Evaluation of Efficacy and Safety of Intravenous Iron Therapy as an Alternative/Adjunct to Allogeneic Blood Transfusion in Obstetric and Gynecological Cases at Srinagarind Hospital: Preliminary Report

Abstract

Objectives: To determine the ratio of Obstetric and Gynecological (OBGYN) cases at Srinagarind Hospital that can omit a blood transfusion;

To analyse the factors effecting the success in omitting  blood transfusion;

To review the symptoms and side-effects of iron-sucrose in clinical use; and,

To compare the risk/benefit of iron-sucrose as an alternative/adjunct to allogeneic blood transfusion.

Methods: We retrieved the records of Ob-Gyn cases between January 2007 and July 2009 that received iron-sucrose (Venofer^â) as an intervention; and, analysed the data on age, hematocrit before and after intervention with iron-sucrose, estimated blood loss, intervention with blood transfusion, symptoms and side-effects of the iron-sucrose.

Results:  Fifteen cases received intravenous iron therapy, 13 of which did not need a blood transfusion (86.7%). Five of 6 obstetric cases (83.3%) and 8 of 9 gynecological cases (88.9%) did not need a blood transfusion.  The factors associated with omitting blood transfusion in the obstetric cases included:  initial hematocrit, amount of blood loss and hematocrit post-intravenous iron therapy.  In the gynecological cases, they were: initial hematocrit, amount of blood loss and type of operation.  Only one case in these 15 cases had an adverse reaction (i.e., feeling hot and flush).  These reactions disappeared when the infusion rate was extended from 1 hour to 4 hours. Considering the risk from blood transfusion, intravenous iron therapy represents a valuable alternative.

Conclusions:  Intravenous iron therapy with iron-sucrose in Ob-Gyn cases was a safe and valuable procedure.  Appropriately selected cases had a high percentage of success in omitting blood transfusion; nevertheless, more cases are needed for confirmation.