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2014, Number 3

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Rev Hematol Mex 2014; 15 (3)

Intravenous delivery of iron dextran: 23 years-experience in a single institution

Alvarado-Ibarra M, López-Hernández M, Álvarez-Vera JL, Ortiz-Zepeda SM, Palomo-Farías F

Language: English
References: 21
Page: 95-102
PDF size: 397.87 Kb.


ABSTRACT

Objective: To analyze the clinicopathologic characteristics of patients with iron deficiency anemia treated with intravenous iron in a Specialty Hospital.
Material and method: A retrospective study was performed including patients older than 15 years with iron deficiency anemia who were treated with intravenous iron dextran from 1987 to 2010. Clinical/ electronic records of patients registered in the hematology service of the 20 de Noviembre Hospital, Mexico City, between July and August 2010 were included, obtaining the data requested in the data collection sheet to evaluate the following variables: sex, age, date of infusion, lab results with a period of no longer than 1 month ago iron administration, involving serum levels of hemoglobin (‹12 g/dL in women and ‹14 g/ dL in men to define the presence of anemia), hematocrit, mean corpuscular volume and hemoglobin percentage of corrected reticulocytes red cell distribution width (RDW), iron profile (serum iron, transferrrin, transferrin saturation index, total capacity and latent iron binding), ferritin and Perls staining.
Results: 761 infusions were done, 110 men and 651 women, average age 52 years, mean Hb and iron deficiency 8.7g/dL of 1,285mg/dL were performed. The main causes were diseases associated with lower gastrointestinal bleeding (48%), including those secondary to treatment (not chronic peptic rheumatological disease, rheumatologic disorders, arthropathy and hepatic cirrhosis) and abnormal uterine bleeding (27%). In 49% of cases there were at least 2 cases and 79% were administered multiple drugs, of these, 45% were potentially harmful to the gastrointestinal mucosa (NSAIDs, antiplatelet agents, oral anticoagulants and steroids) and 27% had polypharmacy (› 5 drugs). There were 111 patients in recurrent anemia, with an average of 3 infusions per patient in this group and an interval of 55 weeks. The number of reported serious adverse events was 0.26% and no cases of anaphylaxis or treatmentrelated death were found.
Conclusions: The main causes of iron deficiency anemia are associated with upper gastrointestinal bleeding diseases, although half of the cases have more than one cause, including administration of harmful drugs to the gastrointestinal mucosa and polypharmacy. There is a low incidence of severe anaphylactic effects with a high level of security.


REFERENCES

  1. Killip S, Bennet JM, Chambers MD. Iron deficiency anemia. Am Fam Physician 2007;75:671-678.

  2. Umbreit J. Iron deficiency: a concise review. Am J Hematol 2005;78:225-231.

  3. Freire WB. La anemia por deficiencia de hierro: estrategias de la OPS/OMS para combatirla. Salud Púb Méx 1998;40:199-205.

  4. Sans-Sabrafen J, Besses C, Vives JL. Hematología clínica. Madrid: Elsevier, 2006.

  5. Beutler E, Coller BS, Kipps TJ, Seligsohn U, Lichtman MA. Williams Hematología. Madrid: Marbán, 2005.

  6. Casanueva E, de Regil LM, Flores MF. Anemia por deficiencia de hierro en mujeres mexicanas en edad reproductiva. Historia de un problema no resuelto. Salud Púb Méx 2006;48:166-175.

  7. Shamah T, Villalpando S, García A, Mundo V, et al. Anemia in Mexican women: results of two national probabilistic surveys. Salud Púb Méx 2009;51:S515-S522.

  8. Martínez H, Casanueva E, Rivera J, Viteri F, Bourges H. La deficiencia de hierro y la anemia en niños mexicanos. Acciones para prevenirlas y corregirlas. Bol Med Hosp Infant Mex 2008;65:86-99.

  9. Olaíz G, Rivera J, Shamah T, Rojas R, et al. Encuesta Nacional de Salud y Nutrición 2006 (ENSANUT 2006). Cuernavaca: Instituto Nacional de Salud Pública, 2006.

  10. Martínez C, González A, Domínguez S. Patología digestiva alta en pacientes de edad avanzada con anemia ferropénica: comparación entre usuarios y no usuarios de anti inflamatorios no esteroideos. An Med Interna (Madrid) 2001;18:357-360.

  11. Weiss G, Gasche C. Pathogenesis and treatment of anemia in inflammatory bowel disease. Haematol 2010;95:176- 179.

  12. Paniagua M, Piñol F. Ectasias vasculares del antro gástrico como causa de hemorragia digestiva crónica. Rev Cubana Med 1999;38:71-78.

  13. García A, Villegas A, González F. Manifestaciones hematológicas en el lupus eritematoso sistémico. An Med interna (Madrid) 2002;19:539-543.

  14. Wilson A, Reyes E, Ofman J. Prevalence and outcomes of anemia in inflammatory bowel disease: a systematic review of the literature. Am J Med 2004;116:44S-49S.

  15. Silvertein S, Rodgers G. Parenteral iron therapy options. Am J Hematol 2004;76:74-78.

  16. Maniatis A. Intravenous iron as an alternative transfusion. Transfus Med 2007;9:13-18.

  17. Katodritou E, Verrou E, Zervas K. Intravenous iron: a useful therapeutic tool but not a panacea. Am J Haematol 2008;83:521-523.

  18. Critchley J, Dunbar Y. Adverse events associated with intravenous iron infusion (low-molecular-weight iron dextran and iron sucrose): a systematic review. Transfus Med 2007;9:8-36.

  19. Chertow GM, Mason PD, Vaage-Nilsen O, Ahlmen J. On the relative safety of parenteral iron formulations. Nephrol Dial Transplant 2004;19:1571-1575.

  20. Baile GR. Hypersensitivity reactions and deaths associated with intravenous iron preparations. Nephrol Dia Transplant 2005;20:1443-1449.

  21. Maslovsky I. Intravenous iron in primary-care clinic. Am J Haematol 2005;78:261-264.




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