iron sucrose

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Presentation Description

treating anemia is a very big challenge in India. parenteral therapy with iron sucrose(orofer -s) can address this problem as it can circumvent the problem of compliance with definitive correction of IDA & replenishment of stores

Comments

By: drshashi10 (28 month(s) ago)

a student has asked me if i v sucrose iron can be given at 8 weeks of pregnancy. any studies ,or guidelines1st trimester.dr.s.kulkarni

By: sbamardeep (39 month(s) ago)

Very nice and knowlegable presentation

By: madhuchittarvu (43 month(s) ago)

Very useful and important topic I find IV Orofer s is very easy and risk free

By: vkumar (53 month(s) ago)

thank you, pl send your contact details including your profession and college, i will send it asap

By: abdulhadi (53 month(s) ago)

Nice presentation solid evidences over the issue kindly sen me this and related presentations for downloading thanks

Presentation Transcript

Parenteral iron therapy-fresh thinking : 

Parenteral iron therapy-fresh thinking Dr.Veerendra Kumar C.M. MD.,DNB Associate Professor Dept of OBG,VIMS,Bellary

Pregnancy -The most dangerous journey of mankind : 

Pregnancy -The most dangerous journey of mankind

A big challenge : 

A big challenge Treating anemia

Slide 4: 

MMR in INDIA is 300/ 100000 live births Anemia accounts for 65% maternal deaths Bhatt R. FOGSI- WHO study. J Obstet Gynecol Ind 1997;47:207-214

Only demons no angels : 

Only demons no angels PNMR is 9 times more LBW risk is tripled PT labor risk doubled Placenta to birth weight ratio increased(predecessor of adult Hypertension) Poor mental & motor performance Barker DJP, Br Med J 1990 ;301: 259-262.

Are we producing a defective generation? : 

Are we producing a defective generation?

A FAILED PROGRAMME : 

A FAILED PROGRAMME IFA programme was started in 1970 Even now -NFH survey- 84% prevalence (9.2% severe) Only 10% of women consume correctly! Indian J Med Res 2006:124:173-184)

Parenteral iron -The solution? : 

Parenteral iron -The solution? Most of the patients ‘psyche’ in favor of injections Myths about oral therapy

Parenteral iron : 

Parenteral iron 1000mg of iron given by 10 im injectionsPrema 1982 250mg of iron 2 doses- just like 2 TT injections R bhat 1996unacceptable incidence of serious reactions

Hazards of blood transfusion in USA : 

Hazards of blood transfusion in USA Hemolytic reactions 1 in 40,000 Non hemolytic febrile reactions 3-4% Anaphylactic reactions 1 in 20,000 GVHD 0.1 to 1% TRALI 0.1-0.2% HBV 1 in 50,000 HCV 1 in 3000 HIV 1 in 1,50,000

Ray of hope ? : 

Ray of hope ? (orofer-s) iron sucrose

Irrefutable evidence : 

Irrefutable evidence IV iron sucrose results in a much more rapid resolution of IDA and because it is administered intravenously, it circumvents the problems of compliance.Am J Obstet Gynecol 2002;88:3-10.Eur J Obstet Gynecol Reprod Biol 1996;69:121-124.

Slide 13: 

Main use is in chronic kidney diseaseNDD-CKD,HDD-CKD,PDD-CKD Most dialysis pts require iv iron to maintain iron stores

Christian Breymann, Zurich : 

Christian Breymann, Zurich I was severely criticized by older colleagues,…..,confident about the safety & effectiveness …glad that other groups are confirming our experience…even more convinced after 14 yearsEuro J Obst & Gynecol 123 (2005) Editorial

Continued…. : 

Continued…. “Please do not be worried of severe anaphylaxis & unpleasant side effects…..less than 0.5% minor side effects ….not aware of any serious reaction in any country” Every obstetric hospital setting should have a therapeutic scheme to treat advanced post partum anemia

Holds good even after 50 yrs! : 

Holds good even after 50 yrs! If oral iron does not work , switch quickly to intravenous iron, don’t waste your & your pt’s time on oral iron that does not workScott, Govan, Lancet -1949 Jan ,253(6540)14-7

Iron Sucrose (Orofer-s) : 

Iron Sucrose (Orofer-s) Polynuclear ferric hydroxide MW 34,000-60,000 daltons Each ml contains 20 mg of Fe After iv administration it dissociates into iron & sucrose t/2 is 6hrs

Peak levels reached in 10 minby 24 hours all the iron sucrose is used (pre & post serum iron was same) : 

Peak levels reached in 10 minby 24 hours all the iron sucrose is used (pre & post serum iron was same)

Less oxidative cell injury : 

Less oxidative cell injury All iron preparations except iron sucrose were capable of causing tissue peroxidation iron sucrose is sequestered much more by the RES and lesser in the parenchyma. Less risk of tissue parenchymal injury by free iron. Zager et al Am J of Kidney disease 2002,40;90-103 Iron sucrose do not over saturate the transferrin Am J soc Nephrology 2004 Jun vol 6

Total dose infusion not recommended : 

Total dose infusion not recommended 200mg max dose per sitting Administered thrice weekly Can be given by either iv bolus undiluted push or iv infusion 50 mg to be injected slowly over 2 minutes, wait for 2-3 min ,then give another 50 mg over 2 min 100mg-200 mg to be diluted with 100ml NS ,infuse at least 15 min LD 50 in mice is > 200mg/kg

Pregnant women with anemia : 

Pregnant women with anemia

Post partum anemia : 

Post partum anemia

Slide 23: 

High EPO state in postpartum anemia Iv iron supplementation in such period increases the erythropoiesis 5 times The Hb rise will be evident in as early as 5 days! Harrisons principles of medicine

Iv bolus v/s iv infusion : 

Iv bolus v/s iv infusion Iv bolus push is less costly, more compliance hema divakar ,myanyonda on a study of 152 pts Presently working on large multicentric trial

VIMS EXPERIENCE : 

VIMS EXPERIENCE RCT (2006-2007) byJoshi Suyajna D Veerendrakumar C M Kusuma Naik

Slide 26: 

Group A 50 pts destined to receive IV sucrose ( orofer –s ) Group B 50 pts destined to receive IV dextran ( imferon)

Slide 27: 

Reactions

Slide 29: 

In Iron Sucrose group the rise in Hb% was by 2.16+0.06gm%, In Iron Dextran group the rise in Hb% was by 1.45+0.05gm%,

Take home message : 

Take home message Iv iron sucrose is safe & effective Faster & certain resolution of IDA 200mg iron sucrose can be given per sitting Can be given thrice weekly Iron sucrose is given both bolus push & infusion

Conclusions contd… : 

Conclusions contd… Other parenteral iron becoming obsolete Highly suitable for pregnancy with anemia Post partum anemia quicker response Pre – post operative anemia can also be cured Less need for blood transfusion

Slide 32: 

Thank you