Is Iron Sucrose the Answer!
This article is for someone who can understand medical language. Not recommended for non medical background.
We as a country have not been able to fight against anemia. It’s a disease whichis eating us from within…… we are loosing far too many mothers to this white ghost……
Rising prevalence of anemiain our country:Anemia is the most important indirect cause of maternal death and suffering inour country, each and every health care provider is aware of this fact. Thenwhy are we taking so long to control it . Its been more than 50 years now sincethe efforts began! Our prevalence of anemia is still around 60 %, some stateseven report close to 80% among pregnant and lactating women.(Iron deficiency being the most important cause)
The National Nutritional Anemia Control Program (NNACP) started way back in 1970, numerous other programs and strategies have been launched there after. But we still have almost the same prevalence of anemia as earlier and we continue toloose our mothers to it. It’s high time we look closely and reevaluate our strategy. Somewhere the plan is not working out. We have to look for better options.
Failure of the IFA programme: It has been found in oneof the studies conducted by parekh and peggy et al in “ Perceptions of anaemia and health seeking behaviour among women in four indian states Technical Working paper #9” That In North Haryana, although more than 90% of the pregnant women were receiving iron folate tablets at some point during pregnancy, only 10% of the women consumed the tablets regularly for the recommended duration of three months. (Similar findings were reported by Agarwal et al in Indian J Med Res2006:124:173-184 that Only 10% of women consume correctly)The reasons for low compliance in the working paper included: lack of knowledge of the importanceof correcting anemia, lack of understanding thepurpose of iron folate supplements, lack of time to obtainsupplements, forgetfulness, unfamiliarity with the need to continue dailyconsumption for a minimum of 90-100 days, and side effect. Women do not seem to understand why it is important for them to consume the “red tablets” that are so widely promoted by their health providers and clinics. The low utilisation of antenatal services is another important factor in the highrates of anemia among pregnant women in India. Majority of whom are registeredin the late second or early third trimester of pregnancy.
Also “gaon mein auratein theekh khurak nahin khatin, sabko khila kar sabse baad mein bachha khuchha kha leti hain” (in villages women don’t take a proper diet; theyeat last, whatever is left). Added to all this the illiteracy among our womenis no less.
So … till our womenget educated and understand their body’s requirement for added nutrition andiron micronutrient supplementation. Till they start making independent decisionsfor themselves regarding their health, about taking early and adequate Antenatal care and care for the food they eat and medicines they should take . Tillthey get full control of their lives ….we have to look for an alternative optionto help them survive and live a better quality life.
Fresh thinking at alternatives : May be its time now we look at options other than oraliron therapy. The new approach would be to catch them and treat them the momentwe encounter them. Whatever be the gestational age if the hemoglobin% is less than 10 give them a push of iron sucrose 200mg iv in the same sitting. We don’tknow if she will turn up again before setting into labor. Iron sucrose isextremely beneficial even in the post partum period ! 200mg of elemental ironraises hemoglobin by 1gm % !
A recent meta-analysis by WHO 2004 shows that correctinganemia of any severity reduces the risk of death: the risk ofmaternal mortality decreases by about 20% for each 1 gm% increase in Hb. This decreased risk is continuous over the full range of Hb between 5 and 12but it is not linear — the decrease in risk is greater at the lower Hb concentrations.
So like two doses of TT if our women also get atleast two shots of 200mg of iron sucrose direct intravenous push, we will makesure that we are improving her chances of survival even in the worst case scenarios.
There is ample evidence available now confirming the safety and efficacy of iron sucrose. It can be given inundiluted form direct intravenous route. Christian Breymann states that “With regard to theuse of intravenous iron in obstetrics, there is increasing evidence that ironsucrose is safe for the mother andthe fetus using the recommended dosages and therapy regimens. Whether it isreasonable to wait for a response to oral iron in moderate to severe anemia istherefore questionable.” Divakar Manyonda et all also statesthat “The administration of iron sucrose by the bolus-push technique has similar efficacy to the conventional slow infusion technique”. Minor side effects like giddiness, itching and pain at injection site, are encountered but resolve rapidly.
The cost of this intervention is not very high, compared to blood transfusion and treatment of complications. May be down the line our Government may even help us financially, if it sees the tremendous difference that it can make to the health of our mothers.
Recommended schedule: After calculating the total iron requirement depending on present hb % and wt of the patient,multiple doses can be given till 11 gm % is achieved. (Calculation of totaliron requirement = weight in kg x hb deficit x2.21 plus 500mg for depleted iron stores). Administer 200 mg slow injection (over 2-5 minutes) on 5 different occasions withina 14-day period. Total cumulative dose: 1000 mg in 14-day period. The rate of administration should not exceed 20 mg per minute. A test dose is also not required and is at the physician’s discretion. Total dose infusion should not be given. Iron sucrose works very well in treatment of postpartum anemia. Repeated intermittent injections avoid the need of blood transfusion, and complications associated with it , in patients with severe to moderate anemia.
Due to a number of social and economic constrains, ourwomen may not be able to comply with the complete required care and treatment during pregnancy and puerperium. The IFA tablets have not worked for us. Our health care workers are experts in giving parenteral injections.!Giving at least two doses of 200mg iron sucrose wheneverpossible, if not more, will surely make a difference in her ability to withstand the most amazing process of nature, labour. It may even give her and her baby a better chance of survival. There are many practitioners who have taken up the use of this intervention and have saved many lives already. So let us strike anemia, where it strikes us the most, in the blood !