Article Published : Journal of perinatal and neonatal care

Rapid versus slow intravenous iron sucrose administration: efficacy, safety and potential cost-savings in an Indian rural pregnant population with iron deficiency anemia.
Published in the journal of perinatology - titled journal of perinatal and neonatal care.

Background: The Iron-Folic Acid (IFA) program launched in India some 30 years ago to provide free iron and folate to pregnant women to eradicate iron deficiency anemia (IDA) has failed, since the prevalence of IDA in pregnancy is still in excess of 50%. Intravenous iron sucrose circumvents many of the obstacles that have contributed to the failure of the IFA program, but requires careful and rigorous evaluation in a low resource setting such as India. Objectives: To compare the efficacy, safety and cost of two methods of administering intravenous iron sucrose, the conventional slow intravenous infusion versus the rapid 'bolus- push' technique.

Patient & Methods: 152 pregnant women with iron deficiency anemia (Haemoglobin < 11g/dl) attending a rural antenatal clinic in India between Nov 2008 and Feb 2009 were randomized to receive two doses of intravenous iron sucrose by one or other of the two methods under comparison. Irrespective of the pre-treatment haemoglobin (Hb), all women received the same total dose of iron sucrose of 400mg divided into two equal doses administered 2-4 days apart at 20-24 weeks gestation. The 75 women randomized to Group A received iron sucrose by the slow infusion (over half an hour) technique, while the 77 women randomized to Group B had the iron sucrose administered by the rapid 'bolus-push technique over 2-5 minutes. Any adverse reactions were recorded after the first injection. Per unit additional costs incurred were calculated for each method.

Results: There were no differences in patient demographics or pre-treatment Hb between the two groups. Both groups recorded a statistically significant increase in the mean Hb level in response to treatment ( p < 0.05), but there were no differences between the two groups. No woman experienced major adverse reactions, but minor reactions were reported in 5 (6.7%) women in Group A and 15 (19.5%) women in Group B (p>0.05). Only two women experiencing minor reactions required intravenous hydrocortisone, and symptoms resolved within 20 minutes in both. Cost analysis revealed that the slow infusion was seven times more expensive than the bolus push technique (200 versus 30 INR)

Conclusions: The administration of iron sucrose by the bolus-push technique has similar efficacy to the conventional slow infusion technique, but is seven times cheaper. Although 2 associated with a higher incidence of adverse reactions, all were minor, and all resolved rapidly. The bolus-push technique may represent a cost-effective approach to the eradication of iron deficiency anemia in pregnancy in low-resource settings. Keywords: Iron deficiency anemia (IDA), iron-folic acid (IFA), Pregnancy, haemoglobin (Hb), iv iron sucrose.