Safety and efficacy of intravenous iron administration for uterine bleeding or postpartum anaemia: a narrative review

Abstract

The management of iron deficiency anaemia (IDA) consists of oral or intravenous administration of iron supplements. The aim of this narrative review is to summarise information regarding the treatment of IDA in women who have postpartum anaemia or uterine bleeding with intravenous (IV) or oral iron supplements. Fourteen randomised control studies comparing IV to oral iron treatment for IDA in 2913 women with uterine bleeding or postpartum haemorrhage are included. All reviewed studies suggest that IV iron administration is important in treating the IDA in such women and in improving their physical performance and quality of life. Comparisons among intravenous iron supplements show advantages of ferric carboxymaltose over others in time of reaching desired haemoglobin and ferritin values and in adverse reactions. Despite the limitation that the above evidence emerges from not systematically collected data, our review highlights that new forms of IV iron supplements seem safe and efficient in treating IDA.

Skin staining following intravenous iron infusion

“…Since existing evidence indicates that intravenous iron is effective and safe to treat IDA in pregnancy,5–7 it is likely that it will be prescribed increasingly for obstetric patients. Given the negative effects of IDA for both mother and infant, as well as the risk of potentially permanent skin staining, intravenous iron infusions should be commenced where clinical benefit outweighs risk of adverse events.…”

“…Ferric carboxymaltose is an intravenous iron supplement useful for rapid correction of IDA or to relieve symptoms associated with this condition. Systematic and narrative reviews indicate intravenous iron not only is safe for pregnant women in the second and third trimesters but also replenishes iron stores at a quicker rate, with fewer adverse effects, in comparison with oral iron 5–7…”

Principles of the diagnosis and treatment of iron deficiency anemia during pregnancy and the postnatal period

“…Во всех описанных исследова-ниях карбоксимальтозат железа превосходил сравнивае-мые препараты (пероральное железо, сахаратный ком-плекс железа и декстран железа) с точки зрения эффек-тивности и обладал очень низким уровнем нежелатель-ных побочных эффектов [27]. В недавно опубликованном крупном рандомизированном контролируемом много-центровом исследовании с карбоксимальтозатом железа во время беременности не выявлено никаких нежела-тельных эффектов у новорожденных, матери которых получали данный препарат [26].…”

“…Исследователи делают выводы о том, что для предотвра-щения блока всасывания, вызванного гепсидином, необ-ходимо либо уменьшать ежедневную дозу железа до 40-60 мг, либо рекомендовать прием препарата в дозе 100 мг через день. Это, по мнению авторов, может улуч-шить усвоение железа и снизить количество нежелатель-ных реакций [2,27].…”

Preventing skin staining: an effective iron infusion protocol

“…Oral iron is considered the first supplement of choice. However, a long course is required to replace iron stores, and this is not recommended for pregnant patients with severe anaemia (Daniilidis et al, 2018).…”