Parental Ferric Hydroxide Saccharate Therapy for Iron Deficiency Anemia: Safety and Efficacy.

Background: Iron deficiency remains the most common cause of anemia both locally and worldwide. In adults, the most common etiology of iron deficiency is blood loss; in men and postmenopausal women, iron deficiency almost inevitably signifies gastrointestinal (GI) blood loss. In women of childbearing age, genitourinary blood loss is the usual culprit. The goal of iron therapy for iron deficiency anemia (IDA) is to supply sufficient iron to repair the hemoglobin deficit and replenish storage iron. Iron can be given in either oral or parenteral forms. Because of the local and systemic side effects linked to parenteral iron therapy, it has been the less favored form of treatment of IDA. In this retrospective review, we report our experience using parenteral iron therapy for certain indications in patients with severe IDA.

Methods: Total number of patients was 57, 54 were females. Mean age was 31 years (12–60 yrs). Iron deficiency anemia was found to be due to: menorrhagia (46%), pregnancy (23%), malabsorption (22%), GI loss (7%) and poor dietary habits (4%). Patients presented with the following symptoms: dizziness (84%), exertional dyspnea (40%), palpitations (28%) and fatigue (23%). The indications for parenteral iron therapy were: severe symptomatic anemia (58%), pregnancy (25%), poor response to oral iron (14%), noncompliance to oral therapy (10%) and bleeding (7%).

Treatment plan: The form of iron used was Ferric Hydroxide Saccharate Complex. Iron requirement was calculated based on the following formula: Total iron deficiency in mg = [body weight (kg) x (normal Hb -actual Hb in g/L)x 0.24] + 500.The mean iron requirement was 1200mg (700mg – 2400mg). This was given in an outpatient setting as daily intravenous infusions starting with a dose of 100mg on the first day. The rest of the requirement was divided into doses of 200mg given over consecutive days.

Results: The mean Hb pre-treatment was 7.96g/dL (4.9–10.7g/dL) and the mean Hb post treatment was 10.6g/dL. (8.2–12.3g/dL). The rise in Hb was at a rate of 0.76/dL per week (0.17– 1.9). All patients tolerated the treatment well with only one complaining of burning sensation at the site of the IV line. There were no other side effects including anaphylactic reactions. In conclusion, the above data demonstrates that parenteral iron therapy, in the form and schedule given, is a fast, convenient, effective and safe means of treating severe, symptomatic IDA.