Single‐dose intravenous iron infusion versus red blood cell transfusion for the treatment of severe postpartum anaemia: a randomized controlled pilot study

Abstract

Background and Objectives There are no randomized trials comparing intravenous iron to RBC transfusion for the treatment of severe postpartum anaemia. The objectives of this study were to evaluate the feasibility of randomizing women with severe postpartum anaemia secondary to postpartum haemorrhage to RBC transfusion or intravenous iron, and to describe patient-reported outcomes, and haematological and iron parameters. Materials and MethodsWomen with a postpartum haemorrhage exceeding 1000 ml and an Hb between 5Á6 and 8Á1 g/dl were randomized to 1500 mg of intravenous iron (n = 7) isomaltoside or RBC transfusion (n = 6). Participants completed the Multidimensional Fatigue Inventory and Edinburgh Postnatal Depression Scale, and blood samples were drawn at inclusion, daily during the first week and at weeks 3, 8 and 12.Results We screened 162 women and included 13 (8%). There was no significant difference between groups in fatigue or depression scores. RBC transfusion was associated with a higher Hb on day 1, inhibition of reticulocytosis during the first week and low iron levels. Intravenous iron was associated with increased reticulocytosis during the first week, repleted iron stores and a higher Hb in weeks 3-12.Conclusion This pilot study shows that intravenous iron could be an attractive alternative to RBC transfusion in severe postpartum anaemia, and that a larger trial is needed and feasible.

Development of an assessment and intervention protocol for postpartum hemorrhage in the mainland of China: an evidence-based method and Delphi consult

“…Continuous care for anemia and potential postpartum depression was barely acceded in the part of health education. This goes consistent with the opinion of Holm et al 24 that clinical outcomes are constantly ignored by researchers who paid more attention to superior parameters of Hb and iron in those manifested with fatigue and deficient cognitive functions and mood disturbances. The qualified levels of agreement might be ascribed to limited abilities of domestic healthcare providers (HCP) to recognize postpartum depression 25 and other psychological disorders.…”

UK guidelines on the management of iron deficiency in pregnancy

“…A large retrospective study of women with a postpartum Hb <80 g/l, confirmed the efficacy of IV iron, with a mean increase in Hb of 19 g/l in 7 days and 31 g/l in 14 days (Broche et al , ). This is supported by a small randomized controlled trial of IV iron versus blood transfusion for postpartum Hb between 56 and 81 g/l (Holm et al , ).…”

A randomised trial evaluating the effect of intraoperative iron administration

“…These findings were evident in the control group at 2 weeks postoperatively, as expected, but not in the iron group. IV iron has been previously shown to improve iron biochemical outcomes and haematopoietic response to severe anaemia and provide long-term normalisation of Hb levels 32 . Prior studies reported that IV iron administered 2 to 4 weeks before surgery decreased perioperative red blood cell transfusion rates and hospital length of stay 14 .…”