Dear Respectable Editor,
While we are reading the article published by Haldar et al. (J Family Med Prim Care. 2018;7 (4):762-768. Doi: 10.4103/jfmpc.jfmpc_303_17) with great interest, there are many queries raised in our minds. We will be grateful if the authors clarify to us and to the readers the answers of the following queries.
First, Haldar et al. stated that they assessed the effect of intravenous iron sucrose (IVIS) on hemoglobin (Hb) levels among the pregnant anemic women.[1]
Other authors mentioned that the IVIS should be used for treatment of iron deficiency (ID) and iron deficiency anemia (IDA), and the diagnosis of IDA should be based the following parameters: Hb concentration (g/dl), serum ferritin (μg/l), mean corpuscular volume (MCV), and mean corpuscular Hb (MCH).[2,3,4,5,6] We think that Haldar et al.[1] should include in their study women with IDA only.[2,3]
Second, Haldar et al.[1] stated that pregnant women, identified as moderately or severely anemic (Hb <10.0 g/dl) in the second or third trimester during routine antenatal care, were prescribed IVIS in a standard dose of 400 mg given as 100 mg on alternate days without dose calculation or allowance for iron store was included in their study.[1]
Other authors stated that total IVIS dose for correction of IDA should be given and calculated following manufacturer's instructions: total iron needed in mg = 2.4 × prepregnancy weight in kg × (target Hb − actual Hb) g/dl + 500 mg. About 12 g/dl is the target Hb concentration, 2.4 is correction factor, and 500 mg is the amount of stored iron in pregnant adult women.[2,3,4,5,6,7,8]
Please clarify to us and to the readers, which type of anemia in pregnancy can be treated by IVIS, how to diagnose IDA, and the ideal method for calculation of the total IVIS dose for correction of IDA during pregnancy.
Conclusion
IVIS should be used for treatment of ID and IDA only and the IDA can be diagnosed by the following parameters: Hb concentration, serum ferritin, MCV, and MCH. The parenteral total IVIS dose for treatment of IDA should be calculated and given according to the manufacturer's instruction as follow: total iron needed in mg = 2.4 × prepregnancy weight × (target Hb − actual Hb) g/dl + 500 mg.
Ethical approval
This article does not contain any studies with human or animal subjects performed by any of the authors.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
- 1.Haldar P, Kant S, Yadav V, Majhi J, Malhotra S, Kaur R, et al. Effect of intravenous iron sucrose on hemoglobin level, when administered in a standard-dose, to anemic pregnant women in rural Northern India. J Family Med Prim Care. 2018;7:762–8. doi: 10.4103/jfmpc.jfmpc_303_17. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Abdelazim IA, Nusair B, Svetlana S, Zhurabekova G. Treatment of iron deficiency and iron deficiency anemia with intravenous ferric carboxymaltose in pregnancy. Arch Gynecol Obstet. 2018;298:1231–2. doi: 10.1007/s00404-018-4943-x. [DOI] [PubMed] [Google Scholar]
- 3.Abdelazim IA, Abu-Faza M, Elbiaa AA, Othman HS, Alsharif DA, Elsawah WF. Heme iron polypeptide (proferrin®-ES) versus iron saccharate complex (ferrosac) for treatment of iron deficiency anemia during pregnancy. Acta Med Int. 2017;4:56–61. [Google Scholar]
- 4.Shafi, D, Purandare SV, Sathe AV. Iron Deficiency anemia in pregnancy: Intravenous versus oral route. J Obstet Gynaecol India. 2012;62:317–21. doi: 10.1007/s13224-012-0222-0. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Bayoumeu F, Subiran-Buisset C, Baka NE, Legagneur H, Monnier-Barbarino P, Laxenaire MC. Iron therapy in iron deficiency anemia in pregnancy: Intravenous route versus oral route. Am J Obstet Gynecol. 2002;186:518–22. doi: 10.1067/mob.2002.121894. [DOI] [PubMed] [Google Scholar]
- 6.Bhavi SB, Jaju PB. Intravenous iron sucrose v/s oral ferrous fumarate for treatment of anemia in pregnancy. A randomized controlled trial. BMC Pregnancy Childbirth. 2017;17:137. doi: 10.1186/s12884-017-1313-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Barut A, Harma M. Intravenous iron treatment for iron deficiency anemia in pregnancy. J Turkish-German Gynecol Assoc. 2009;10:109–15. [Google Scholar]
- 8.Kalaivani K. Prevalence and consequences of anemia in pregnancy. Indian J Med Res. 2009;130:627–33. [PubMed] [Google Scholar]