intravenous sucrose vidhi

8/11/2019 Intravenous Sucrose Vidhi

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INTRAVENOUS SUCROSE IN

IRON DEFICIENCY ANEMIAIN PREGNANCY.

DR. ABHA SINGH

HEAD OF DEPARTMENT

(OBS & GYNAE)LHMC& SSKH , DELHI


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Iron deficiency anaemia (IDA)

Most common nutritional deficiency inpregnant women in India.

Prevalence of IDA is 35-75 % in developingcountries &18 % in developed countries.(WHO)

Prevalence of anaemia is highest amongpregnant women in INDIA-50-90%.

(Planning Commission. Government of India.Tenth Five-5. Year Plan 2002-2007.)


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IRON LOSSES

Men Women

Obligatory losses 1.0 mg/d 1.0 mg/dMenstruation - 0.5 mg/d

Total losses 1.0 mg/d 1.5 mg/d

Iron absorbed 1.0 mg/d 1.5 mg/d


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Iron Transport

into Plasma

Ferroportin1

Macrophages

Fe+2

Ferro-

portin 1

Macrophage

Fe+2

Senescent

RBC

Hb

Fe

Fe+3 TfCerulo-plasmin

Ferroportin 1

Duodenal

cytochromeb

Ferroportin 1

Duodenal

cytochromeb

Adapted from Andrews,

NEJM 1999;341:1986


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Iron Absorption

1. Heme iron (meats) absorbed better thannon-heme iron (grains).

2. Gastric acid keeps Fe reduced to Fe++formthat is absorbed.

3. Occurs in proximal small bowel-duodenum(major)


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Iron Absorption

Increases with:

high erythropoiesis

low iron stores

Gastric acid

Vitamin C

Inhibited inflammation

tea

phytates


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WHO CLASSIFICATION OF

ANEMIAclassification Non

Anaemia

Mild Moderate Severe

haemoglobin

level(g/L)

120 or

higher

110-119 80-109 lower than

80


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Treatment :options

Oral iron therapy

Parenteral therapy Packed red cell transfusion


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ORAL IRON

ADVANTAGES

least invasive,

cheap and safe

Disadvantages

Increased failure of treatment :

dietary inhibitors

GI intolerance

poor compliance


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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. Ironprophylaxis in pregnancy: Intravenous route versusoral route. Eur J Obstet Gynecol Reprod B iol 2009;144 : 135-9.


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Parenteral Iron Therapy

Parenteral iron bypasses the gut and

circumvents the natural regulatory

mechanism to deliver non-protein-bound

iron.


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Parenteral: Intramuscular Iron

therapy Iron dextran

Iron-Sorbitol-Citric Acid Complex(Jectofer)


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Parenteral: Intramuscular Iron

therapy : Why skepticism??Test dose required

Systemic: Anaphylaxis Most dangerous

Local : Pain, muscle necrosis, phlebitis

Slow iron mobilization and occasionallyincomplete.

Fishbane S1, Kowalski EA.The comparative safety of intravenous iron dextran, ironsaccharate, 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.


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Intravenous Iron Sucrose

Brown, sterile, aqueous complex of

polynuclear iron hydroxide in sucrose

containing 20mg elemental iron per ml.

No preservatives.


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DOSE

Required iron dose (mg) = (2.4 x (target

Hb-actual Hb) x pre-pregnancy weight

(kg)) + 1000 mg for replenishment of

storesAdamson JW. Iron deficiency and other hypoproliferative anemias. In:

Braunwald E, Fauci AS, Kasper DL, editors. Harrisons textbook of

intern al medic ine, 17th ed. New York : McGraw Hil l ; 2008. p. 628-33.


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WHY I/V SUCROSE :SAFETY

Best safety profile.

< 0.5% minor side effects.

Safer than intramuscular & iron gluconatepreparation

Sane R, Baribeault D, Rosenberg CL.Safe administration of iron sucrose in a patient with aprevious 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. Safetyand efficacy of iron sucrose in patients sensitive to iron dextran: North American clinicaltrial. Am J Kidney Dis 2000; 36 : 88-97.


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WHY I/V SUCROSE : SAFETY

Ferric carboxy maltose ??

No randomised trials


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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 thepostpartum period. Semin Hematol 2006; 43 : S28-S31.

Litton etal.Safety and efficacy of intravenous iron therapy in reducingrequirement for allogeneic blood transfusion: systematic review and meta-analysis of randomised clinical trials. BMJ. 2013 Aug 15;347:f4822. doi:10.1136/bmj.f4822.
http://www.ncbi.nlm.nih.gov/pubmed?term=Litton%20E[Author]&cauthor=true&cauthor_uid=23950195http://www.ncbi.nlm.nih.gov/pubmed?term=Litton%20E[Author]&cauthor=true&cauthor_uid=23950195


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WHY I/V SUCROSE

Accumulation of Fesucrose in

parenchyma of organs is low compared

with Fe

dextrans or Fe

gluconate

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

Nu tr 2002; 88 : 3-10. (switzerland)


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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.

intravenous sucrose vidhi

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