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

Authors

  • Samson Chin Ho LAU
  • Catherine Man Wai HUNG
  • Wing Cheong LEUNG
  • Tsin Wah LEUNG

DOI:

https://doi.org/10.12809/hkjgom.19.2.04

Keywords:

Anemia, iron-deficiency, Iron, Menorrhagia

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.

References

Côté I, Jacobs P, Cumming DC. Use of health services associated with increased menstrual loss in the United States. Am J Obstet Gynecol 2003;188:343-8.

Santer M, Warner P, Wyke S. A Scottish postal survey suggested that the prevailing clinical preoccupation with heavy periods does not reflect the epidemiology of reported symptoms and problems. J Clin Epidemiol 2005;58:1206-10.

Shapley M, Jordan K, Croft PR. An epidemiological survey of symptoms of menstrual loss in the community. Br J Gen Pract 2004;54:359-63.

Auerbach M, Adamson JW. How we diagnose and treat iron deficiency anemia. Am J Hematol 2016;91:31-8.

Tolkien Z, Stecher L, Mander AP, Pereira DI, Powell JJ. Ferrous sulfate supplementation causes significant gastrointestinal side-effects in adults: a systematic review and meta-analysis. PLoS One 2015;10:e0117383.

Litton E, Xiao J, Ho KM. Safety and efficacy of intravenous iron therapy in reducing requirement for allogeneic blood transfusion: systematic review and meta-analysis of randomised clinical trials. BMJ 2013;347:f4822.

Kim YH, Chung HH, Kang SB, Kim SC, Kim YT. Safety and usefulness of intravenous iron sucrose in the management of preoperative anemia in patients with menorrhagia: a phase IV, open-label, prospective, randomized study. Acta Haematol 2009;121:37-41.

Dewan B, Philipose N, Balasubramanian A. Assessment of intravenous iron sucrose in the management of anemia in gynecological and obstetrical practice. J Obstet Gynaecol India 2012;62:281-5.

Herfs R, Fleitmann L, Kocsis I. Treatment of iron deficiency with or without anaemia with intravenous ferric carboxymaltose in gynaecological practices: a non-interventional study. Geburtshilfe Frauenheilkd 2014;74:81-8.

Lau CW. Iron therapy in obstetrics and gynaecology: a review. Hong Kong J Gynaecol Obstet Midwifery 2019;19:49-55.

Adkinson NF, Strauss WE, Macdougall IC, et al. Comparative safety of intravenous ferumoxytol versus ferric carboxymaltose in iron deficiency anemia: a randomized trial. Am J Hematol 2018;93:683-90.

Muckenthaler MU, Rivella S, Hentze MW, Galy B. A red carpet for iron metabolism. Cell 2017;168:344-61.

Bhandari S, Pereira DIA, Chappell HF, Drakesmith H. Intravenous irons: from basic science to clinical practice. Pharmaceuticals (Basel) 2018;11.pii:E82.

Kim YW, Bae JM, Park YK, et al. Effect of intravenous ferric carboxymaltose on hemoglobin response among patients with acute isovolemic anemia following gastrectomy: the FAIRY randomized clinical trial. JAMA 2017;317:2097-104.

Auerbach M, Deloughery T. Single-dose intravenous iron for iron deficiency: a new paradigm. Hematology Am Soc Hematol Educ Program 2016;2016:57-66.

Downloads

Published

2023-04-06

How to Cite

1.
LAU SCH, HUNG CMW, LEUNG WC, LEUNG TW. Intravenous iron therapy for menorrhagic patients with severe iron-deficiency anaemia: a retrospective cohort study. Hong Kong J Gynaecol Obstet Midwifery [Internet]. 2023 Apr. 6 [cited 2024 Jun. 17];19(2). Available from: https://hkjgom.org/home/article/view/266

Issue

Section

Original Article