To the rescue: the role of intravenous iron in the management of severe anaemia in the peri-partum setting.

Abstract

Maternal death from obstetric haemorrhage remains a common cause of maternal mortality worldwide1. Iron deficiency and iron-deficiency anaemia (IDA) in pregnancy is a global health problem affecting around 20% of women in the western world and increasing to 56% in developing countries2. It is associated with adverse physiological and psychological outcomes in both mother3,4 and child5,6 (Table I). Iron-deficient women are also at increased risk of requiring an allogeneic red blood cell (RBC) transfusion during the peri-partum period, which is an expensive and often scarce resource with well-described risks7,8. Additional complexity arises in the management of women refusing blood products1. Table I Effects of iron deficiency in pregnancy. Meticulous antenatal care and careful planning of the delivery is crucial for all pregnant women. Optimisation of iron stores with oral iron supplementation plays an important role in treating IDA and improving haemoglobin (Hb) but up to 59% of those to whom oral iron is prescribed report significant gastrointestinal side effects9. However, intravenous (IV) iron can be an effective, rapid and safe alternative for non-responding or non-compliant patients and for those presenting too late for successful oral supplementation10,11. We report two cases of severe peri-partum anaemia in which the administration of IV iron was utilised to support erythropoiesis in order to boost Hb and compensate for iron loss.