INTRAVENOUS SUCROSE IN

IRON DEFICIENCY ANEMIA

IN PREGNANCY.
DR. ABHA SINGH
HEAD OF DEPARTMENT
(OBS & GYNAE)
LHMC& SSKH , DELHI

Iron deficiency anaemia (IDA)
Most common nutritional deficiency in
pregnant women in India.
Prevalence of IDA is 35-75 % in developing
countries &18 % in developed countries.
(WHO)
Prevalence of anaemia is highest among
pregnant women in INDIA-50-90%.
(Planning Commission. Government of India.
Tenth Five-5. Year Plan 2002-2007.)
IRON LOSSES
Men Women
Obligatory losses 1.0 mg/d 1.0 mg/d
Menstruation - 0.5 mg/d
Total losses 1.0 mg/d 1.5 mg/d

Iron absorbed 1.0 mg/d 1.5 mg/d
Iron Transport
into Plasma
Ferroportin 1
Macrophages
Fe
+2
Ferro-
portin 1
Macrophage
Fe
+2
Senescent
RBC
Hb
Fe
Fe
+3
Tf
Cerulo-
plasmin
Ferroportin 1
Duodenal
cytochrome b
Ferroportin 1
Duodenal
cytochrome b
Adapted from Andrews,
NEJ M 1999;341:1986
Iron Absorption
1. Heme iron (meats) absorbed better than
non-heme iron (grains).
2. Gastric acid keeps Fe reduced to Fe
++
form
that is absorbed.
3. Occurs in proximal small bowel-duodenum
(major)
Iron Absorption
Increases with:
high erythropoiesis
low iron stores
Gastric acid
Vitamin C
Inhibited
inflammation
tea
phytates
WHO CLASSIFICATION OF
ANEMIA
classification Non
Anaemia
Mild Moderate

Severe
haemoglobin
level(g/L)


120 or
higher
110-119 80-109 lower than
80

Treatment :options
Oral iron therapy
Parenteral therapy
Packed red cell transfusion
ORAL IRON
ADVANTAGES
least invasive,
cheap and safe
Disadvantages
Increased failure of treatment :
dietary inhibitors
GI intolerance
poor compliance
Parenteral Iron Therapy
Indications
Intolerance to oral form
iron loss exceeds oral iron replacement
Inflammatory bowel disease, celiac disease
Malabsorption
Chronic, renal disease ,Dialysis patients
Anemic cancer patients

Bencaiova G, von Mandach U, Zimmermann R. Iron
prophylaxis in pregnancy: Intravenous route versus
oral route. Eur J Obstet Gynecol Reprod Biol 2009;
144 : 135-9.

Parenteral Iron Therapy
Parenteral iron bypasses the gut and
circumvents the natural regulatory
mechanism to deliver non-protein-bound
iron.
Parenteral: Intramuscular Iron
therapy
Iron dextran
Iron-Sorbitol-Citric Acid Complex
(Jectofer)
Parenteral: Intramuscular Iron
therapy : Why skepticism??
Test dose required
Systemic: Anaphylaxis Most dangerous
Local : Pain, muscle necrosis, phlebitis
Slow iron mobilization and occasionally
incomplete.

Fishbane S1, Kowalski EA.The comparative safety of intravenous iron dextran, iron
saccharate, and sodium ferric gluconate. Semin Dial. 2000 Nov-Dec;13(6):381-4.
Silverstein SB, Rodgers GM. Parenteral iron therapy options. Am J Hematol 2004; 76 :
74-8.

Intravenous Iron Sucrose
Brown, sterile, aqueous complex of
polynuclear iron hydroxide in sucrose
containing 20mg elemental iron per ml.
No preservatives.


DOSE
Required iron dose (mg) = (2.4 x (target
Hb-actual Hb) x pre-pregnancy weight
(kg)) + 1000 mg for replenishment of
stores
Adamson JW. Iron deficiency and other hypoproliferative anemias. In:
Braunwald E, Fauci AS, Kasper DL, editors. Harrisons textbook of
internal medicine, 17th ed. New York: McGraw Hill; 2008. p. 628-33.
WHY I/V SUCROSE :SAFETY
Best safety profile.
< 0.5% minor side effects.
Safer than intramuscular & iron gluconate
preparation

Sane R, Baribeault D, Rosenberg CL.Safe administration of iron sucrose in a patient with a
previous hypersensitivity reaction to ferricgluconate.Pharmacotherapy. 2007 Apr;27(4):613-
5.
Van Wyck D22. B, Cavallo G, Spinowitz BS, Adhikarla R, Gagnon S, Charytan C, et al. Safety
and efficacy of iron sucrose in patients sensitive to iron dextran: North American clinical
trial. Am J Kidney Dis 2000; 36 : 88-97.



WHY I/V SUCROSE : SAFETY
Ferric carboxy maltose ??
No randomised trials

WHY I/V SUCROSE
Higher increase in values for hemoglobin ,
hematocrit, transferrin saturation, and ferritin
at 4 weeks. (Perewusnyk G Etal)
Significant decrease in need for blood
transfusion

Breymann C. The use of iron sucrose complex for anemia in pregnancy and the
postpartum period. Semin Hematol 2006; 43 : S28-S31.
Litton etal.Safety and efficacy of intravenous iron therapy in reducing
requirement for allogeneic blood transfusion: systematic review and meta-
analysis of randomised clinical trials. BMJ. 2013 Aug 15;347:f4822. doi:
10.1136/bmj.f4822.

WHY I/V SUCROSE
Accumulation of Fesucrose in
parenchyma of organs is low compared
with Fedextrans or Fegluconate
Incorporation into the bone marrow for
erythropoiesis is considerably faster.

Perewusnyk G, Huch R, Huch A, Breymann C. Parenteral iron therapy
in obstetrics: 8 years experience with iron-sucrose complex. Br J
Nutr 2002; 88 : 3-10. (switzerland)

CONCLUSION
Intravenous iron sucrose appears to have
the potential for eradicating IDA because it
overcomes the problems of compliance
and absorption and has an excellent safety
record.