Supplementing iron intravenously in pregnancy: A way to avoid blood transfusions

OBJECTIVE: To determine the safety and efficacy of maternal intravenous iron administration to avoid blood transfusion in patients who cannot use oral preparations. METHODS: Patients with persistent iron deficiency anemia who had one of the following indications were included in this study: severe side effects from oral preparations, lack of improvement despite oral iron intake or history of gastrointestinal operations. The total iron amount needed to regenerate iron stores was calculated according to hemoglobin and the patients' weight. Hemoglobin, hematocrit, mean corpuscular volume, serum iron, transferrin and ferritin were evaluated at the start and conclusion of therapy as well as two weeks afterward. RESULTS: Twenty-six patients were included in the study; four of them delivered during the therapy course. One patient developed mild signs of allergy (urticaria) after the test dose and was excluded from the study. The remaining 21 pregnant patients (mean gestational age 28 weeks) completed the therapy course and received a mean of 1,000 mg of elemental iron. The hemoglobin was increased from 8.4 ± 1.0 to 10.1 ± 0.6 g/dL at the start and end of therapy, respectively (P < .01) and continued to rise to 10.9 ± 0.6 g/dL two weeks later (P < .01). The serum iron was increased from 3.9 ± 2.0 μmol/L at the start of therapy to 15.5 ± 7.2 at the end (P<.01). The transferrin was decreased from 47.0 ± 7.8 to 41.4 ± 5.3 to 37.1 ± 11.8 μmol/L at the start of, end of and two weeks after therapy, respectively (P < .01). Ferritin levels were increased from 2.9 ± 2.7 ng/mL at the start to 122.8 ± 87.1 at the end of therapy (P < .01) and decreased to 109.4 ± 90.7 ng/mL two weeks after treatment (not significant). Only mild and transient side effects were occasionally reported. CONCLUSION: Intravenous iron administration during pregnancy is an effective method of regenerating hemoglobin and iron stores. It should be considered for patients with severe iron-deficiency anemia who cannot use oral preparations.