Intravenous iron therapy for menorrhagic patients with severe iron-deficiency anaemia: a retrospective cohort study

Abstract

Background: Patient blood management plays an increasingly important role in the management of menorrhagia. We have used a dose-standardised protocol for intravenous (IV) iron therapy for menorrhagic patients, without complicated dose calculation or prolonged hospitalisation. This study aims to evaluate the efficacy, safety, and patient acceptability of IV iron therapy followed by oral iron supplement based on a dose-standardised protocol for menorrhagic patients with severe iron-deficiency anaemia.
Methods: We retrospectively reviewed records of haemodynamically stable menorrhagic patients with severe irondeficiency anaemia (haemoglobin level, 6-8 g/dL) who were admitted to Kwong Wah Hospital between October 2017 and October 2018. The IV iron therapy involved two doses of 200 mg iron (ferric hydroxide sucrose complex, Venofer) followed by oral iron supplement for at least 4 weeks. Outcome measures included haemoglobin (Hb) and ferritin levels and total iron binding capacity before treatment and 4 weeks after the first dose, and resolution of anaemic symptoms.
Results: Of 182 patients counselled with the option of IV iron therapy or blood transfusion, 138 (75.8%) opted for IV iron therapy. 24 of them were excluded. Of the 114 patients included, 52 (45.6%) had uterine fibroids, 23 (20.2%) had adenomyosis, and 39 (34.2%) had dysfunctional uterine bleeding. At 4 weeks after starting treatment, the mean Hb level increased significantly by 3.4 g/dL, the mean ferritin level increased significantly by 34.4 ng/mL, and the total iron binding capacity reduced significantly by 12.7 μmol/L. Before treatment, 103 (90.4%) patients reported anaemic symptoms. At 4 weeks after treatment started, anaemic symptoms had resolved in 102 (99.0%) patients. The increase in Hb level was not correlated with age, body weight, pre-treatment Hb level, or the interval between the two iron doses. One patient reported an adverse reaction with skin rash, which was treated with antihistamine. She had no anaphylaxis and her second dose was withheld.
Conclusion: IV iron therapy based on a dose-standardised protocol followed by oral iron supplement is a cost-effective, safe, well-accepted, and well-tolerated treatment for menorrhagic patients with severe iron-deficiency anaemia.