Intravenous Iron Sucrose vs. Blood Transfusion in the Management of Symptomatic Post Partum Iron Deficiency Anaemia

Objective: To compare the efficacy and safety of intravenous iron with blood transfusion in post partum women with symptomatic iron deficiency anaemia. Methods: Ninety women were included in the study. The inclusion criteria were: hemoglobin <9g/dl and/or haematocrit <28%, mean corpuscular volume <80fl, ferritin level <15ng/ml, and symptoms of anaemia within 48 hours of delivery. Women with postpartum haemorrhage and haemodynamic instability were excluded. Women were divided into two groups, group B received blood transfusion and group I received intravenous iron sucrose (400mg infusion in 250ml Normal Saline over half an hour) (Venofer, Vifor St Gallen's, Switzerland). The outcome measures were relief of symptoms of anaemia. Hemoglobin, haematocrit, mean corpuscular volume and ferritin levels were measured before and one week after the treatment. Results: The two groups were comparable in terms of age, mode of delivery and symptoms. Group B had a mean age of 31.1 years (22-39) vs. 32.3 years (20-43). Twenty four women from group B had C/S vs. 23 women in group I. However, women in group B had a lower baseline mean hemoglobin (6.8 g/dl (4-8) vs. 7.7g/dl (6.1-9 g/dl) and lower haematocrit (23.2 %( 18-26) vs. 25.3 %( 18-28). At one week post treatment the mean rise in hemoglobin was 2.35 g/dl (34%) in group B vs. 2.15g/dl (27%) in group I. The mean rise in haematocrit was 7.0 % and 6.3% respectively. The mean rise in ferritin level was higher in group I (220%) vs. 150% in group B. Symptoms relief occurred in 29 cases in group B and in 28 cases in group I. No serious side effects occurred in either group. Conclusion: Intravenous iron sucrose is an effective and safe treatment for postpartum iron deficiency anaemia. It is hoped that this treatment will reduce the need for blood transfusion.