Authors (including presenting author) :
Wong CK(1), Hung MW(1), Ng KS(1), Lau WL(1), Lee CK(2), Leung WC(1)
On behalf of KWH Obstetrics Patient Blood Management Team
Affiliation :
(1)Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Kowloon Central Cluster
(2)Hong Kong Red Cross Blood Transfusion Service, Kowloon Central Cluster
Introduction :
In Hong Kong, it has been reported that 2.3% of women experienced severe postpartum anaemia with haemoglobin less than 8 g/dL. It could increase the risk of maternal fatigue, puerperal sepsis and postpartum depression. To improve the situation, we introduced the use of intravenous iron therapy for women at postpartum period since early 2020.
Objectives :
To study the efficacy and safety of intravenous iron followed by oral iron supplement in treating women with severe postpartum anaemia. Moreover, we also explored if there is any reduction in the use of blood products and overall medical costs.
Methodology :
We retrospectively reviewed the records of those haemodynamically stable women with haemoglobin 6 - 8g/dL on day 2 postpartum who were given intravenous iron infusion between January and December 2020. Women with documented postpartum haemorrhage or haemoglobin dropping more than 3 g/dL from pre-delivery level but otherwise asymptomatic were eligible for the intravenous iron therapy. The treatment regimen included a single infusion of 500mg iron isomaltoside (Monofer) followed by oral FeSO4 300mg daily for 12 weeks. Haemoglobin and ferritin level were measured at 2 weeks and 6 weeks after delivery during their routine follow up.
Result & Outcome :
29 patients received intravenous iron for severe postpartum anaemia were identified. The mean haemoglobin level was 7.2 g/dL and the mean ferritin level was 104.1 pmol/L on day 2 postpartum. After administration of intravenous iron, the mean haemoglobin level increased by 3.5 g/dL to 10.7 g/dL at 2 weeks and by 5.3 g/dL to 12.4 g/dL at 6 weeks respectively. The mean ferritin level increased to 456.6 pmol/ L at 2 weeks and 171.5 pmol/L at 6 weeks. There was no adverse nor allergic reaction in all women received intravenous iron. The reduction of red cell transfusion was estimated to be at least 29 units. As the cost of each unit red cell is around HKD$1200 and 500mg intravenous Monofer is HKD$642.3, a total of HKD$16173.3 is saved.
To conclude,single fixed-dose intravenous iron is effective and safe in treating severe postpartum anaemia. Further research is required to compare the efficacy and outcomes between intravenous iron and blood transfusion.
