Intravenous Iron Sucrose versus Packed Cell Volume for Treatment of Severe Iron Deficiency Anaemia in Pregnancy: A Randomization Clinical Trial QC05-QC08
Dr. Girija Wagh,
B-402, Ziggurat, Near Navale Bridge, Ambegaon-BK, Pune-411046, Maharashtra, India.
Introduction: Severe Iron Deficiency Anaemia (IDA) in pregnancy is usually treated with whole blood or Packed Cell Volume (PCV) transfusion to maintain feto-placental perfusion and replete the haemodynamic mechanisms before delivery. Administration of whole blood or PCV may not always be feasible and therefore Intravenous Iron Sucrose (IVIS) is proposed to be therapeutically better approach to treat severe IDA during pregnancy.
Aim: To compare the efficacy and safety of IVIS to PCV for the treatment of severe IDA in pregnancy.
Materials and Methods: This was prospective, randomised, open label study which included 30 pregnant women with severe IDA. Patients were randomised to receive either PCV or IVIS calculated as per the haemoglobin deficit. The deficit was divided as per the iron sucrose dose of 100/200 mg in 100 mL Normal Saline (NS) infused over a period of 20 minutes per day. The number of PCVs was decided based on the fact that 1 PCV raises the haemoglobin level by 1 g/dL. Adverse drug reactions were noted in both the groups. Haemoglobin level, MCV, reticulocyte count was done on day 8, 15, 30 and at delivery in both the groups while serum ferritin levels were done on day 30 and at delivery.
Results: Both modalities were efficacious in producing significant rise in haemoglobin. Immediate 8th day follow-up showed significant rise of haemoglobin in both the groups. Comparison of successive follow-up values with baseline showed that the group receiving PCV showed significant rise in haemoglobin on day 8 and day 15 (p<0.05). The subjects which were administered IVIS showed progressive rise in haemoglobin which was significant on the day of delivery as compared to the ones receiving PCV (p<0.05). Adverse reactions for both the groups were documented.
Conclusion: IVIS showed sustained haemoglobin rise and better restoration of iron stores as compared to PCV for treatment of severe IDA in pregnancy. A larger study group would help in establishing this fact better.