Open Access Morales-Borges, J Blood Disorders Transf 2013, 4:6 DOI: 10.4172/2155-9864.1000171 Open Access Volume 4 • Issue 6 • 1000170 J Blood Disorders Transf ISSN: 2155-9864 JBDT, an open access journal Anemia in Pregnancy & Parenteral Iron Therapy Raúl H Morales-Borges 1,2,3* 1 Ashford Institute of Hematology & Oncology, San Juan, PR, USA 2 American Red Cross, Puerto Rico Region, USA 3 Ashford Presbyterian Community Hospital, San Juan, PR, USA *Corresponding author: Raúl H. Morales-Borges, MD, Ashford Institute of Hematology & Oncology, 29 Washington Street, Suite # 107, San Juan, PR, 00907-1509, USA, Tel: (787) 722-0412; Fax: (787) 723-0554; E-mail: rmoralesborges@yahoo.com Received August 31, 2013; Accepted September 20, 2013; Published September 24, 2013 Citation: Morales-Borges RH (2013) Anemia in Pregnancy & Parenteral Iron Therapy. J Blood Disorders Transf 4: 171. doi: 10.4172/2155-9864.1000171 Copyright: © 2013 Morales-Borges RH. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Keywords: Anemia; Pregnancy; Parenteral; Iron Introduction Anemia is a frequent condition during pregnancy, particularly among women from developing countries who have insufcient iron intake to meet increased iron needs of both the mother and the fetus. Traditionally, gestational anemia has been prevented with the provision of daily iron supplements throughout pregnancy, but adherence to this regimen due to side efects, interrupted supply of the supplements, and concerns about safety among women with an adequate iron intake, have limited the use of this intervention. Intermittent (i.e. one, two or three times a week on non-consecutive days) supplementation with iron alone or in combination with folic acid or other vitamins and minerals has recently been proposed as an alternative to daily supplementation [1]. Intermittent iron and folic acid regimens produce similar maternal and infant outcomes at birth as daily supplementation but are associated with fewer side efects. Women receiving daily supplements had increased risk of developing high levels of hemoglobin (Hb) in mid and late pregnancy but were less likely to present mild anemia near term. Although the evidence is limited. Large doses of iron are most ofen prescribed and are associated with side efects and with increased oxidative damage. Alternatively, delayed-release preparations and intermittent oral iron supplementation lead to better overall compliance and alleviate side efects. Daily iron intervention provides more protection against a decline in the storage iron pool in pregnant women than does an intermittent schedule, but the latter is generally associated with fewer side efects, better compliance, and possibly a reduction in risk of oxidative damage. An improved cost-beneft ratio associated with a lower-dose oral iron supplement may prove to be quite positive in the future. Currently, no single approach may be universally acceptable, although a moderate iron dosage protocol will likely provide the most beneft to those who require supplemental iron [2]. Parenteral iron seems to be an alternative and it is well known since 1960 [3]. It is ofen required in many pregnant women. It is preferred whenever they presented with failure to oral iron or increased demands despite oral iron therapy. Tere are two presentations: iron dextran and iron sorbitol citric acid [4]. Anaphylactic reaction is the principal problem with iron dextran, but iron sucrose is safe and efective without requirement of a test dose [5-7]. Tey are given is most of the ambulatory infusion clinics or centers with minimal facilities. Terefore, this review was aimed to comparing the efcacy and safety of parenteral iron therapy of our practice with the current worldwide practice in this area. Methods I reviewed the statistics of deliveries (including cesarean section) of the fscal year 2012 (July 2012 to June 2013) provided by Labor & Delivery Room of the Ashford Presbyterian Community Hospital (APCH), the cases of anemia in pregnancy (ICD-9 codes 648.23, 648.21) as in patients provided by Record Room of APCH from the calendar year 2012 (January 1 to December 31 of 2012), and the in patient cases that used sodium ferric gluconate complex in sucrose injection (FERRLECIT) from the Obstetrics/Gynecology Ward of the same hospital from the fscal year 2012 provided by the Department of Pharmacy of APCH. Te hospital is a community based non-proft health care facility of 200 beds with ambulatory and in patient services located at the Condado Area of San Juan, Puerto Rico. Teir expertise are obstetrics (in particularly, high risk pregnant women), orthopedics, internal medicine, and ambulatory surgery. Te records from my practice were reviewed too regarding the pregnant women referred to me who required parenteral iron therapy. We paid attention to the Hb and the Hematocrit (Hct). Serum iron and Abstract Anemia is common in pregnancy and iron defciency is the most common cause. Oral iron is the standard therapy, but there is a problem of adherence due the gastrointestinal side effects. Intravenous iron therapy has more advantages, therefore, intravenous iron therapy is the best treatment for pregnant women during the third trimester. We reviewed the statistics of deliveries of the fscal year 2012, the cases of anemia in pregnancy as in patients provided by Record Room from the calendar year 2012 and the patient cases that used sodium ferric gluconate complex in sucrose injection (FERRLECIT) from the Obstetrics/Gynecology Ward from the fscal year 2012 provided by the Department of Pharmacy of the Ashford Presbyterian Community Hospital (APCH). A review of the records of pregnant women receiving iron dextran injection (INFeD) intravenously in our ambulatory infusion center was also performed. Our data confrmed that either presentations elevated the hemoglobin and they were well tolerable. Iron sucrose is the preferred and it has demonstrated a high success rate. I recommend considering this alternative earlier at the third trimester and establishing guidelines using parenteral iron and erythropoietin in combination in refractory cases. Journal of Blood Disorders & Transfusion J o u r n a l o f B l o o d D i s o r d e r s & T r a n s f u s i o n ISSN: 2155-9864 Research Article