Can a primigravid woman at 8 months gestation with anemia (hemoglobin 7.4 g/dL) and peripheral edema, but normal blood pressure and no proteinuria, be given iron sucrose (iron sucrose)?

From the Guidelines

Yes, iron sucrose can be administered to this primigravida woman at 8 months gestation with hemoglobin of 7.4 g/dL, pedal edema, normal blood pressure, and normal urinary albumin. The recommended dosage is typically 200 mg of iron sucrose intravenously, administered 2-3 times weekly until the calculated total iron deficit is reached 1. Each dose should be given as a slow infusion over 15-30 minutes. Before starting treatment, a test dose may be advisable to monitor for hypersensitivity reactions. This patient has moderate to severe anemia in late pregnancy, which increases risks of maternal morbidity, postpartum hemorrhage, and poor fetal outcomes. Iron sucrose is preferred over oral iron in this case due to the severity of anemia, limited time before delivery, and superior absorption. The normal blood pressure and absence of proteinuria suggest this is likely iron deficiency anemia rather than anemia associated with preeclampsia. Close monitoring of hemoglobin levels, vital signs during infusion, and assessment for adverse reactions is essential. Concurrent oral iron should be temporarily discontinued during parenteral iron therapy. Some key points to consider include:

• The patient's hemoglobin level is below the normal range, indicating anemia 1
• Iron deficiency anemia is a common condition in pregnancy, especially in the third trimester 1
• Intravenous iron treatment is a effective way to rapidly increase hemoglobin levels and improve iron stores 1
• The patient's normal blood pressure and absence of proteinuria suggest that preeclampsia is unlikely, making iron deficiency anemia a more likely diagnosis 1
• Close monitoring of the patient's condition and adjustment of the treatment plan as needed is crucial to ensure the best possible outcomes 1.

From the FDA Drug Label

Published studies on intravenous iron sucrose treatment after the first trimester of pregnancy have not shown adverse maternal or fetal outcomes Iron deficiency anemia during pregnancy should be treated. Untreated IDA in pregnancy is associated with adverse maternal outcomes such as post-partum anemia Adverse pregnancy outcomes associated with IDA include increased risk for preterm delivery and low birth weight

The patient is in her 8th month of gestation with low hemoglobin (7.4 gm), which indicates iron deficiency anemia (IDA). Given that untreated IDA in pregnancy is associated with adverse maternal and fetal outcomes, and published studies on intravenous iron sucrose treatment after the first trimester of pregnancy have not shown adverse maternal or fetal outcomes, iron sucrose can be considered for treatment. Key points to consider:

• The patient's gestation period is beyond the first trimester, where the use of iron sucrose has not shown adverse outcomes.
• The patient has low hemoglobin, indicating a need for treatment of iron deficiency anemia.
• Normal blood pressure and urine albumin suggest no immediate contraindications to iron sucrose treatment. Therefore, iron sucrose can be given to this patient, considering the benefits of treating iron deficiency anemia in pregnancy outweigh the risks 2.

From the Research

Patient's Condition

• The patient is a primi pregnant woman at 8 months gestation with a hemoglobin level of 7.4 gm.
• She has oedema in her feet, but her blood pressure and urine albumin levels are normal.

Iron Sucrose Therapy

• According to the study 3, iron sucrose therapy is effective in achieving target hemoglobin levels in patients with iron deficiency anemia.
• The study 4 found that intravenous iron sucrose significantly increases hemoglobin levels within two weeks of therapy without major adverse effects.
• Iron sucrose therapy is safe, effective, and well-tolerated for the treatment of iron deficiency anemia, as stated in the study 3.

Administration of Iron Sucrose

• The study 5 explains that intravenous iron may work where oral iron has not, and provides context on how and when intravenous iron should be administered.
• The study 6 highlights the benefits of iron sucrose treatment, including its ability to rapidly increase hemoglobin, ferritin, and transferrin saturation levels with an acceptable safety profile.
• The study 7 found that iron sucrose injection can significantly increase hemoglobin concentration in anemia patients with reduced serum iron concentration.

Conclusion for the Patient's Treatment

• Based on the studies 3, 4, 5, 6, 7, iron sucrose therapy can be considered a suitable treatment option for the patient, given her iron deficiency anemia and normal blood pressure and urine albumin levels.