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Postpartum iron deficiency anemia (IDA) is a common problem throughout the world. Various treatment modalities like oral iron therapy, parenteral iron therapy and blood transfusion are used to treat anemia in the postpartum period. This study aimed to compare efficacy, safety, tolerability and side effects of treatment with either intravenous iron sucrose or oral ferrous gluconate for postpartum iron deficiency anemia to ascertain whether administering intravenous iron sucrose to women with postpartum anemia results in higher hemoglobin concentration and improved iron stores than using standard treatment with oral iron. This comparative, randomized and prospective study conducted in Obstetrics and Gynecology Department of Benha University Hospital and Benha Teaching Hospital in the period from 1/11/2018 to 30/9/2019. This study was carried on 60 women with postpartum iron deficiency anemia. The inclusion criteria was hemoglobin concentration <10 g/dl and serum ferritin of < 15 μg/l at 24 hours post-delivery. The exclusion criteria was intolerance to iron derivatives, peripartum blood transfusion or a history of asthma, thromboembolism, seizure, alcohol, drug abuse, renal or hepatic dysfunction. Patients were randomized into either group 1, where they were received intravenous iron sucrose (Inj Sacrofer 100mg/Amp), two to three doses were given on alternate days as an intravenous infusion in 250 ml of 0.9% sodium chloride for at least 2 hrs or group 2, where they were received oral ferrous gluconate (Tab Glucofer) 300mg twice daily 2 hrs after meals for 6 weeks. Blood samples for hemoglobin (Hb) level, hematocrit (Hct) value, mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), C- reactive protein (CRP) test, serum ferritin and serum total iron binding capacity (TIBC) were measured on day 0, 7, 14 and 40 postpartum. There was no statistically significant difference in Day 0 Hb among group 1 (I.V Iron group) compared to group 2 (Oral Iron group). There was statistically significant increase in Day 7 Hb, Day 14 Hb and Day 40 Hb level among group 1 than group 2. There was no statistically significant difference between group 1 and group 2 regarding Day 0 Hct. There was statistically significant increase in Day 7 Hct and Day 14 and Day 40 Hct among group 1 than group 2. There was no statistically significant difference between group 1 and group 2 regarding Day 0 MCV. There was statistically significant increase in Day 7 MCV, Day 14 MCV and Day 40 MCV among group 1 than group 2. There was no statistically significant difference between group 1 and group 2 regarding Day 0 MCHC. There was statistically significant increase in Day 7 MCHC, Day 14 MCHC and Day 40 MCHC among group 1 than group 2. There was no statistically significant difference between group 1 and group 2 regarding Day 0 Ferritin. There was statistically significant increase in Day 7 Ferritin, Day 14 Ferritin and Day 40 Ferritin among group 1 than group 2. There was no statistically significant difference between group 1 and group 2 regarding nausea, dyspepsia, facial flushing and constipation. Intravenous iron sucrose is more effective than oral ferrous gluconate regarding the increase of hemoglobin level. Ferritin levels rose rapidly in those treated with intravenous iron and remained significantly higher than in those treated with oral iron without any significant serious side effects .

Key words

Ferritin, Oral ferrous gluconate, Intravenous iron sucrose, Postpartum iron deficiency anemia.