Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 31  |  Issue : 1  |  Page : 23-30

A comparativestudy of intravenous iron versus oral iron supplementation for postpartum anemia


Department of Obstetrics and Gynecology, Faculty of Medicine, Menoufia University, Quesna, Egypt

Date of Submission01-Nov-2016
Date of Acceptance16-Jan-2017
Date of Web Publication14-Jun-2018

Correspondence Address:
Mohamed M Youssef
Department of Obstetrics and Gynecology, Faculty of Medicine, Menoufia University, Shebin Elkom, Menoufia
Egypt
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_587_16

Rights and Permissions
  Abstract 


Objective
The aim of our study was to compare the safety, tolerability, and effectiveness of treatment with either intravenous(i.v.) ferrous sucrose or oral ferrous sulfate on postpartum iron deficiency anemia.
Background
Iron deficiency anemia is very common in women postpartum and oral ferrous sulfate has been considered the standard of care. However, parenteral iron treatment is expected to be advantageous in cases where oral iron is not possible due to poor compliance or gastrointestinal side effects.
Patients and methods
The patients of the study(100patients) were randomly divided into two groups(50patients/group) using a computer-generated randomization schedule. The first group consisted of 50 women (i.v. group) who received iron by the i.v. route and the second group consisted of 50 women (oral group) who received iron by the oral route, two capsules daily 150mg twice daily for 6weeks. The serum ferritin level, hemoglobin(Hb) level, and red blood cell indices hematocrit, mean corpuscle volume, and mean corpuscular Hb concentration data were collected at home 0, 5, 14, 40days after treatment.
Results
The current study showed that i.v. ferrous sucrose significantly increases the mean level of Hb from 7.9mg/dl at pretreatment to 11.5mg/dl at 40days after treatment, whereas oral ferrous sulfate increases the mean level of Hb from 7.8mg/dl pretreatment to 11.2mg/dl; these results showed that i.v. iron is more effective than oral iron regarding the increase of Hb level.
Conclusion
The present study concluded that i.v. ferrous sucrose increases the Hb level more rapidly than oral ferrous sulfate in women with postpartum iron deficiency anemia; it also appears to replenish iron stores more rapidly without any significant side effects.

Keywords: intravenous ferrous sucrose, oral ferrous sulfate, postpartum anemia


How to cite this article:
Helmy ME, Al Halaby AE, El Khouly NI, Youssef MM. A comparativestudy of intravenous iron versus oral iron supplementation for postpartum anemia. Menoufia Med J 2018;31:23-30

How to cite this URL:
Helmy ME, Al Halaby AE, El Khouly NI, Youssef MM. A comparativestudy of intravenous iron versus oral iron supplementation for postpartum anemia. Menoufia Med J [serial online] 2018 [cited 2018 Nov 17];31:23-30. Available from: http://www.mmj.eg.net/text.asp?2018/31/1/23/234231




  Introduction Top


Iron-deficiency anemia(IDA) is very common in women postpartum and oral ferrous sulfate has been considered as the standard of care [1]. However, parenteral iron treatment is expected to be advantageous in cases where oral iron is not possible due to poor compliance or gastrointestinal side effects [2]. Postpartum anemia, defined by the WHO as a hemoglobin(Hb) level below 11g/dl is very common, usually resulting from a combination of blood loss at delivery and pre-existing iron-deficiency anemia. Postpartum Hb levels of less than 10g/dl are observed in up to 30% of women, with more severe anemia(Hb<8g/dl) seen in 10% [3]. Iron deficiency is the principal cause. This is partly attributable to an iron deficit during pregnancy caused by the increased iron demands of the fetoplacental unit and an increased maternal red cell mass [4]. From the previous studies Bhandal and Russell [5], Perewunsnyk etal. [6] and Jain etal. [7], it was found that treatment with intravenous(i.v.) iron sucrose increases the Hb concentration by 25% by day 5.


  Aim of the Study Top


The aim of our study was to compare the safety, tolerability, and efficacy of treatment with i.v. ferrous sucrose or oral ferrous sulfate for postpartum iron-deficiency anemia.


  Patients and Methods Top


Study design

A prospective randomized study that was conducted at the labor ward of the department of Obstetrics and Gynecology, Shebin El-Kom Teaching Hospital, to compare the efficacy, safety, tolerability, and side effects of i.v. ferrous sucrose and oral ferrous sulfate in the management of postpartum iron-deficiency anemia. Local ethics committee approval and written consent from all women were obtained before participation in the study.

Sample size justification

The study was conducted at Shebin El-Kom Teaching hospital over10months from February 2015 to December 2015. To detect an increase with 90% power at the 5% significance level with 95% confidence interval, we calculated that 50patients were needed to be recruited to each group; a total 100 anemic postpartum women were included in this study.

The patients of the study(100patients) were randomly divided into two groups(50patients/group) using a computer-generated randomization schedule.

GroupI was treated by i.v. ferrous sucrose.

GroupII was treated by oral ferrous sulfate.

Randomization

The women were randomized to one of two groups using a computer-generated randomization schedule. After obtaining written consent, the women were prescribed treatment with either i.v. ferrous sucrose(groupI) or oral ferrous sulfate(groupII).

Inclusion criteria

Women aged 18years or more, with postpartum iron-deficiency anemia(defined as Hb≤9g/dl and serum ferritin<15μg/1 at 24–48h after delivery).

Exclusion criteria

Women with severe anemia(Hb<7g/dl), women with anemia due to causes other than iron deficiency, history of blood transfusion, iron intolerance, women with signs of infection or evidence of renal or hepatic dysfunction and history of asthma, thromboembolism, seizures, previous iron therapy during pregnancy, chronic uncontrolled systemic diseases such as hypertention and diabetes mellitus were excluded.

Methods

In the initial visit, written consent was obtained and the patients were counseled about the iron therapy, its benefits, and risk of discontinuation.

All women were subjected to the following:

  1. History taking


    1. Personal history: age and special habits
    2. Obstetric history


    3. Parity, multiple pregnancies, bleeding during pregnancy, and history of postpartum hemorrhage

    4. Past history


    History of chronic diseases such as diabetes or hypertension, blood transfusion, blood donation, and either oral or i.v. treatment

  2. Clinical examination


  3. BMI, pallor, pulse, and blood pressure

  4. Investigations.


  5. Blood sample was taken at recruitment into the study, day 0, day 5, day 14, and day 40 of therapy. These time points were chosen on the basis of previous studies and to minimize inconvenience to women.



    The time points were also chosen to detect any difference in the speed of restoration of HB% and iron stores.



    The blood sample was examined for the following:

    1. Complete blood picture


    2. A sample of 2ml venous blood was collected in EDTA vacutainers.

      The device used was Urit-2900plus; Urit Medical Electronic Co. Ltd. Guilin. Guangxi 541004.P.R. China.

    3. Serum ferritin evaluation
    4. A sample of 2ml venous blood was collected in serum vacutainers and the separated sera were stored at 20°C until the time of assay by turbidimetric technique.

      The device used was X52/107PM; Lavite Co. Ltd, Germany.

    5. C-reactive protein using latex at each time point to exclude artificial elevation of serum ferritin due to acute inflammatory response.


  6. Doses and administration


Treatment was started at 24–48h after delivery. Women were randomized either to groupI, where they received three doses of i.v. ferrous sucrose(Sacrofer; Amoun Co., Egypt; El Obour city – Cairo – Egypt) given every alternate day for 3days after recruitment or to groupII, where they received oral ferrous sulfate 150mg twice daily with two capsules daily(Ferrofol capsules; Eipico, Egypt' 10th Of Ramadan City, Industrial Zone B 1) for 6weeks. In groupI, the ferrous sucrose(Sacrofer; Amoun Co.) was administrated in the labor ward in the Department of Obstetrics and Gynecology at Shebin El-Kom Teaching Hospital, as an i.v. infusion in 250ml of 0.9% sodium chloride slowly over30min, and then discontinued for another 30min to detect any hypersensitivity reactions with monitoring of vital signs during infusion; antishock measures were prepared beside the patient during administration(corticosteroids, antihistaminic, calcium, and oxygen). Patients were asked to note any symptoms or adverse effects of treatment such as facial flushing, nausea, metallic taste, dyspepsia, and burning at the injection site.

The dose was calculated by means of the formula total required iron in mg=2.4×W×deficit, where W is the body weight in kg, and deficit is the target Hb minus actual Hb in g%(target Hb: 12 g%) [8]. The total required dose of iron was divided into three doses, which were given every alternate day, and the maximum daily dose was three ampoules of 250mg. This group received no further iron supplementation. They were asked to note any symptoms or adverse effects of treatment.

In groupII, the women were advised to take 150mg ferrous sulfate(Ferrofol capsules; Eipico) twice daily (two capsules) with meals for 6weeks from the day of recruitment. Date was given when to stop oral supplementation after 6weeks; this group was advised to note side effects such as nausea, metallic taste, dyspepsia, and constipation.

We added 500 μg of folic acid orally to patients of the group1(i.v. iron) twice daily for 6weeks to eliminate the differences in the results between the groups as Ferrofol(oral iron for second group) contains 500 μg folic acid.

Statistical analysis

All statistical data at each of the three postbaseline assessment times were analyzed by analysis of covariance. The analyses were conducted using computer programs Microsoft excel 2003, and SPSS for Microsoft windows, version10(SPSS Inc., Chicago, Illinois, USA).

Data were statistically described in terms of mean±SD for comparison between the i.v. group and the oral group at time 0, 5, 14, and 40days after treatment.

For quantitative data, we used the Student t-test, and for qualitative data we used c 2-test.

Difference in variables was expressed by P value: P value less than 0.05 was considered statistically significant, less than 0.01 was highly significant, and more than 0.05 was not significant).


  Results Top


A total of 120 anemic postpartum patients were assessed for eligibility, written consent was obtained after exclusion of 20patients, and 100patients were randomized into two groups.

The first group consisted of 50 women(i.v. group) who received iron by the i.v. route, in the form of standardized aqueous alkaline solution of iron hydroxidesaccharate complex (iron saccharate) (Sacrofer; Amoun Co.) (30 ferrous sucrose). The second group consisted of 50 women (oral group) who received iron by the oral route, in the form of ferrous sulfate capsule(Ferrofol capsules; Eipico). Two capsules 150mg twice daily for 6weeks. Data were collected from 48patients from the first group (i.v. group) and two patients were lost to follow-up. From the second group,(oral group) data were collected from 46patients and four patients were lost to follow-up [Figure1].
Figure 1: Patient's progress through the randomized study.

Click here to view


Differences invariables were expressed by P value: P value less than 0.05 was considered statistically significant, less than 0.01 was highly significant, and more than 0.05 was not significant[Table 1] and [Table 2].
Table 1: Demographic data of both groups of the study

Click here to view
Table 2: Hemoglobin level, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin concentration, and serum ferritin at day 0 in both groups

Click here to view


The current study showed that i.v. ferrous sucrose significantly increases the mean level of Hb from 7.9g/dl at day 0 to 9.9g/dl at day 5, 11.2g/dl at day 14, and 11.5g/dl at day 40 after treatment, whereas oral ferrous sulfate increases the mean level of Hb from 7.8g/dl at day 0 to 8.4g/dl at day 5, 9.1g/dl at day 14, and 11.2 at day 40; the mean change in Hb level from the baseline at day 40 was 3.6g/dl in the i.v. iron group and 3.4g/dl in the oral iron group; these results showed significant differences between the two groups and proved that i.v. iron was more effective and more rapid than oral iron regarding the mean increase in Hb level from the baseline level as in [Table3] and [Figure2].
Table 3: Hemoglobin level at 0, 5, 14, and 40 days after treatment in both groups of the study

Click here to view
Figure 2: Hemoglobin levels at 0, 5, 14, and 40 days after treatment in both groups of the study.

Click here to view


Hematocrit(HCT) at 5 and 14days was higher in the first group(i.v. iron) than in the second group(oral iron) and no significant differences were noticed at 40days after treatment in both groups of the study[Table4].
Table 4: Hematocrit at 0, 5, 14, and 40 days after treatment in both groups of the study

Click here to view


We observed that i.v. ferrous sucrose replenished iron stores within 5days in the first group(i.v. iron), which was more rapid than in the second group(oral iron), as our finding showed that the mean level of serum ferritin was significantly higher in the first group(from 12.5 to 45 μg/l) than in the second group(from 12 to 17 μg/l) at day 5 after treatment as in [Table5] and [Figure3].
Table 5: Serum ferritin at 0, 5, 14, and 40 days after treatment in both groups of the study

Click here to view
Figure 3: Serum ferritin at 0, 5, 14, and 40 days after treatment in both groups of the study.

Click here to view


The mean change from the baseline of Hb and serum ferritin at days 5 and 14 was higher in the first group on i.v. iron than in the second group on oral iron and there was no significant difference at 40days after treatment in both groups of the study[Table6].
Table 6 Mean change from the baseline in hemoglobin and serum ferritin at day 5, 14, and 40 after treatment in both groups of the study

Click here to view


Gastrointestinal side effects were higher in the second group(oral iron) than in the first group(i.v. iron) [Table7].
Table 7: Side effects of treatment in both groups of the study

Click here to view



  Discussion Top


IDA is very common in women postpartum and oral ferrous sulfate has been considered as the standard of care. However, parenteral iron treatment is expected to be advantageous incases where oral iron is not possible due to poor compliance or gastrointestinal side effects, where it can provide greater and more rapid iron supply than oral iron supplementation [1].

Our study was performed to ascertain whether administering i.v. ferrous sucrose to women with postpartum anemia results in higher Hb concentration and improved iron stores than using standard treatment with oral iron.

Serum ferritin was used as an indicator of iron storage. Although serum ferritin levels are low in pregnancy due to plasma dilution, serum ferritin remains a reliable indicator of iron deficiency, where a cut-off level of less than 15 μg/l is used [9].

The current study showed that i.v. ferrous sucrose significantly increases the mean level of Hb from 7.9g/dl at day 0 to 9.9g/dl at day 5, 11.2g/dl at day 14, and 11.5g/dl at day 40 after treatment, whereas oral ferrous sulfate increases the mean level of Hb from 7.8g/dl at day 0 to 8.4g/dl at day 5, 9.1g/dl at day 14, and 11.2 at day 40; the mean change in Hb level from the baseline at day 40 was 3.6g/dl in the i.v. iron group and 3.4g/dl in the oral iron group; these results showed significant differences between the two groups and proved that i.v. iron was more effective and more rapid than oral iron.

Our study results were in harmony with those of Kanwal etal. [8] who studied 322patients with postpartum iron-deficiency anemia, divided into two groups (i.v. iron and oral iron), and reported that i.v. ferrous sucrose increased Hb level from 7.2 to 11.49g/dl at day 40, whereas oral ferrous sulfate increased levels from 7.1 to 11.17g/dl, thus proving that i.v. iron was more effective than oral iron.

The mean increase in Hb level at day 14 in our study is supported by the study conducted by Broche etal. [10] in which the mean increase in Hb by day 14 was higher in the i.v. group(3.1g/dl) than in the oral group(1.9g/dl).

Similarly, Jain etal. [7] studied 40patients with postpartum IDA who were divided into two groups. The i.v. group was treated with i.v. iron sucrose (300–600mg) and the oral group was treated by ferrous fumarate 300mg once daily for 14days; on day 14, the increase in mean Hb in the i.v. group was higher(2.4g/dl) than that in the oral group(1.2g/dl), suggesting that i.v. iron sucrose increased the Hb level more rapidly than oral ferrous fumarate in postpartum anemia without any serious side effects.

In contrast to the current study, Westad etal. [11] studied 128 postpartum anemic women(with Hb levels between 6.5 and 8.5), who were randomized into a first group that received 600mg i.v. ferrous sucrose followed by 100mg oral ferrous sulfate twice daily for 4weeks, and the second group that received 100g oral ferrous sulfate twice daily for 4weeks; this study reported that there was no significant difference in the improvement in Hb levels after 4weeks as it was 12g/dl in the i.v. iron group and 11.9 in the oral iron group.

Recently, Perello etal. [12], who studied 72 postpartum anemic women with severe anemia(Hb levels between 6 and 8g/dl), were randomized into a first group that received i.v. ferrous sucrose 200mg for 2days in addition to two oral ferrous sulfate tablets daily with elemental iron 105mg for 30days, and the second group that received i.v. placebo in addition to oral ferrous sulfate at the same dose as the first group; this study observed that when i.v. iron was added to oral iron therapy, there was no significant difference over placebo in the Hb level after 6weeks.

The mean increase in the Hb level in our study is not matched with that in previous studies by Westad etal. [11] and Perello etal. [12]; their finding was explained using oral iron concurrently with i.v. iron, and they studied patients with severe postpartum anemia with Hb levels between 6.5 and 8.5 in Westad etal. [11], and between 6 and 8 in Perello etal. [12]; they also suggested that gastrointestinal absorption of oral iron increased with severe anemia.

We observed that i.v. ferrous sucrose replenished iron stores within 5days in the first group(i.v. iron), which was more rapid than in the second group(oral iron), as our finding showed that the mean level of serum ferritin was significantly higher in the first group (from 12.64 to 44.14 μg/l) than in the second group (from 12.56 to 14.59 μg/l) at day 5 after treatment.

Our study results coincide with those of the study conducted by Bhandal and Russell [5], on 44 women with postpartum IDA anemia, who were randomized into two groups: the i.v. group, which received i.v. ferrous sucrose 200mg on days 2 and 4 after recruitment and the oral group, which received oral ferrous sulfate 200mg twice daily for 6weeks; this study showed that rapid and profound response can be directly attributed to a high amount of iron that could be delivered directly to the hemopoietic tissues, which in turn restores iron reserves.

Similarly, the study conducted by Breymann etal. [13] on 349 anemic postpartum women who were randomized into two groups(the first group treated by i.v. ferric carboxymaltose and the second group by oral ferrous sulfate 100mg twice daily for 12weeks) reported that iron carboxymaltose was more effective than oral iron sulfate in changing Hb level and rapidly restoring iron storage.

Recently, in a similar study by Becuzzi etal. [14] on 150 women with postpartum(IDA) who received oral iron sulfate 80mg elemental iron once daily for 6weeks and 77 who women received a single dose of i.v. iron carboxymaltose, the data analyzed after 6months showed that i.v. iron supplementation was the more effective approach for long-term iron store replenishment.

Although Westad etal. [11] and Perello etal. [12] reported that there was no significant difference between i.v. iron and oral iron in terms of the increase of Hb level, they also found that i.v. iron increases serum ferritin levels more rapidly than oral iron at day 5 after treatment.

The results of our study showed a significant difference between the two groups of the study in red blood cells indices(HCT, MCV, and MCHC), which were higher in the first group(i.v. iron) compared with the second group(oral iron) after day 40 from treatment.

According to Verna etal. [15] who studied 150 women with postpartum anemia(Hb<8g/dl) randomized into a first group treated by i.v. ferrous sucrose 600mg and a second group treated by oral ferrous sulfate 200mg twice daily for 4weeks, the results of this study reported that HCT, MCV, and MCHC were higher with i.v. iron sucrose than with oral ferrous sulfate after 6weeks; hence, our study matched with these results.

Also, Bhandal and Russell [5] reported that HCT, MCV, and MCHC were higher with i.v. ferrous sucrose than with oral ferrous sulfate at 40days after treatment.

Similarly, Giannoulis etal. [16] and Van Wync etal. [17] concluded that i.v. iron was superior in the efficacy than oral iron in increasing Hb level and red blood cell indices HCT, MCV, and MCHC; hence, our study is in agreement with these studies.

Regarding the incidence of side effects of the drugs in our study, it was 8.1% in the first group(i.v. iron) and 17.2% in the second group(oral iron); we found a significant difference in the incidence of gastrointestinal symptoms in the oral group, whereas in the i.v. group, iron appeared to be safer without any serious side effects.

We also observed that i.v. ferrous sucrose was well tolerated and not associated with any serious adverse effects. This finding is supported by previous larger studies that had investigated the safety profile of i.v. ferrous sucrose both during pregnancy and in postpartum period [1].

In our study, we observed that the high tolerance of ferrous sucrose has been partly attributed to slow release of iron from the complex and also due to the low allergenicity of sucrose.

Our finding is supported by the study conducted by Jain etal. [7], Kanwal etal. [8] and Becuzzi etal. [14], who observed that i.v. iron was safer and more tolerable without serious side effects compared with oral iron.

Similarly, Perewunsnyk etal. [6] studied 400 postpartum anemic patients who received a total of 2000 ampoules of ferrous sucrose, and found that minor general adverse effects including a metallic taste, flushing of the face, and burning at the site of injection occurred in 0.5% of the cases with doses up to 200mg.

In our study, we found that compliance with oral treatment was good and reinforced by regular visits and verbal contact with the patients under the study and this contrasts with compliance findings described in the study conducted by Al-Momen etal. [18], in which they found gastrointestinal adverse effects with frequencies up to 30% in the women who were treated with oral iron; this finding was explained by the higher dose of oral ferrous sulfate(300mg three times daily for 8weeks) in women less than 32weeks pregnant.

Also, Perello etal. [12] reported that i.v. iron added to oral iron therapy did not show significant benefits over the placebo added to oral iron therapy in terms of symptoms or adverse effects. This was because they used a limited dose of i.v. ferrous sucrose.

In the future, hepcidin measurement may allow a more accurate assessment of the degree of iron overload and maldistribution of iron in iron overload patients [19].


  Conclusion Top


Our study illustrates clearly that i.v. ferrous sucrose is safe, convenient, and effective without serious side effects in the treatment of postpartum iron-deficiency anemia as compared with oral ferrous sulfate. This rapid and profound response was directly related to the high amount of iron that could be delivered directly to the hemopoietic tissues. Ferrous sucrose appears to be effective because it is rapidly removed from the plasma and used for erythropoiesis. The present study concluded that i.v. ferrous sucrose increases the Hb level more rapidly than oral ferrous sulfate in women with postpartum iron-deficiency anemia; it also appears to replenish iron stores more rapidly without any significant side effects.

However, more studies will be needed for the evaluation of the effect of iron administration on the iron stores in the maternal body after delivery.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Milman N. Postpartum anemia II: prevention and treatment. Ann Hematol. 2012 Feb;91(2):143-54. doi: 10.1007/s00277-011-1381-2. Epub 2011 Dec 9. Review.  Back to cited text no. 1
    
2.
Atkinson LA, Baxley EG. Postpartum fatigue. Am Fam Physician 2004; 50:113–18.  Back to cited text no. 2
    
3.
Agget P. Iron and women in the reproductive years. In: British Nutrition Foundations Tasks Force, editors. Iron nutritional and physiological significance. 1sted. London: Chapman and Hall; 2005. pp.110–118.  Back to cited text no. 3
    
4.
Baker W. Iron deficiency in pregnancy, obstetrics, and gynecology. Hematol Oncol Clin North Am 2000; 14:1061–1077.  Back to cited text no. 4
    
5.
Bhandal N, Russell R. Intravenous versus oral iron therapy for postpartum anemia. BJOG 2006; 113:1248–1252.  Back to cited text no. 5
    
6.
Perewunsnyk G, Huch A Breymann C. Parenteral iron therapy in obsteries: 8years experience with iron-sucrose complex. Br J Nutr 2002; 88:3–10.  Back to cited text no. 6
    
7.
Jain G, Palaria, Jha SK. Intravenous iron in postpartum anemia. JObstet Gynecol India 2013; 63:45–48.  Back to cited text no. 7
    
8.
Kanwal A, Shadab W, Rehman A. To evaluate safety and efficacy of intravenous iron versus oral iron for postpartum anemia. JSOGP 2013; 3:223–226.  Back to cited text no. 8
    
9.
World Health Organization. The prevalence of anemia in women Geneva: World Health Organization; 2010. pp.1–99.  Back to cited text no. 9
    
10.
Broche D-E, Guy C, Amand-Branger S, Grangeasse L, Terzibachian J-J. Acute postpartum anemia. Clinical practice and interest of intravenous iron. Gynecol Obstet fertile 2004; 32:613–619.  Back to cited text no. 10
    
11.
Westad S, Baker B, Salvensen KA. A12week randomized study compared intravenous ferrous sucrose versus oral ferrous sulfate for treatment of postpartum anemia. Acta Obstetricia Gynecol Scand 2008; 87:916–917.  Back to cited text no. 11
    
12.
Perello MF, Coloma JL, Masoller N, Palacio M. Intravenous ferrous sucrose versus placeboin addition to oral iron therapy for treatment of severe postpartum anemia, a randomized controlled trial. BJOG 2014; 121:706–707.  Back to cited text no. 12
    
13.
Breymann C, Gliga F, Strizhova N, Bejenariu C. Comparative efficacy and safety of intravenous ferric carboxymaltose in treatment of postpartum anemia. Int J Gynecol Obstet 2008; 101:67–73.  Back to cited text no. 13
    
14.
Becuzzi N, Zimmermann R, Krafft A. Long term efficacy of postpartum intravenous iron therapy university hospital, 8091 Zurich, Switzerland. BioMed Res Int 2014; 3:113–115.  Back to cited text no. 14
    
15.
Verna S, Inamdar SA, Malhotra N. Intravenous iron therapy versus oral iron in postpartum patients in rural area. JSAFOG 2011; 3:67–70.  Back to cited text no. 15
    
16.
Giannoulis C, Danilidis A, Tantanasis T, Dinas K. Intravenous administration of iron sucrose for treating anemia in postpartum women, Hippokratia 2009; 13:38–40.  Back to cited text no. 16
    
17.
Van Wyck DB, Martens MG. Intravenous ferric carboxymaltose compared with oral iron in treatment of postpartum anemia, a randomized controlled trial. Obstet Gynecol 2007; 10:267–278.  Back to cited text no. 17
    
18.
Al-Momen AK, Al-Meshari A, Al-Nuaim L, Saddique A, Abotalib Z, Khashogji T. Intravenous iron sucrose complex in the treatment of iron deficiency anemia during pregnancy. Eur J Obster Gynecol Reprod Biol 1996; 69:121–124.  Back to cited text no. 18
    
19.
Rashidy FH, Abo Elghar HM, Kamal Eldin SM, Taha MZ. Hepcidin and iron regulation in chronic hemolytic anemia. Menoufia Med J 2015; 28:463–467.  Back to cited text no. 19
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table3], [Table4], [Table5], [Table6], [Table7]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Results
Discussion
Conclusion
Introduction
Aim of the Study
Patients and Methods
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed216    
    Printed6    
    Emailed0    
    PDF Downloaded41    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]