Use of iron in perinatal anaemia: Indications for women’s health care policies and procedure

Abstract

This paper reviews management of obstetric anaemia and the role of intravenous iron for the treatment of obstetric anaemia. Red blood cell transfusions are routinely used for haemoglobin restoration in anaemic women. The decision for red blood cell transfusion is made on a combination of haemoglobin level and clinical status, and it is suggested that transfusions are not necessary in those who are well compensated or when alternative therapy is available. To reduce the risk, intravenous iron infusion is proposed as a bloodless therapeutic approach. There are a variety of iron preparations. Intravenous iron infusion can reduce the requirement for blood transfusion in hemodynamically stable women with perinatal anaemia, especially in resource-scarce settings. It a cost-effective bloodless approach for the treatment of anaemia than can enhance patient outcomes. According to the literature, when haemoglobin is greater than 90 g/L, blood transfusion is not often required. In perinatal women with anaemia, the decision whether to administer blood or iron is based on patient preferences, haemoglobin levels, clinical symptoms, past and present medical conditions and the clinician’s judgement. Nevertheless, due to the lack of rigid criteria for blood transfusions in the majority of clinical settings, it is considered the default treatment for anaemia in perinatal women.

Keywords: Anaemia; Blood transfusion; Iron deficiency; Iron infusion; Postpartum haemorrhage; Pregnancy

Core Tip: Red blood cell (RBC) transfusions are routinely used for haemoglobin (Hb) restoration in anaemic women. However, unnecessary RBC transfusion is associated with adverse outcomes. Obstetrics patient blood management guidelines aims to reduce the use of RBC through utilisation of iron. Iron preparations can improve haematological parameters including Hb and ferritin. Iron infusion is a cost-effective bloodless approach for the treatment of anaemia.