Oral and Intravenous Iron therapy in iron deficiency anemia

• Dr Sanjay Gupte,  
• Dr Rishma Pai Dhillon,  
• Dr Surekha Tayade,  
• Dr Atul Ganatra,  
• Dr Sheela Mane,  
• Dr Anahita Chauhan,  
• Dr Egbert Saldhana,  
• Dr Charmila Ayyavoo,  
• Dr Vanita Raut,  
• Dr Parikshit Tank,*  
• Dr Shailesh Kore,  
• Dr Siddhi Kore,  
• Dr Sandhya Saharan

Abstract

An estimated 52.2% of pregnant women of 15-49 years age in India have iron deficiency anemia (IDA). Guidelines for prevention and treatment of antenatal IDA under the Indian government’s Anemia Mukt Bharat initiative and by the Federation of Obstetric and Gynaecological Societies of India, differ in their recommendations. Hence, leading experts in obstetrics in India met to arrive at a consensus on the treatment of ID and IDA during pregnancy. As per expert consensus, early serum ferritin testing should be considered. All patients with anemia should be screened for hemoglobinopathies, especially thalassemia, using hemoglobin electrophoresis. Elemental iron was recommended for prophylaxis at 30 to 60 mg/day and for treatment, experts recommended 60 mg twice daily while others suggested 100 mg/day with vitamin-C. Oral iron is recommended in patients with mild anemia with vitamin-C and parenteral iron in moderate or severe anemia. However, at least a single dose of 1000 mg parenteral iron along with oral iron in moderate anemia during second trimester was advocated. Both oral as well as parenteral iron options are to be offered in moderate anemia. With no improvement with oral iron, they should be switched to parenteral iron. In third trimester, all patients with moderate or severe anemia should be given intravenous iron though serum ferritin should be tested before. Hb monitoring is recommended every 4 weeks after initiating iron therapy. Ferrous ascorbate is most preferred oral iron. For parenteral iron, ferric carboxymaltose should be preferred. Blood transfusion is recommended in pregnant women of 34 weeks of gestation and Hb <7 g/dL, blood transfusion is recommended irrespective of cardiac failure or hypoxia signs.

Keywords

Iron deficiency anemia (IDA) ,Serum ferritin ,Hemoglobinopathies,Thalassemia Major