with postpartum anaemia and blunted erythropoiesis. European Journal of Clinical Investigation 30, 154161.CrossRefGoogle ScholarPubMed
Breymann, C, Visca, E, Huch, R & Huch, A (2001) Efficacy and safety of intravenous iron source with vs without rhEPO for resistant iron deficiency anemia in pregnancy. American Journal of Obstetrics and Gynecology 184, 662667.Google Scholar
Breymann, C, Zimmermann, R, Huch, R & Huch, A (1996) Use of rhEPO in combination with parenteral iron for the treatment of postpartum anemia. European Journal of Clinical Investigation 23, 123126.CrossRefGoogle Scholar
Carriaga, MT, Skikne, BS, Finley, B, Cutler, B & Cook, JD (1991) Serum transferrin receptor for the detection of iron deficiency in pregnancy. American Journal of Clinical Nutrition 54, 10771081.Google Scholar
Centers for Disease Control and Prevention (1989) CDC criteria for anemia in children and childbearing-aged women. Morbidity and Mortality Weekly Report 38, 400404.Google Scholar
Conrad, ME, Umbreit, JN & Moore, EG (1991) A role for mucin in the absorption of inorganic iron and other metal cations. A study in rats. Gastroenterology 100, 129136.CrossRefGoogle ScholarPubMed
Cook, J, Skikne, B & Baynes, R (1994) Iron deficiency: The global perspective. In Progress in Iron Research, pp. 219228 [Hershko, C, editor]. New York, NY: Plenum Press.CrossRefGoogle Scholar
Cook, JD & Lynch, SR (1981) The liabilities of iron deficiency. Blood 68, 803809.CrossRefGoogle Scholar
Danielson, BG (1998) Intravenous iron therapy – efficacy and safety of iron sucrose. In Prevention and Management of Anaemia in Pregnancy and Postpartum Haemorrhage pp. 93106 [Huch, A, Huch, R and Breymann, C, editors]. Zurich: Schellenberg.Google Scholar
Danielson, BG, Salmonson, T, Derendorf, H & Geisser, P (1996) Pharmacokinetics of iron (III)-hydroxide sucrose complex after a single intravenous dose in healthy volunteers. Arzneimittelforschung 46, 615621.Google ScholarPubMed
Forth, W & Rummel, W (1992) Eisen: pharmakotherapie des eisenmangels. In Allgemeine und Spezielle Pharmakologie und Toxikologie (Iron: pharmacotherapy of iron deficiency. In General and Special Pharmacology and Toxicology), pp. 457465 [Forth, W, Henschler, D, Rummel, W and Starke, K, editors]. Wissenschaftsverlag: Mannheim Leipzig Vienna Zurich.Google Scholar
Garn, SM, Ridella, SA, Petzold, AS & Falkner, F (1981) Maternal haematologic values and pregnancy outcome. Seminars in Perinatology 5, 155162.Google Scholar
Hercberg, S, Galan, P & Preziosi, P (2000) Consequences of iron deficiency in pregnant women: current issues. Clinical Drug Investigation 19 Suppl. 1, 17.CrossRefGoogle Scholar
Hoigné, R, Breymann, C, Künzi, UP & Brunner, F (1998) Parenterale Eisentherapie: Probleme und mögliche Losungen (Parenteral iron therapy: problems and possible solutions). Schweizerische Medizinische Wochenschrift 128, 528535.Google ScholarPubMed
Krafft, A, Breymann, C, Huch, R & Huch, A (2000) Intravenous iron sucrose in two pregnant women with inflammatory bowel disease and severe anaemia iron deficiency anemia. Acta Obstetrica Gynaecologica Scandinavica 79, 720722.CrossRefGoogle ScholarPubMed
Krafft, A, Breymann, C, Schneider, J, Perewusnyk, G, Huch, R & Huch, A (1999) Neopterin und sTfR bei vermeintlicher schwerer Eisenmangelanämie in der Schwangerschaft (Neopterin and sTfR in presumed severe iron-deficiency anaemia in pregnancy). Gynäkologische Geburtshilfliche Rundschau 39 145.Google Scholar
Letsky, EA (1995) Erythropoiesis in pregnancy. Journal of Perinatal Medicine 23, 3945.Google Scholar
Macdougall, IC, Hutton, RD, Cavill, I, Coles, GA & Williams, JD (1989) Poor response to treatment of renal anaemia with erythropoietin corrected by iron given intravenously. British Medical Journal 299, 157158.Google Scholar
Milman, N, Agger, AO & Nielsen, OJ (1994) Iron status markers and serum erythropoietin in 120 mothers and newborn infants. Effect of iron supplementation in normal pregnancy. Acta Obstetrica Gynacologica Scandinavica 73, 200204.CrossRefGoogle ScholarPubMed
Murphy, JF, O'Riordan, J, Newcombe, RG, Coles, EC & Pearson, JF (1986) Relation of haemoglobin levels in first and second trimesters to outcome of pregnancy. Lancet 1, 992995.CrossRefGoogle ScholarPubMed
Perewusnyk, G & Funk, F (1997) Iron uptake by rabbit intestinal brush border membrane vesicles involves movement through the outer surface, membrane interior, inner surface and aqueous interior. Journal of Nutrition 127, 10921098.CrossRefGoogle ScholarPubMed
Perewusnyk, G, Guntermann, H, Breymann, C, Huch, R & Huch, A (1999) Bedeutung von Neopterin. Ferritin und sTfR bei der peripartalen Beurteilung des Eisenstatus (Role of neopterin, ferritin and sTfR in peripartum assessment of iron status). Gynäkologische Geburtshilfliche Rundschau 39, 156.Google Scholar
Punnonen, K, Irjala, K & Rajamaki, A (1997) Serum transferrin receptor and its ratio to serum ferritin in the diagnosis of iron deficiency. Blood 89, 10521057.CrossRefGoogle ScholarPubMed
Rohling, R, Zimmermann, A & Breymann, C (2000) Intravenous versus oral iron supplementation for preoperative stimulation of haemoglobin synthesis using recombinant human erythropoietin. Journal of Hematology and Stem Cell Research 9, 497500.Google Scholar
Rusia, U, Flowers, C, Madan, N, Agarwal, N, Sood, SK & Sikka, M (1999) Serum transferrin receptors in detection of iron deficiency in pregnancy. Annals of Hematology 78, 358363.CrossRefGoogle ScholarPubMed
Sato, S (1991) Iron deficiency: structural and microchemical changes in hair, nails, and skin. Seminars in Dermatology 10, 313319.Google Scholar
Schobersberger, W & Jelkmann, W (1995) Neopterin induced suppression of erythropoietin production in vitro. Pteridines 6, 1216.Google Scholar
Umbreit, JN, Conrad, MD, Moore, EG & Latour, LF (1998) Iron absorption and cellular transport: the mobilferrin/paraferrin paradigm. Seminars in Hematology 35, 1326.Google ScholarPubMed
World Health Organization (1972) Nutritional Anemias. Technical Report Series, p. 503. Geneva: WHO.Google Scholar