Selective Use of Recombinant Human Erythropoietin in Pregnant Patients With Severe Anemia or Nonresponsive to Iron Sucrose Alone

Abstract

Iron deficiency is a common problem for women in both third world countries and industrialized nations, but treatment during pregnancy with orally administered high-dose iron is limited by adverse effects and noncompliance. Previous studies have demonstrated that parenteral administration of iron sucrose alone or combined with recombinant human erythropoietin (rhEPO) is effective and safe in the treatment of anemia in pregnancy. Because of the high cost of this combined therapy, the investigators designed this study to distinguish patients who need this therapy from those who can be managed with intravenous iron sucrose alone. This study utilized a stepwise protocol for administration of iron sucrose to pregnant women, either alone or in combination with rhEPO for rapid treatment of severe iron deficiency or for those who are nonresponsive to intravenous iron. The study subjects were 84 pregnant women who had gestational anemia, defined as an hemoglobin (Hb) level <10.0 g/dL and a ferritin level ≤15 mcg/L, despite routine oral iron therapy initiated in the second trimester. Patients were divided into 3 groups. At baseline, group A patients (n = 27) had a Hb level ≥9.0 g/dL and <10.0 gm/dL and received intravenous doses of iron sucrose monotherapy 200 mg twice weekly. Group B patients (n = 32) were those who responded poorly to iron sucrose monotherapy and additionally received intravenous doses of rhEPO twice weekly. Group C patients (n = 25) had a baseline Hb level <9.0 g/dL and received combined iron sucrose and rhEPO twice weekly from the beginning of therapy. For all 3 groups, therapy was stopped after a Hb level of ≥11.0 g/dL was reached or after infusion of a maximum iron dose of 1600 mg. The mean duration of therapy was 3.5 weeks. Of the 84 patients, 31 achieved a Hb level between 10.0 and 10.9 g/dL, and 53 patients reached a level of 11.0 g/dL or higher. There was no difference between the 3 groups in mean gestational age at delivery, infant birth weight, or other clinical parameters. No serious adverse events were noted in any of the groups. The investigators conclude from these findings that combined use of iron sucrose and rhEPO may be indicated in patients with severe iron deficiency anemia or poor response to parenteral iron monotherapy.

Part of CIRS Nexus · Curated by Lauren Lowenstein, The Biotoxin Lady