Intravenous Sucrose Vidhi
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Transcript of Intravenous Sucrose Vidhi
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INTRAVENOUS SUCROSE IN
IRON DEFICIENCY ANEMIAIN PREGNANCY.
DR. ABHA SINGH
HEAD OF DEPARTMENT
(OBS & GYNAE)LHMC& SSKH , DELHI
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Iron deficiency anaemia (IDA)
Most common nutritional deficiency inpregnant women in India.
Prevalence of IDA is 35-75 % in developingcountries &18 % in developed countries.(WHO)
Prevalence of anaemia is highest amongpregnant women in INDIA-50-90%.
(Planning Commission. Government of India.Tenth Five-5. Year Plan 2002-2007.)
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IRON LOSSES
Men Women
Obligatory losses 1.0 mg/d 1.0 mg/dMenstruation - 0.5 mg/d
Total losses 1.0 mg/d 1.5 mg/d
Iron absorbed 1.0 mg/d 1.5 mg/d
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Iron Transport
into Plasma
Ferroportin1
Macrophages
Fe+2
Ferro-
portin 1
Macrophage
Fe+2
Senescent
RBC
Hb
Fe
Fe+3 TfCerulo-plasmin
Ferroportin 1
Duodenal
cytochromeb
Ferroportin 1
Duodenal
cytochromeb
Adapted from Andrews,
NEJM 1999;341:1986
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Iron Absorption
1. Heme iron (meats) absorbed better thannon-heme iron (grains).
2. Gastric acid keeps Fe reduced to Fe++formthat is absorbed.
3. Occurs in proximal small bowel-duodenum(major)
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Iron Absorption
Increases with:
high erythropoiesis
low iron stores
Gastric acid
Vitamin C
Inhibited inflammation
tea
phytates
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WHO CLASSIFICATION OF
ANEMIAclassification Non
Anaemia
Mild Moderate Severe
haemoglobin
level(g/L)
120 or
higher
110-119 80-109 lower than
80
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Treatment :options
Oral iron therapy
Parenteral therapy Packed red cell transfusion
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ORAL IRON
ADVANTAGES
least invasive,
cheap and safe
Disadvantages
Increased failure of treatment :
dietary inhibitors
GI intolerance
poor compliance
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Parenteral Iron Therapy
Indications
Intolerance to oral form
iron loss exceeds oral iron replacement Inflammatory bowel disease, celiac disease
Malabsorption
Chronic, renal disease ,Dialysis patients
Anemic cancer patients
Bencaiova G, von Mandach U, Zimmermann R. Ironprophylaxis in pregnancy: Intravenous route versusoral route. Eur J Obstet Gynecol Reprod B iol 2009;144 : 135-9.
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Parenteral Iron Therapy
Parenteral iron bypasses the gut and
circumvents the natural regulatory
mechanism to deliver non-protein-bound
iron.
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Parenteral: Intramuscular Iron
therapy Iron dextran
Iron-Sorbitol-Citric Acid Complex(Jectofer)
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Parenteral: Intramuscular Iron
therapy : Why skepticism??Test dose required
Systemic: Anaphylaxis Most dangerous
Local : Pain, muscle necrosis, phlebitis
Slow iron mobilization and occasionallyincomplete.
Fishbane S1, Kowalski EA.The comparative safety of intravenous iron dextran, ironsaccharate, and sodium ferric gluconate. Semin Dial. 2000 Nov-Dec;13(6):381-4.
Silverstein SB, Rodgers GM. Parenteral iron therapy options. Am J Hematol 2004; 76 :74-8.
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Intravenous Iron Sucrose
Brown, sterile, aqueous complex of
polynuclear iron hydroxide in sucrose
containing 20mg elemental iron per ml.
No preservatives.
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DOSE
Required iron dose (mg) = (2.4 x (target
Hb-actual Hb) x pre-pregnancy weight
(kg)) + 1000 mg for replenishment of
storesAdamson JW. Iron deficiency and other hypoproliferative anemias. In:
Braunwald E, Fauci AS, Kasper DL, editors. Harrisons textbook of
intern al medic ine, 17th ed. New York : McGraw Hil l ; 2008. p. 628-33.
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WHY I/V SUCROSE :SAFETY
Best safety profile.
< 0.5% minor side effects.
Safer than intramuscular & iron gluconatepreparation
Sane R, Baribeault D, Rosenberg CL.Safe administration of iron sucrose in a patient with aprevious hypersensitivity reaction to ferricgluconate.Pharmacotherapy. 2007 Apr;27(4):613-5.
Van Wyck D22. B, Cavallo G, Spinowitz BS, Adhikarla R, Gagnon S, Charytan C, et al. Safetyand efficacy of iron sucrose in patients sensitive to iron dextran: North American clinicaltrial. Am J Kidney Dis 2000; 36 : 88-97.
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WHY I/V SUCROSE : SAFETY
Ferric carboxy maltose ??
No randomised trials
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WHY I/V SUCROSE
Higher increase in values for hemoglobin ,hematocrit, transferrin saturation, and ferritin
at 4 weeks.(Perewusnyk G Etal) Significant decrease in need for blood
transfusion
Breymann C. The use of iron sucrose complex for anemia in pregnancy and thepostpartum period. Semin Hematol 2006; 43 : S28-S31.
Litton etal.Safety and efficacy of intravenous iron therapy in reducingrequirement for allogeneic blood transfusion: systematic review and meta-analysis of randomised clinical trials. BMJ. 2013 Aug 15;347:f4822. doi:10.1136/bmj.f4822.
http://www.ncbi.nlm.nih.gov/pubmed?term=Litton%20E[Author]&cauthor=true&cauthor_uid=23950195http://www.ncbi.nlm.nih.gov/pubmed?term=Litton%20E[Author]&cauthor=true&cauthor_uid=23950195 -
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WHY I/V SUCROSE
Accumulation of Fesucrose in
parenchyma of organs is low compared
with Fe
dextrans or Fe
gluconate
Incorporation into the bone marrow for
erythropoiesis is considerably faster.
Perewusnyk G, Huch R, Huch A, Breymann C. Parenteral iron therapy
in obstetrics: 8 years experience with iron-sucrose complex. Br J
Nu tr 2002; 88 : 3-10. (switzerland)
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CONCLUSION
Intravenous iron sucrose appears to have
the potential for eradicating IDA because it
overcomes the problems of compliance
and absorption and has an excellent safety
record.