Wali A, Mushtaq A
Aga Khan Hospital for Women and Children, Kharadar, Karachi, Pakistan.
J Pak Med Assoc. 2002 Sep;52(9):392-5.
(1) To determine an alternative iron supplementation with better efficacy, compliance & safety in treatment of iron deficiency anemia during pregnancy, (2) to reduce blood transfusion during pregnancy, labor and puerperium.
A prospective comparative study. A total number of 60 pregnant women with the gestational age of 12-34 weeks were included in the study who were suffering from iron deficiency anemia. They were divided in 3 groups (A, B and C). Group A (n = 15) received intravenous iron sucrose according to recommended dose containing 500 mg of iron sucrose for storage, in group B (n = 20) iron sucrose was administered according to deficit calculated as per formula but 200 mg of iron was given for storage instead of 500 mg, to reduce cost. While group C received intra muscular iron Sorbitol in the dose used as practice.
Mean hemoglobin in group A and B was 8.0 +/- 1.1 g/dl and 8.9 +/- 0.7 respectively, in group C, it was 8.8 +/- 0.9 g/dl. In group A & B initial hemoglobin was assessed 3 weeks post therapy which showed an average rise of 2.8 g/dl (group A) and 1.9 g/dl (group B) and second assessment of Hemoglobin was done prior to delivery (ave: 6.6 weeks) showed a total rise of 3.8 g/dl (group A) and 2.4 g/dl (group B). Pre delivery mean Hemoglobin in group A and B was 11.8 g/dl and 11.3 g/dl respectively. In group C, the Hemoglobin was assessed only prior to delivery (average: 8.4 weeks from the start of therapy), and a rise of 1.4 g/dl was observed with pre delivery mean Hemoglobin of 10.2 g/dl. Target hemoglobin levels i.e. 11 g/dl was achieved by 80% in Group A, 70% in Group B and 28% in Group C by the time of delivery. Blood transfusion was not required in any group. In group A and B one patient had moderate abdominal pain, 2 had weakness and shivering and 3 had phlebitis at the site where intravenous canula was retained. None of patient discontinued the therapy due to any adverse effect. In group C majority complained of pain at injection site while 5 patients dropped out from the study due to intolerance.
Intravenous iron therapy is safe, convenient and more effective then intramuscular iron therapy in treatment of iron deficiency anemia during pregnancy. The intravenous iron therapy can replace blood transfusion in antenatal period.
（1）确定一种在治疗孕期缺铁性贫血方面疗效更佳、依从性更好且安全性更高的铁补充剂；（2）减少孕期、分娩期及产褥期的输血情况。
一项前瞻性对照研究。共纳入60名孕周为12 - 34周且患有缺铁性贫血的孕妇。她们被分为3组（A组、B组和C组）。A组（n = 15）按照推荐剂量静脉输注蔗糖铁，其中含500mg蔗糖铁用于储存；B组（n = 20）根据公式计算的缺铁量给予蔗糖铁，但为降低成本，储存用铁给予200mg而非500mg；C组按实际应用剂量肌肉注射山梨醇铁。
A组和B组的平均血红蛋白分别为8.0±1.1g/dl和8.9±0.7g/dl，C组为8.8±0.9g/dl。A组和B组在治疗3周后评估初始血红蛋白，显示平均升高2.8g/dl（A组）和1.9g/dl（B组），第二次血红蛋白评估在分娩前进行（平均：6.6周），显示总共升高3.8g/dl（A组）和2.4g/dl（B组）。A组和B组分娩前平均血红蛋白分别为11.8g/dl和11.3g/dl。C组仅在分娩前评估血红蛋白（平均：从治疗开始8.4周），观察到升高1.4g/dl，分娩前平均血红蛋白为10.2g/dl。到分娩时，A组80%、B组70%、C组28%达到目标血红蛋白水平即11g/dl。任何组均无需输血。A组和B组各有1例患者出现中度腹痛，2例出现虚弱和寒战，3例在静脉留置套管部位发生静脉炎。无患者因任何不良反应而停止治疗。C组多数患者抱怨注射部位疼痛，5例患者因不耐受退出研究。
在治疗孕期缺铁性贫血方面，静脉铁剂治疗比肌肉注射铁剂治疗更安全、方便且有效。静脉铁剂治疗可在产前替代输血。
