Objective
The aim of the study was to evaluate the therapeutic yield of intravenous iron for
preoperative preparation of patients assigned for uterine myomectomy compared with
oral iron therapy and to determine the value of supplemental erythropoietin therapy in
resistant cases.
Patients and methods
Sixty women assigned for myomectomy were allocated into two groups: the
intravenous group and the oral group. The intravenous group received intravenous iron
sucrose therapy every other day to fulfill the calculated dose and the oral group
received ferrous bis-glycine sulfate with folic acid yielding 100 mg elemental iron daily.
Vitamin C effervescent tablets were given to group oral women to enhance iron
absorption. Women who did not approach hemoglobin concentration (Hb conc.) of
more than 10 g/dl (the surgical target concentration) within 4 weeks received weekly
subcutaneous injection of epoetin-a up to a total dose of more than 600 IU/kg plus oral
iron therapy. Venous blood samples were obtained at the time of enrollment and at 2,
4, and 6 weeks of intervention for estimation of Hb conc. and ELISA estimation of
serum ferritin.
Results
Both groups showed a steady, progressive, significant increase of Hb conc. with
concomitant significant decrease of concentration deficit. Patients in the intravenous
group showed significantly higher Hb conc. at 2 weeks compared with the oral group,
and the difference was higher at 4 weeks of therapy. Intravenous therapy led to a
significantly lower frequency of patients requiring epoetin-a therapy compared with
oral therapy. Both groups showed a steady, progressive, significant increase of serum
ferritin levels, with significantly higher levels in the intravenous group compared with
the oral group throughout the study period. At 2- and 4-week estimations, serum
ferritin level was significantly higher compared with baseline level in both groups, with
significantly higher levels at 4 weeks compared with 2 weeks. At week 6, serum ferritin
level was significantly higher in the oral group but was nonsignificantly higher in the
intravenous group compared with 4-week levels, despite the significantly higher levels
in both groups compared with baseline and 2-week levels.
Conclusion
Intravenous iron sucrose therapy allowed rapid and efficient alleviation of anemia and
spares the need and cost of erythropoietin therapy. Combination of oral iron and
erythropoietin allowed resistant cases to approach the surgical target concentration. |
