Table 4 Free text responses
Common themes | Representative responses |
|---|---|
Advantages of IV iron | |
Specific difficulties with oral iron (n = 6) | Low ferritin, not responding to oral iron Avoid side effects of oral iron Noncompliance with oral iron Avoids the daily hassle of taking oral tabs |
Avoidance of blood transfusion (n = 4) | Reduction in need for transfusion peri-partum |
Well timed, it can be a step to consider before packed RBCs transfusion, although this consideration has more merit in the immediate postpartum period | |
Useful after a mild postpartum haemorrhage | |
Postpartum haemorrhage when Hb is between 7 and 9 | |
Reduced PPH risk (n = 1) | Women bleed less at delivery |
Maternal QOL outcomes (n = 1) | Health related QOL outcomes https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3488743/ |
Others (n = 8) | Although NOT in favour of infusion, hospital dictates one to implement infusion Symptomatic women You know the iron status will improve Severe iron deficiency |
Disadvantages of IV iron | |
Anaphylaxis (n = 18) | Risk of anaphylaxis (although low) Anaphylaxis 1/1000 = risk to mother and baby |
Other adverse effects (n = 12) | Potential side effects Adverse reactions in up to 20% |
Risk of allergic reactions (n = 10) | Possibility of allergic reactions Risk of allergic and anaphylactoid events not inconsiderable and overall adverse reactions - a few/100 |
Administrative difficulties (n = 4) | Tedious process to prescribe. Too much admin for clinic |
Cost and resource factors (n = 4) | Cost of (hospital) admission to administer the drug Cost to health services and personal needed |
Over-prescription (n = 3) | Over prescribed, e.g. women with low serum iron but normal Hb It’s often not necessary |
Lack of evidence regarding improved pregnancy outcomes (n = 2) | Lack of evidence on its efficacy No evidence of improved outcome of pregnancy; possible increased adverse outcome |
Others (n = 7) | Minimal disadvantages - a few have reactions, mainly fever but not seen major adverse effects Most women prefer it compared to side effects of oral iron Risks of toxicity, huge doses used are above physiological, risks of free radical generation |
Indications for IV iron in the treatment of iron deficiency without anaemia | |
Symptomatic iron deficiency (n = 9) | Extreme tiredness after other options tried Very rarely if restless legs or severe fatigue if not tolerating oral supplementation |
Special circumstances (n = 4) | Hyperemesis with PICC (peripherally inserted central) line, influenza or bronchitis, bowel disease I would only do this where a woman was unable to access regular antenatal care … and where oral iron was not well tolerated. Intolerance to oral iron in a Jehovah’s witness with a high bleeding risk |
Not used (n = 4) | I have recently modified my practice so that the target is Hb not ferritin. I therefore … modify oral iron supplements … and actively try to avoid IV infusions of iron In my institution I do not prescribe, but many others do |
Women’s preference (n = 3) | Women prefer it. Most of the women I see dislike oral replacement and avoid secondary to sides effects, i.e. constipation, nausea Patient request |
Response to oral iron (n = 3) | Failure of oral iron supplements with falling Hb AND altered RBC indices Lack of response to oral iron |
Precaution in case of PPH (n = 2) | To increase iron store as a precaution against PPH |
Other (n = 4) | Only on the advice of obstetric medicine colleagues Iron deficiency (with or without anaemia) is a condition that requires treatment. Aim for normal iron stores in fetus Would consider on case by case. Wouldn’t routinely measure iron unless anaemic or if notable drop over successive trimesters. |