Treatment of Anemia of Chronic Disease with True Iron Deficiency in Pregnancy

Abstract

Objective We assess and compare the efficacy of anemia treatment in pregnant women with anemia of chronic disease with true iron deficiency and in women with iron deficiency anemia. Study Design Fifty patients with moderate anemia (hemoglobin 8.0–9.9 g/dl) and iron deficiency (ferritin < 15 μg/l) were treated in the Anemia Clinic at the Department of Obstetrics. Results All patients showed stimulation of erythropoiesis as evidenced by an increase in reticulocyte count at day eight of therapy and showed an increase in hemoglobin and hematocrit at the end of therapy (p < 0.001). The target hemoglobin (≥10.5 g/dl) was achieved in 45/50 women (90%). 12 patients showed anemia of chronic disease with true iron deficiency (12/50; 24%). Seven women (7/12; 59%) with anemia of chronic disease and iron deficiency responded well to anemia treatment. 50% of women with anemia of chronic disease and iron deficiency (3/6) responded well to intravenous iron, and 67% (4/6) responded well to the combination of intravenous iron and recombinant human erythropoietin. Conclusion Because of frequent true iron deficiency in pregnant women with anemia of chronic disease, anemia of chronic disease in pregnancy is often falsely diagnosed as iron deficiency anemia.

Erythropoietin Response in Patients with Anaemia of Chronic Disorders

“…ACD usually presents as a mild to moderate anemia with an underlying co-morbidity like infectious diseases in sub saharan Africa, where appropriate and timely intervention would reduce the deletarious sequealae of anemia on the cardiovascular system through adequate tissue perfussion, improving the prognosis of the chronic disease and ultimately increase and improve the quality of life of these patients. [9,18,19,24,25,26,27] The result of our study confirms the prevalence of anemia in the 125 participants with chronic disease as 72%, the prevalence of ACD at 65.5%, based on the criteria serum iron (<13mmol/L), ferritin (>20µg/L) and erythropoietin(>4.2U/L), and establishing a 33.3% prevalence of inappropriate EPO response to anaemia in these individuals. When compared to the different studies on the prevalence of ACD, ours' was closeset to figures quoted by Opasich et al 57%73 and 52.32% by Cazzola.…”

“…This observations is of clinical importance, as a combination of intravenous iron and subcutaneous administration of recombinant human EPO, in selected cases has been proven to be of benefit as a rational theraputic approach to managing the anaemia in these patients. [9,22,23,24,25,26,27] The predominant red blood cell morphological type observed was normocytic normochronic. 60% of our cases exhibited the expected normocytic normochronic picture, while the remaining 40% represented a spectrum of the other morphological subtypes.…”

“…The morphological picture of patients with ACD is also dependent on the length of the illness, severity and the presence of other co-morbid states. [3,4,7,11,13,18,20,21,22,24,25,27] Figure 2 shows the Red cell morphology distribution of study group. Based on rbc morphology from blood films made, normocytic normochronic anemia was the commonest morphologic type while macrocytic anaemia was the least common in both controls and study group.…”

Influence of Iron Deficiency on HbA1c Levels in Pregnant Women: Comparison with Non-Pregnant Women

“…Third, serum ferritin levels in pregnant women are decreased due to hemodilution. However, diagnosis of IDA in pregnant women is usually performed using the serum ferritin [ 26 ]. Fourth, the cases used for the pregnant and non-pregnant women were from different institutions.…”

High fever after sublingual administration of misoprostol for treatment of post‐partum haemorrhage: a hospital‐based, prospective observational study in Argentina

“…Pre‐delivery anaemia was also identified as a significant predictor of misoprostol‐induced fever. For various known reasons, anaemia can result in higher levels of pro‐inflammatory cytokine production [37‐39] that, in turn, activates elevated prostaglandin expression [36,40]. Applying insights from research on genetic susceptibility to misoprostol‐induced fever [23], it is plausible that genetic variants are responsible for some women having more expeditious prostaglandin transporters that resulted in heightened side effects.…”