Alice Goodman

May 17, 2011

May 17, 2011 (Washington, DC) — Iron deficiency is common during pregnancy and in women with heavy menstrual bleeding. Intravenous (IV) iron supplementation given just once over a 1-hour infusion was found to be effective and safe for iron-deficient women in a single-center study reported at a poster session here at the American Congress of Obstetricians and Gynecologists 59th Annual Clinical Meeting.

"Up to 68% of pregnant women have iron deficiency. They are prescribed oral iron supplementation 3 times daily, but they hate it because of the metallic taste, gastric irritation, and constipation," explained lead author Michael Auerbach, MD, a hematologist in private in Baltimore, Maryland. "Many patients refuse to take the oral iron, and about one quarter of patients are intolerant of oral iron. IV dextran is much more tolerable than oral iron 3 times a day for weeks or months."

Although there are other forms of IV iron supplementation, Dr. Auerbach said he prefers to use low-molecular-weight iron dextran as a total infusion, although this method of administration is not approved by the US Food and Drug Administration. "It is safe and commonly used in the clinical setting, and has a long history of efficacy and safety," he said.

The study consisted of 164 consecutive iron-deficient women (39 of them pregnant) treated with 1 g of low-molecular-weight iron dextran between July 2008 and February 2010. The women were 14 to 64 years of age (mean age, 39.3 years), and 64% were white, 34% were black, and 2% were Asian. Seventy percent had no drug allergies and 30% had 1 or more drug allergy. Slightly more than three quarters (77%) had menorrhagia, 34% were pregnant, 4% had fibroids, and the remaining patients had various associated diagnoses.

At a mean follow-up of 6 weeks after the administration of IV iron dextran, hemoglobin levels had significantly increased by a mean of 1.5 g/dL (from a mean of 10.5 g/day at baseline to a mean of 11.9 g/day; P < .0001). No patient required a transfusion.

Adverse events were reported in 13 patients (7.9%); the most common were back pain (3.6%), myalgia (1.8%), and nausea (1.8%). These events were mainly transient and did not require treatment. No serious adverse events or discontinuations because of adverse events were reported. Pregnant women were no more likely to experience adverse events than nonpregnant women.

"IV administration of low-molecular-weight dextran is safe and effective, and has the advantages of a shorter treatment period, ensured compliance, and a lower incidence of side effects, compared with oral iron," Dr. Auerbach said.

Mehtap A. Aygun, MD, an obstetrician/gynecologist from Mercy Medical Center in Baltimore, Maryland, who was a coauthor of the poster, has first-hand experience with this treatment. "I had blood loss anemia related to surgery and was treated with IV iron dextran. I felt better in less than a week. Now I refer all my iron-deficient patients for this treatment, and I am impressed with the results," she said.

Watson Laboratories assisted with the data analyses and poster preparation. Dr. Auerbach and Dr. Aygun have disclosed no relevant financial relationships.

American Congress of Obstetricians and Gynecologists (ACOG) 59th Annual Clinical Meeting: Abstract 33. Presented May 3, 2011.

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