Preetha, G V (2011) Efficacy of Intravenous Iron Sucrose in treating Iron Deficiency Anaemia in Antenatal Patients. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION: Anemia is one of the major public health problems in the developing world. More then 70% of pregnant women in South-East Asia region suffer from nutritional anemia. Anemia is the direct cause of maternal death in 10-15% of cases but is an associated cause in many maternal deaths due to haemorrhage, sepsis and cardiac failure. Anemia in pregnancy is associated with an adverse obstetric outcome in form of spontaneous abortions, preterm labor, low birth weight babies and intrauterine growth retardation. It is paradoxical but true that though the cause of pregnancy anemia is known and iron therapy is cheap, anemia continues to take a heavy toll of maternal lives in most developing countries. The World Health Organisation (WHO) defines anemia in pregnant women as hemoglobin level below 11 g / dl. Iron deficiency is the most common hematinic deficiency in pregnancy, followed by folate deficiency. Prevention or early treatment of pregancy anemia is the best prophylaxis against maternal mortality. Supplementation with iron and folic acid during pregnancy is an effective method for preventing mortality and morbidity associated with anemia and improving the outcome of pregnancy. One of the primary aims of antenatal care is to prevent and treat anemia during pregnancy, since the safety of labour and the puerperal state, to say nothing of the future health, depend upon the state of the patient’s hemoglobin reserve Iron is an essential component of hemoglobin in blood. The pregnant women needs 1000 mg of iron all through her pregnancy to maintain iron balance. Traditional iron therapy which is based on either oral administration of iron or blood transfusion has many drawbacks. Now parenteral administration of new well tolerated iron preparations like iron sucrose which has been successfully used in treatment of anemia has revolutionised the treatment of anemia. This study was done to find out the efficacy and safety of intravenous iron sucrose in treatment of iron deficiency anemia in second trimester of pregnancy. AIM OF STUDY: 1. To determine efficacy of iron sucrose in treating iron deficiency anemia in antenatal patients. 2. To determine safety of iron sucrose in treatment of iron deficiency anemia in antenatal patients. MATERIALS AND METHODS: Study Place : Institute of Obstetrics and Gynaecology. Study Period : 2009 to 2010. Study Design : Prospective Study. 50 antenatal patients in second trimester with hemoglobin > 6 grams % and < 11 grams % were selected. Inclusion Criteria: a) Gestational age 13 to 28 weeks, b) Hemoglobin > 6 gm % to < 11 gm %. Exclusion Criteria: 1) Patients in first and third trimester of pregnancy, 2) Bleeding disorders, 3) Patients who had known allergy to parenteral iron. METHOD: Iron sucrose was given as an intravenous infusion. No test dose required. 200mg iron sucrose was diluted with 100 ml of normal saline immediately prior to infusion and is to be infused over a period of atleast 30 minutes to 1 hour. The same dose repeated after 2 days. We did not calculate the optimal dose of iron sucrose required by each women based on her pre – treatment hemoglobin; we studied the response to a uniform dose over a range of pre – treatment hemoglobin values. Hemoglobin, packed cell volume were analysed by automatic cell counter. Serum iron, total iron binding capacity was calculated using semi auto analyser. An informed consent obtained from patient and a detailed history taken. SUMMARY: In our study of 50 antenatal patients with iron deficiency anemia, were selected according to inclusion & exclusion criteria mentioned. METHOD: 200 mg of iron sucrose was given intravenously 2 doses 2 days apart, & followed up 1 month after administration of iron sucrose and at delivery. The following parameters were assessed; 1. Hb in g/dl. 2. PCV. 3. Serum ferritin in μg/l. 4. Serum iron in μg/dl. 5. Total iron binding capacity. 6. Percentage saturation of iron. THE RESULTS OF THE STUDY ARE AS FOLLOWS; 1. Majority of patients around 36%, were in age group 21 – 25 yrs. 2. 80% of patients were in class V socio economic status. 3. 76% patients were booked. 4. Majority of patients were multiparous. 5. Average rise in hemoglobin after treatment was 3.73 g/dl with p value < 0.05, statistically significant. 6. Average rise in serum ferritin after treatment was 155.89 μg/l with p value < 0.05, statistically significant. 7. Average rise in packed cell volume after treatment was 7.83 with p value < 0.05, statistically significant. 8. Average rise in serum iron after treatment was 33.82 μg/ l with p value < 0.05, statistically significant. 9. Average rise in total iron binding capacity after treatment was 119.5 with p value < 0.05, statistically significant. 10. Average rise in percentage saturation of iron after treatment was 21.686% with p value < 0.05, statistically significant. 11. Side effect profile were very minimal with 90% patients (45/50) had no side effects. 2 patients had chills & rigors, 1 patients had headache, 1 patients had nausea, 1 patients had thrombophlebitis. No anaphylactic reactions occurred. CONCLUSION: 1. Intravenous iron sucrose has become a major interest to prevent functional iron deficiency. 2. Iron sucrose has been found to be effective in improving hemoglobin, hematocrit, serum iron & ferritin values significantly in antenatal women with iron deficiency anemia. 3. There is good tolerance to this formulation partly due to low allergenic effect and partly due to slow release of elementary iron from the complex. 4. By using intravenous iron sucrose to treat iron deficiency anemia in antenatal patients, the rate of blood transfusions could be reduced. To conclude intravenous iron sucrose is safe, convenient and more effective therapy for treatment of iron deficiency anemia in antenatal patients requiring shorter period to achieve maximum hemoglobin concentration. It has convenient dosage and administration. It can be used to replace blood transfusion in antenatal period.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Efficacy ; Intravenous Iron Sucrose ; treating Iron Deficiency Anaemia ; Antenatal Patients. |
| Subjects: | MEDICAL > Obstetrics and Gynaecology |
| Depositing User: | Subramani R |
| Date Deposited: | 25 Nov 2017 11:03 |
| Last Modified: | 10 Dec 2017 02:16 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/4086 |
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