Author(s): Rama Sarala Devi1, T. Nirmala Kumari2, K. Soujanya3, V. Usharani4
AIM This case study focuses on the efficacy of iron sucrose in moderate-to-severe anaemia in pregnancy and to compare the efficacy of iron sucrose with packed cell transfusion and based on the study to establish whether iron sucrose could be an alternative to packed cells transfusion for the management of moderate-to-severe anaemia complicating pregnancy remote from the term gestation.
MATERIALS AND METHODS It is a case control study for a period of 2 years. Women were randomly selected where for the study group 50 patients intravenous iron sucrose was given and for control group 50 patients packed cells transfusion was given.
RESULTS The study group and the control group had 50 subjects each. On an average 80% were in the age group of 15-24 yrs. in both groups. In both groups, on an average 85% were with moderate anaemia (6-8 g/dL) and 15% were with severe anaemia (<6 g/dL). Mean requirement of iron sucrose for moderate anaemia was 1100 mg and for severe anaemia it was 1300 mg. Mean requirement of packed cells for moderate anaemia was 3 units and for severe anaemia 4-5 units. In iron sucrose group, mean haemoglobin% at baseline 7.1±0.8 g/dL, after 1 week 7.9±0.6, after 4 weeks 11±0.5 g/dL and at delivery 11.7±0.6 g/dL. In packed cells group, mean haemoglobin% at baseline 7.0±0.7 g/dL, after 1 week 10.2±0.5 g/dL, after 4 weeks 10.3±0.5 g/dL and at delivery 10.4±0.4 g/dL. The mean haematocrit values in iron sucrose group at baseline 20.9±2.5%, after 1 week 25.3±2.2% and after 4 weeks 33.6±2.0%. The mean haematocrit values in packed cells group at baseline 20.8±2.3%, after 1 week 30.0±1.9% and after 4 weeks 30.2±2.0%. Mean rise of haematocrit from baseline to 1 week in iron sucrose and packed cells group were 4.4±1.3% and 9.1±2.0% respectively. Mean rise of haematocrit from baseline to 4 weeks in iron sucrose and packed cell group were 12.7±2.1% and 9.3±2.3 respectively. The mean ferritin values in iron sucrose group at baseline and after 4 weeks are 8.9±1.7 ng/L and 89.8±6.7 ng/L respectively whereas in packed cells group, at baseline 8.7±1.8 ng/L and at 4 weeks 40.1±5.4 ng/L. The mean rise in ferritin values from baseline to 4 weeks in both groups is 80.9±6.7 ng/L and 31.4±4.9 ng/L respectively in iron and packed cells group.
CONCLUSION There is a need for an alternate line of management for moderate-to-severe anaemia complicating pregnancy other than routine packed cells transfusion. The risks associated with packed cell transfusion like hypersensitivity reactions, risk of transmitting viral diseases like HIV, hepatitis B, febrile reactions preclude the use of transfusion of packed cells. Parenteral iron sucrose is a safe, nontoxic alternative to packed cell transfusion in the management of moderate-to-severe anaemia complicating pregnancy.