Pacific University CommonKnowledge School of Physician Assistant Studies Theses, Dissertations and Capstone Projects 8-14-2010 Intravenous Iron Versus Oral Iron in the Treatment of Postpartum Iron Deficiency Anemia Meghan Crowley Pacific University Follow this and additional works at:http://commons.pacificu.edu/pa Part of theMedicine and Health Sciences Commons Recommended Citation Crowley, Meghan, "Intravenous Iron Versus Oral Iron in the Treatment of Postpartum Iron Deficiency Anemia" (2010).School of Physician Assistant Studies.Paper 228. This Capstone Project is brought to you for free and open access by the Theses, Dissertations and Capstone Projects at CommonKnowledge. It has been accepted for inclusion in School of Physician Assistant Studies by an authorized administrator of CommonKnowledge. For more information, please [email protected]. Intravenous Iron Versus Oral Iron in the Treatment of Postpartum Iron Deficiency Anemia Abstract Background: Postpartum anemia can develop after delivery because of unforeseen medical problems during and after delivery which could complicate a mother’s ability to properly care for her newborn child. The current treatment for postpartum anemia is oral iron supplementation but this treatment has been associated with several gastrointestinal side effects. Alternative treatments include blood transfusions and intravenous (IV) iron therapy. Since blood transfusions are very costly, IV iron treatments have become more popular. Objectives: The objective of this review is to evaluate the hematological parameters and quality of life of women with postpartum anemia while being treated with IV iron sucrose or IV ferrous carboxymaltose compared to oral ferrous sulfate. Methods: An exhaustive search of available medical literature was performed using three databases: MEDLINE, EMBASE and CINAHL. All keywords were originally searched individually and then combined to refine the search. The inclusion criteria consisted of randomized control trials (RCT) published in English after January 2000, which looked at hematologic parameters in postpartum anemic women being treated with either an oral iron supplement or IV iron therapy. Results: Six RCTs involving 1140 women were reviewed. Four of the studies showed that anemia was corrected with iron therapy at some point during the trial regardless of the treatment method. Three studies showed a significantly decreased amount of time to increase hemoglobin (Hb) levels in the women who where treated with IV iron therapy. All of the studies showed a significant increase in ferritin levels in the IV iron therapy group when compared to the oral iron group, with five of the six studies ending their studies with significantly continued ferritin elevation in the IV iron group. The two studies that examined maternal quality- of-life parameters reported non-significant improvements in the IV treatment group. Although both of these studies also assessed maternal fatigue, only one study reported significant declines in physical and total fatigue. Conclusion: Both ferric carboxymaltose and iron sucrose are safe and effective ways to treat postpartum iron deficiency anemia. Both forms of IV iron are superior to oral ferrous sulfate as they require a shorter treatment period, increase the likelihood of compliance, have no gastrointestinal side effects and rapidly replenish iron stores. Degree Type Capstone Project Degree Name Master of Science in Physician Assistant Studies First Advisor Annjanette Sommers MS, PAC Second Advisor Rob Rosenow PharmD, OD This capstone project is available at CommonKnowledge:http://commons.pacificu.edu/pa/228 Keywords postpartum anemia, intravenous iron, oral iron, ferric carboxymaltose, ferrous sulphate, anemia, iron deficiency Subject Categories Medicine and Health Sciences Rights Terms of use for work posted in CommonKnowledge. This capstone project is available at CommonKnowledge:http://commons.pacificu.edu/pa/228 Copyright and terms of use If you have downloaded this document directly from the web or from CommonKnowledge, see the “Rights” section on the previous page for the terms of use. If you have received this document through an interlibrary loan/document delivery service, the following terms of use apply: Copyright in this work is held by the author(s). 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Intravenous Iron Versus Oral Iron in the Treatment of Postpartum Iron Deficiency Anemia Meghan Crowley A Clinical Graduate Project Submitted to the Faculty of the School of Physician Assistant Studies Pacific University Hillsboro, OR For the Masters of Science Degree, August 14, 2010 Faculty Advisor: Annjanette Sommers MS, PAC Clinical Graduate Project Coordinators: Annjanette Sommers MS, PAC & Rob Rosenow PharmD, OD Biography [Redacted for privacy] 1 Abstract Background: Postpartum anemia can develop after delivery because of unforeseen medical problems during and after delivery which could complicate a mother’s ability to properly care for her newborn child. The current treatment for postpartum anemia is oral iron supplementation but this treatment has been associated with several gastrointestinal side effects. Alternative treatments include blood transfusions and intravenous (IV) iron therapy. Since blood transfusions are very costly, IV iron treatments have become more popular. Objectives: The objective of this review is to evaluate the hematological parameters and quality of life of women with postpartum anemia while being treated with IV iron sucrose or IV ferrous carboxymaltose compared to oral ferrous sulfate. Methods: An exhaustive search of available medical literature was performed using three databases: MEDLINE, EMBASE and CINAHL. All keywords were originally searched individually and then combined to refine the search. The inclusion criteria consisted of randomized control trials (RCT) published in English after January 2000, which looked at hematologic parameters in postpartum anemic women being treated with either an oral iron supplement or IV iron therapy. Results: Six RCTs involving 1140 women were reviewed. Four of the studies showed that anemia was corrected with iron therapy at some point during the trial regardless of the treatment method. Three studies showed a significantly decreased amount of time to increase hemoglobin (Hb) levels in the women who where treated with IV iron therapy. All of the studies showed a significant increase in ferritin levels in the IV iron therapy group when compared to the oral iron group, with five of the six studies ending their studies with significantly continued ferritin elevation in the IV iron group. The two studies that examined maternal quality-of-life parameters reported non-significant improvements in the IV treatment group. Although both of these studies also assessed maternal fatigue, only one study reported significant declines in physical and total fatigue. Conclusion: Both ferric carboxymaltose and iron sucrose are safe and effective ways to treat postpartum iron deficiency anemia. Both forms of IV iron are superior to oral ferrous sulfate as they require a shorter treatment period, increase the likelihood of compliance, have no gastrointestinal side effects and rapidly replenish iron stores. Keywords: postpartum anemia, intravenous iron, oral iron, ferric carboxymaltose, ferrous sulphate, anemia, iron deficiency. 2 Acknowledgements To my parents To my siblings, Dr Nation and Nurse Ann… To my friends… To Tad… 3 Table of Contents Biography 1 Abstract 2 Acknowledgements 3 Table of Contents 4 List of Tables 5 List of Figures 5 List of Abbreviations 5 Background 6 Methods 9 Results 9 Discussion 19 Conclusion 23 References 24 Tables 28 Figures 30 4