Intravenous iron sucrose for treatment of anemia in gynecology patients awaiting surgery

Background: Anemia refers to reduction in the total circulatory erythrocyte mass which results in decrease in the oxygen carrying capacity of the blood. Patients who require a surgical intervention as regards their complaints are many a times denied fitness because of anemia. Current anesthetic and surgical practice ideally recommend a hemoglobin level of > 10 g/dl or a hematocrit of >30 % for any surgical intervention. Surgery is postponed until cause of anemia is identified and the anemia corrected without resorting to blood transfusions. The current study evaluates other alternatives to increase the hemoglobin as early as possible without resorting to blood transfusion. The efficacy and safety of intravenous iron sucrose along with the achievement of the desired hemoglobin values for patients posted for elective gynecological surgeries within the next menstrual cycle was evaluated. Methods: This study was an open label, single arm, and prospective study of women with iron deficiency anemia in gynecological disorders. 100 patients attending Gynecology OPD of Seth G. S. Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India requiring surgical intervention but not given fitness due to anaemia were the subjects of this study. All patients with surgically treatable conditions with hemoglobin level >7g/dL but < 10 g/dl were the inclusion criteria Selected subjects received intravenous iron sucrose. Maximum dose 200mg/weekX3 weeks initially. At the end of three weeks of starting therapy Hb estimation was done and compared with the baseline levels as regarding the hemoglobin rise. The results were statistically analyzed using the “paired t” test. Results: The requirement of iron-sucrose for the individual patient was calculated based on the weight of the patient. The analysis of iron requirement-sucrose combination showed a mean of 481.7 mg with standard deviation (SD) of 62.72 mg and a range of 378.85 mg. The minimum iron-sucrose requirement was 361.55 mg and the maximum was 740.40 mg The mean Hb (gm%) value before intervention was 8.43 with a standard deviation of 0.56, whereas, the mean Hb (gm %) value after intervention was higher, 10.41 with standard deviation (SD) of .56 the mean Hb (gm %) Increase in 2 weeks was 1.60 with standard deviation (SD) of 0.31, whereas, in 3 weeks was 2.03 with standard deviation (SD) of 0.51. The mean Hb (gm %) increase was higher in participants with 3 weeks, which was statistically significant (p<0.05). Conclusions: Parenteral iron therapy was not safe in the past but iron sucrose has made it the safest and effective therapy. Parenteral iron therapy can be used for patients with Hb level between 6-8mg/dl It is highly efficacious and reliable way to achieve the desired Hb level patient compliance is assured with intravenous iron sucrose patient can be satisfactorily posted for surgery within a period of 3 weeks i.e. within her next menstrual period by reliably and effectively correcting her anemia with intravenous iron sucrose.