Intravenous ferric carboxymaltose for the treatment of iron deficiency anemia: Letter to Editor

While we are reading with great interest the article published by Friedrisch et al. in the Revista Brasileira de Hematologia e Hemoterapia 2015;37(6):400–5. doi:10.1016/j.bjhh.2015.08.012, many questions came to mind. We would be grateful if the authors clarified the following queries to us and to the readers.

First, Friedrisch et al., stated that treatment with intravenous ferric carboxymaltose (FCM) improves indices of anemia, hemoglobin, ferritin and trans-ferrin saturation values.¹

Other authors mentioned that the efficacy of the parenteral iron infusion used for treatment of iron deficiency anemia (IDA), checked by comparing the pre-treatment hemoglobin concentration, serum ferritin, mean corpuscular volume and mean corpuscular hemoglobin with the post-treatment value.^2-6

Second, Friedrisch et al. stated that the intravenous FCM properties permit the administration of large doses (15 mg/kg, maximum of 1000 mg/infusion) in a single and rapid session (15-min infusion), without the requirement of a test dose.¹

Other authors stated that the total parenteral dose for correction of IDA should be given and calculated according to the body weight, hemoglobin deficiency and depleted iron stores, using the following formula: total parenteral iron needed in mg = 2.4 × pre-pregnancy weight in kg × (target hemoglobin − actual hemoglobin) g/dL + 500 mg. Twelve (12) g/dL is the target hemoglobin concentration, 2.4 is the correction factor and 500 mg is the amount of stored iron in pregnant adult women.^2-8

Recently, Froessler et al. applied another regimen of 20 mg/kg body-weight of FCM for treatment of IDA in pregnancy with a maximum dose of 1000 mg in a single infusion and they stated that an ideal dosing regimen currently does not exist.^9,10

Please clarify to us and to the readers the ideal method for checking the efficacy of parenteral iron treatment and the ideal method for the calculation of the total parenteral iron needed for treatment of IDA in pregnancy.

Conclusion

The efficacy of the parenteral iron infusion used for treatment of IDA is checked by comparing the pre-treatment hemoglobin concentration, serum ferritin, MCV and MCH with the post-treatment value. Total parenteral dose for correction of IDA should be given and calculated according to the body weight, hemoglobin deficiency and depleted iron stores, using the following formula: total iron needed in mg = 2.4 × pre-pregnancy weight in kg × (target hemoglobin − actual hemoglobin) g/dL + 500 mg. Twelve (12) g/dL is the target hemoglobin concentration, 2.4 is the correction factor and 500 mg is the amount of stored iron in pregnant adult women.

Compliance with ethics guidelines.

• Ethical approval
  This article does not contain any studies with human or animal subjects performed by any of the authors.

References

• ¹
  Friedrisch JR, Cançado RD. Intravenous ferric carboxymaltose for the treatment of iron deficiency anemia. Rev Bras Hematol Hemoter. 2015;37(6):400-5.
• ²
  Abdelazim IA, Nusair B, Svetlana S, Zhurabekova G. Treatment of iron deficiency and iron deficiency anemia with intravenous ferric carboxymaltose in pregnancy. Arch Gynecol Obstet. 2018;298(6):1231-2.
• ³
  Abdelazim IA, Abu-Faza M, Elbiaa AA, Othman HS, Alsharif DA, Elsawah WF. Heme iron polypeptide (proferrin®-ES) versus iron saccharate complex (ferrosac) for treatment of iron deficiency anemia during pregnancy. Acta Med Int. 2017;4:56-61. Available from: http://www.actamedicainternational.com/text.asp?2017/4/1/56/209822 [cited 04.08.18].
  » http://www.actamedicainternational.com/text.asp?2017/4/1/56/209822
• ⁴
  Shafi D, Purandare SV, Sathe AV. Iron deficiency anemia in pregnancy: intravenous versus oral route. J Obstet Gynaecol India. 2012;62(3):317-21.
• ⁵
  Bayoumeu F, Subiran-Buisset C, Baka NE, Legagneur H, Monnier-Barbarino P, Laxenaire MC. Iron therapy in iron deficiency anemia in pregnancy: intravenous route versus oral route. Am J Obstet Gynecol. 2002;186(3):518-22.
• ⁶
  Bhavi SB, Jaju PB. Intravenous iron sucrose v/s oral ferrous fumarate for treatment of anemia in pregnancy. A randomized controlled trial. BMC Pregnancy Childbirth. 2017;17(1):137.
• ⁷
  Barut A, Harma M. Intravenous iron treatment for iron deficiency anemia in pregnancy. J Turkish-German Gynecol Assoc. 2009;10:109-15.
• ⁸
  Kalaivani K. Prevalence and consequences of anemia in pregnancy. Indian J Med Res. 2009;130(5):627-33.
• ⁹
  Froessler B, Gajic T, Dekker G, Hodyl NA. Treatment of iron deficiency and iron deficiency anemia with intravenous ferric carboxymaltose in pregnancy. Arch Gynecol Obstet. 2018;298(1):75-82.
• ¹⁰
  Froessler B, Gajic T, Dekker G, Hodyl NA. Response to letter to the Editor: Treatment of iron deficiency and iron deficiency anemia with intravenous ferric carboxymaltose in pregnancy. Arch Gynecol Obstet. 2018;298(6):1233-4.

Publication Dates

• Publication in this collection
  30 Mar 2020
• Date of issue
  Jan-Mar 2020

History

• Received
  18 Dec 2018
• Accepted
  29 Jan 2019