Safety and efficacy of rapid (1,000 mg in 1 hr) intravenous iron dextran for treatment of maternal iron deficient anemia of pregnancy

Abstract

Maternal iron deficiency anemia (IDA) is associated with risk of adverse perinatal outcomes. Oral iron is recommended to reverse anemia, but has gastrointestinal toxicity and frequent non-adherence. Intravenous (IV) iron is reserved for intolerance of, or unresponsiveness to, oral therapy, malabsorption, and severe anemia (1% with hemoglobin [Hgb] levels <7 g/dL). With rare (<100 per one million) adverse events (AEs) ability to infuse a sufficient dose of low molecular weight iron dextran (LMWID) over 60 min, LMWID is an attractive option. This study demonstrated safety and efficacy of rapid IV infusion of 1,000 mg LMWID to gravidas with moderate to severe IDA. An observational treatment study of 1,000 mg LMWID administered over 1 hr for IDA in 189 consecutive, unselected second and third trimester gravidas after oral iron failure was conducted. All received a test dose of 25 mg LMWID and were monitored for AEs during the 60-min infusion. No premedication was administered unless more than one drug allergy or asthma was present in which case IV methylprednisolone was administered. All were followed through pregnancy and delivery. Monitored parameters included Hgb, mean corpuscular volume, serum ferritin, and percent transferrin saturation. About 189 subjects received 1,000 mg LMWID. No serious AEs occurred. About 2% experienced transient infusion reactions. Hgb improved by 1-1.9 g/dL in 82% and 2 g/dL in 24%. Second trimester treatment was not associated with greater Hgb improvement than third trimester treatment. Anemia resolved in 95%. Administration of a single large dose of IV LMWID was effective, safe, and convenient.

How I treat anemia in pregnancy: iron, cobalamin, and folate

“…65 An observational study of 189 women treated with LMW iron dextran in second and third trimester reported no severe adverse events and only 2% transient infusion reactions. 66 These results corroborated outcomes in other studies showing safety of LMW iron dextran, 67,68 which allows complete replacement of IV iron in a single infusion over 15 to 60 minutes. Despite well-established safety, LMW iron dextran still requires a test dose.…”

Perinatal Iron Deficiency: Implications for Mothers and Infants

“…Anemia resolved in 95% of subjects, and no SAEs occurred. The authors concluded a large, single, rapidly administered dose of intravenous iron was effective, safe, and convenient [36]. …”

FIGO consensus guidelines on placenta accreta spectrum disorders: Nonconservative surgical management,

“…Intravenous iron therapy is safe in pregnancy and has been demonstrated to correct anemia in more women than oral iron . In addition, efficacy with a single dose intravenous therapy is possible . There are some centers where, resources permitting, erythropoietin therapy is combined with concomitant intravenous iron treatment.…”