Oral and parenteral iron preparations in pregnancy free download as powerpoint presentation. Oral iron is the standard therapy, but there is a problem of adherence due the gastrointestinal side effects. Pdf parenteral iron therapy in the treatment of iron. When the body does not get enough iron, it cannot produce the number of normal red blood cells needed to keep you in good health. The burden of iron deficiency anaemia during pregnancy and postpartum continues to remain high especially in india. Toxicity of parenteral iron dextran therapy sciencedirect. Intravenous iron therapy venofer or feraheme or iron. Oral and parenteral iron preparations in pregnancy obstetrics. Evidence that stainable bone marrow iron following. The median interval to parenteral iron therapy after bariatric surgery was 42.
The established indications for intravenous iron therapy were adapted from wintrobes clinical hematology 1999. Intravenous iron therapy venofer or feraheme or iron dextran. Comparative studies of oral versus parenteral iron therapy have concluded that the parenteral route is superior in dialysis patients. Iron deficiency can make anaemia worse, and reduce response to drugs that stimulate erythropoietin production. Parenteral iron administration coverage in nondialysis usage. For more than 50 years, iron dextran has been the mainstay of parenteral iron therapy in the united states. Oral iron replacement therapy is a simple, inexpensive treatment, but is. Treatment of iron deficiency anemia associated with. Available parenteral iron therapy options include iron dextran, iron gluconate, and iron sucrose. A high intake of antacids or other substances that bind. Labs should be drawn using microsampling for cbc, reticulocyte, and iron studies with serum ferritin. Parenteral iron therapy is as effective but somewhat more dangerous and considerably more expensive than oral therapy. Guidelines for the management of iron deficiency anaemia.
Hemodialysis, which chronically results in significant blood loss, may necessitate the use of parenteral iron therapy to restore the hemoglobin level. Dexferrum iron dextran injectafer ferric carboxymaltose feraheme ferumoxytol. An area of increasing interest for parenteral iron therapy is in the perioperative sphere. Parenteral iron therapy replenishes iron stores quicker and is better tolerated than oral therapy. Iron dextran is the only parenteral iron product that can also be administered by the intramuscular route. Iron supplements are necessary when the following lab values are abnormal. Medicare also covers iron sucrose injection as a first line treatment of iron deficiency anemia when furnished intravenously to patients undergoing chronic hemodialysis who are receiving supplemental erythropoietin therapy. Hb levels are extracted from the complete blood count test. The possible occurrence of severe adverse reactions emphasizes the need for close medical observation. It is preferred whenever they presented with failure to oral iron or increased demands despite oral iron therapy. However, pain on injection, staining of the skin, unpredictabledelivery,andabsorptionofironmakethe intramuscular route undesirable. While parenteral iron provides a more rapid therapeutic response than oral iron, it can cause adverse effects including allergic reactions. The main criterion is that other causes of anemia have also been investigated, such as vitamin b 12 or folate deficiency.
Parenteral iron therapy in cancerassociated anemia. This condition is called iron deficiency iron shortage or iron deficiency anemia. Parenteral iron produces therapeutic responses similar to those of oral iron. Iron supplement oral route, parenteral route description. Parenteral iron dextran is efficacious and safe for iron repletion in patients with irondeficiency anemia. Blood loss, a major cause of iron deficiency, is highly prevalent e. Iron therapy should be withheld in patients with tsat. Prior to its use as an adjunct to erythropoietin therapy in dialysis patients, however, it was considered dangerous therapy. In october 2009, the food and drug administration expanded its existing black box warning that cautioned practitioners to administer a test dose first because of the risk of anaphylactic, often fatal adverse reactions. Ferritin and other hematological parameters in pregnant women. Parenteral iron therapy for treatment of moderate to severe anemia in pregnancy.
Dec 04, 2010 in 1947, nissim 7 introduced iron saccharide for iv injection and concluded that this form of iron was safer and more suitable for parenteral administration. Oral iron is the preferred, and safest, firstline therapy for most patients with iron deficiency anaemia but many users experience gastrointestinal side effects and compliance with treatment is poor. Parenteral iron therapy in the treatment of iron deficiency anemia during pregnancy journal of the college of physicians and surgeons pakistan 2015, vol. Parenteral iron dextran is efficacious and safe for iron repletion in patients with iron deficiency anemia. Feraheme, injectafer, and monoferric are medically necessary when the. Coverage for parenteral iron in iron deficiency anemia ida. Iron supplements are used to treat iron deficiency and irondeficiency anemia. The interval to parenteral iron therapy was calculated from the date of bariatric surgery to the date of the first parenteral iron replacement therapy table 2 and fig. The preexisting iron levels may be reduced by 50% within one week of erythropoietin therapy. The purpose of this study is to summarize our institutions experience with parenteral iron therapy over a 5year period, with a focus on comparative safety profiles.
The use of parenteral iron therapy for the treatment of. Some 30% of preoperative patients have been observed to be anemic, and this anemia is associated with increased perioperative complication rates, including that of blood transfusion which has itself serious risks associated. Hb parenteral therapy of iron deficiency are intolerance of the orally administered salts, gastrointestinal disease, need to create iron stores to protect against future bleeding, and poor absorption of oral iron. Compared with oral iron supplements, parenteral iron is associated with a more rapid rise in serum ferritin and hemoglobin and improved maternal fatigue scores in the postpartum period. Indications for iv iron therapy in iron deficiency anaemia ida where oral iron therapy may be impractical or insufficient due to gi intolerance, noncompliance, malabsorption or gastric surgery. However, recent information related to the role of oxidants and iron in the pathophysiology of disease has raised new concerns about parenteral iron beyond the risk of anaphylaxis 2. Parenteral iron therapy for treatment of moderate to. Parenteral iron therapy in children with iron deficiency. Iron isomaltoside trade name monofer is a newer formulation of parenteral iron that has a matrix structure that results in very low levels of free iron and labile iron. The use of parenteral iron in the treatment of anemia in patients with chronic kidney disease has become routine.
This parenteral iron calculator uses the patient weight and haemoglobin level to compute the iron deficit. Therapeutic management of ida is focused primarily on repletion of. Intravenous iron is indicated as a source of iron replacement in iron deficiency anemia if the patient. Pdf update on parenteral iron therapy researchgate. Update on parenteral iron therapy article pdf available in nutrition in clinical practice 184. There is flexibility in terms of the measurement unit for the variables used. Parenteral iron therapy options wiley online library. In order to determine iron deficiency, it is recommended to obtain baseline labs before beginning iron therapy.
The risk for developing reactions to parenteral iron infusion can be attenuated if patients are carefully selected. Iron dextran was approved by the fda prior to 1982. In 1947, nissim 7 introduced iron saccharide for iv injection and concluded that this form of iron was safer and more suitable for parenteral administration. Comparing the sfgc group to the historic iron dextran group, there was a significantly higher incidence of drug intolerance events 0.
Original article from the new england journal of medicine parenteral iron therapy with special reference to a new preparation for intramuscular injection. Intravenous administration purpose to assure the safe. Intravenous iv iron is given under supervision in hospitals. Parenteral iron therapy is occasionally necessary for patients intolerant or unresponsive to oral iron therapy, for receiving recombinant erythropoietin therapy, or for use in treating functional iron deficiency. Parenteral iron may be considered in select clinical situations for the treatment of postpartum anemia. Iron is an essential element and its balance must be maintained for proper physiologic functioning. Iron can be taken orally by mouth or injected intravenously via a vein. Patients receiving regular parenteral iron therapy require monitoring of hematologic parameters and iron indices hb, hct, tsat, and ferritin sufficient iv iron should be administered to maintain tsat between 20% and 50%. While iron deficient individuals without inflammation may. The dose is 125 mg elemental iron per 10 ml either by iv infusion or slow iv injection. Hb england journal of medicine parenteral iron therapy with special reference to a new preparation for intramuscular injection logo32 logo40. Therapeutic management of ida is focused primarily on repletion of iron stores 1 4. In 1954, baird and podmore 8 introduced imferon high molecular weight iron dextran hmw id, fisons plc, homes chapel england, ipswich, uk.
One advantage of parenteral iron is that iron stores are rapidly repleted, which may take months to achieve with oral iron therapy. However, oral iron dose may be reduced with no effect on its efficacy while decreasing side effects and patient discontinuation rates. Oral and parenteral iron preparations in pregnancy iron. Nevertheless, failure of oral therapy is to be expected in certain clinical situations. For assessment of storage iron, aspirate smears were stained with prussian blue. Tolerability and efficacy of parenteral iron therapy in. Parenteral iron therapy with special reference to a new. There are now three parenteral iron products available. The availability of newer, safer parenteral iron therapy choices further. Anemia is common in pregnancy and iron deficiency is the most common cause. Parenteral iron seems to be an alternative and it is well known since 1960 3. To provide clinicians with evidencebased guidance for iron therapy dosing in patients with iron deficiency anemia ida, we conducted a study examining the benefits of a higher cumulative dose of intravenous iv iron than what is typically administered.
Original article from the new england journal of medicine parenteral iron therapy with special reference to a new preparation for intramuscular injection logo32 logo40. It can be given at high doses 20 mgkg in a single visit no upper dose limit. Oral iron preparations are efficacious but poorly tolerated due to nonabsorbed iron mediated gi side effects. Iron sucrose can be administered with or without erythropoietin to raise hemoglobin levels and may be used in cases of oral iron therapy intolerance or ineffectiveness. Does chronic inflammation has impact on iron absorption and how. Coverage also includes for parenteral iron in iron deficiency anemia. Free fe is a potential toxin andor carcinogen, leading to the production of hydroxide radicals and stimulating the growth of transformed cells by inhibiting the defence system. In situations where a rapid repletion of ferritin is required i. Iron dextran was the first parenteral iron preparation available in the united states and is supported with the most clinical experience with regard to intravenous iron therapy.
Intravenous iron therapy in patients with iron deficiency. Parenteral versus oral iron for treatment of iron deficiency. Indeed, it is now the recommended mode of iron delivery in dialysis patients resulting in up to a 75% reduction in epo requirements. There are currently 3 parenteral iron preparations available, including iron dextran, sodium ferric gluconate, and iron sucrose. Conclusion parenteral iron therapy should be considered in a group of children with iron deficiency anemia who fail to respond to oral iron preparations due to malabsorption, intolerance or poor compliance. More recent parenteral iron preparations are considered to. There is uncertainty about whether iv iron should be used rather than oral iron. We first individually analyzed 5 clinical studies, averaging the total iron deficit across all patients utilizing a. The first parenteral iron preparations to be used clinically in the early. The possible occurrence of severe adverse reactions emphasizes the. Jan 17, 2019 the burden of iron deficiency anaemia during pregnancy and postpartum continues to remain high especially in india.
Thirtyeight children received iron sucrose for nonrenal indications, with iron deficiency refractory to oral iron therapy, with iron malabsorption or dependence on parenteral nutrition, 7. Hypersensitivity reactions are less common with iron sucrose compared to other parenteral iron products, such as iron dextran. Challenges to treatment include gastrointestinal side effects and non compliance to oral iron therapy. In addition, there are less obvious conditions that warrant parenteral iron therapy. Iron deficiency anemia ida without chronic kidney disease ckd. Need for parenteral iron therapy after bariatric surgery. Pdf safety, therapeutic effectiveness, and cost of. When oral supplementation has been tried and the patient has demonstrated significant gastrointestinal distress whereas compliance with an oral regimen is no longer feasible. Iron is a mineral that the body needs to produce red blood cells. Parenteral versus oral iron therapy for adults and. Intravenous iron therapy has more advantages, therefore, intravenous iron therapy is the best treatment for pregnant women during the third trimester.