Hallak M, Sharon A S, Diukman R, Auslender R, Abramovici H
Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel.
J Reprod Med. 1997 Feb;42(2):99-103.
To determine the safety and efficacy of maternal intravenous iron administration to avoid blood transfusion in patients who cannot use oral preparations.
Patients with persistent iron-deficiency anemia who had one of the following indications were included in this study: severe side effects from oral preparations, lack of improvement despite oral iron intake or history of gastrointestinal operations. The total iron amount needed to regenerate iron stores was calculated according to hemoglobin and the patients' weight. Hemoglobin, hematocrit, mean corpuscular volume, serum iron, transferrin and ferritin were evaluated at the start and conclusion of therapy as well as two weeks afterward.
Twenty-six patients were included in the study; four of them delivered during the therapy course. One patient developed mild signs of allergy (urticaria) after the test dose and was excluded from the study. The remaining 21 pregnant patients (mean gestational age 28 weeks) completed the therapy course and received a mean of 1,000 mg of elemental iron. The hemoglobin was increased from 8.4 +/- 1.0 to 10.1 +/- 0.6 g/dL at the start and end of therapy, respectively (P < .01) and continued to rise to 10.9 +/- 0.6 g/dL two weeks later (P < .01). The serum iron was increased from 3.9 +/- 2.0 mumol/L at the start of therapy to 15.5 +/- 7.2 at the end (P < .01). The transferrin was decreased from 47.0 +/- 7.8 to 41.4 +/- 5.3 to 37.1 +/- 11.8 mumol/L at the start of, end of and two weeks after therapy, respectively (P < .01). Ferritin levels were increased from 2.9 +/- 2.7 ng/mL at the start to 122.8 +/- 87.1 at the end of therapy (P < .01) and decreased to 109.4 +/- 90.7 ng/mL two weeks after treatment (not significant). Only mild and transient side effects were occasionally reported.
Intravenous iron administration during pregnancy is an effective method of regenerating hemoglobin and iron stores. It should be considered for patients with severe iron-deficiency anemia who cannot use oral preparations.
确定静脉注射铁剂对无法使用口服制剂的患者避免输血的安全性和有效性。
患有持续性缺铁性贫血且有以下指征之一的患者纳入本研究：口服制剂出现严重副作用、尽管口服铁剂但无改善或有胃肠道手术史。根据血红蛋白和患者体重计算恢复铁储备所需的总铁量。在治疗开始、结束时以及两周后评估血红蛋白、血细胞比容、平均红细胞体积、血清铁、转铁蛋白和铁蛋白。
26例患者纳入研究；其中4例在治疗过程中分娩。1例患者在试验剂量后出现轻度过敏体征（荨麻疹），被排除在研究之外。其余21例孕妇（平均孕周28周）完成治疗疗程，平均接受1000mg元素铁。治疗开始和结束时血红蛋白分别从8.4±1.0g/dL升至10.1±0.6g/dL（P<.01），两周后继续升至10.9±0.6g/dL（P<.01）。血清铁从治疗开始时的3.9±2.0μmol/L升至结束时的15.5±7.2μmol/L（P<.01）。转铁蛋白在治疗开始、结束时及两周后分别从47.0±7.8降至41.4±5.3再降至37.1±11.8μmol/L（P<.01）。铁蛋白水平从开始时的2.9±2.7ng/mL升至治疗结束时的122.8±87.1ng/mL（P<.01），治疗后两周降至109.4±90.7ng/mL（无显著性差异）。仅偶尔报告有轻度和短暂的副作用。
孕期静脉注射铁剂是恢复血红蛋白和铁储备的有效方法。对于无法使用口服制剂的严重缺铁性贫血患者应考虑使用。
