Home Print this page Email this page
Users Online: 559
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 9  |  Issue : 3  |  Page : 292-293

Hypersensitivity reaction to iron sucrose in a postpartum woman


1 Department of Pharmacy Practice, N. E. T Pharmacy College, Raichur, Karnataka, India
2 Department of Obstetrics and Gynecology, Navodaya Medical College Hospital and Research Center, Raichur, Karnataka, India

Date of Submission31-Jan-2020
Date of Decision22-Feb-2020
Date of Acceptance16-Apr-2020
Date of Web Publication28-Jul-2020

Correspondence Address:
Dr. Shiv Kumar
Department of Pharmacy Practice, N. E. T Pharmacy College, Raichur, Karnataka
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijhas.IJHAS_15_20

Rights and Permissions
  Abstract 


Anemia is one of the most common nutritional deficiency disorders and global issues affecting pregnant women. It is associated with high maternal morbidity and mortality. It is the most common disorder affecting approximately 25% of the world's population. Although oral iron therapy has beneficial effects, intravenous iron is preferred to treat moderate-to-severe anemia for much more rapid resolution of iron-deficiency anemia with minimal adverse reactions. Iron sucrose has a favorable safety profile, and it can act as an alternative to other forms of parenteral iron preparations in correction of iron store depletion. This report highlights the adverse reaction to iron sucrose in a postpartum woman with moderate iron-deficiency anemia.

Keywords: Anaphylactic reaction, anemia, iron sucrose, postpartum


How to cite this article:
Kumar S, Madhuri G, Rita D. Hypersensitivity reaction to iron sucrose in a postpartum woman. Int J Health Allied Sci 2020;9:292-3

How to cite this URL:
Kumar S, Madhuri G, Rita D. Hypersensitivity reaction to iron sucrose in a postpartum woman. Int J Health Allied Sci [serial online] 2020 [cited 2020 Aug 6];9:292-3. Available from: http://www.ijhas.in/text.asp?2020/9/3/292/290713




  Introduction Top


Iron deficiency (ID) during pregnancy is highly prevalent worldwide in both developed and developing nations [1] and the most common cause of anemia.[2] The prevalence in developed countries is 14%, in developing countries, it is 51%, and in India, it varies from 65% to 75%.[3],[4] Moreover, in Karnataka, it is 45.4%.[5] Oral iron supplements are the first choice of treatment of ID anemia for almost all patients because of its cost, safety, and effectiveness,[2] but high and repeated dosing of oral Iron can cause significant side effects. On the other hand, intravenous (IV) Iron preparations results in faster increase in hemoglobin levels and iron stores, and acts as alternative to transfusion.[6] Almost all available iron preparations cause side effects, including anaphylactic reactions. Here, we report a serious adverse reaction to iron sucrose preparation in pregnant women with moderate anemia.


  Case Report Top


A 22-year-old G2P1L1 with 9-month amenorrhea with anemia presented to the obstetrics and gynecology department with severe abdominal pain, and the patient got operated (emergency lower-segment cesarean section + bilateral abdominal tubectomy). Based on history, it was observed that the patient was on medications (tablet folic acid + iron and tablet calcium) After 3 days of lower-segment cesarean section, the patient was advised to undergo complete blood profile test in which her hemoglobin levels were found to be low (i.e., 8.6 gm%). Hence, the patient was prescribed with injection IROZORB-S (iron sucrose) 200 mg (two vials – 100 mg in each) in 100 ml normal saline over 15–20 min. After the complete administration of the drug, the patient developed fever with chills and breathlessness. Blood pressure and pulse rate were found to be normal. Immediate after developing symptoms, the patient was administered with injection avil (pheniramine) and hydrocortisone, and then, the patient's condition got stabilized within 10–15 min.


  Discussion Top


Anemia is a global health problem, around 1.62 billion people suffering from anemia in the world.[5] The condition is even worse in Southeast Asia. The levels of hemoglobin used for classification of anemia in pregnant women were recommended by the Indian Council of Medical Research, and it is defined as follows: mild anemia: Hb = 10.0–10.9 mg/dl; moderate anemia: Hb = 7.0–10.0 mg/dl; severe anemia: Hb = 5.0–7 mg/dl; and very severe anemia: Hb <4 mg/dl.[3]

The first choice treatment of ID anemia is oral iron replacement. However, many clinical studies have demonstrated the high incidence of side effects related to oral therapy. IV iron therapy has been recommended in case of intolerance or contraindications to oral iron therapy, and in severe anemia, especially if accompanied by significant ongoing bleeding and inflammatory diseases, IV iron therapy will be recommended.[2] Moderate-to-severe anemia should be better treated with parenteral iron therapy and/or blood transfusion depending on an individual case and severity of the condition.[7]

Three commercial formulations, i.e., iron dextran, sodium ferric gluconate complex, and iron sucrose, are currently available for IV iron therapy. All available iron preparations for parenteral use can cause short-term side effects, such as back pain, nausea, vomiting, diarrhea, abdominal pain, hypotension, and allergic or even anaphylactic reactions.[6] Initially, iron dextran and iron sorbitol citrate were used earlier. However, test dose was required to be given before these injections as severe anaphylactic reactions were reported with IV iron dextran.[7]

Iron sucrose is well tolerated with minimal and/or no serious adverse effects and with a lower incidence. Because of this biologic advantage associated with its effective in correcting anemia more rapidly, safely, and effectively than oral iron, IV iron sucrose has been approved in the treatment of IDA in many clinical settings. IV iron sucrose has been reported to be safe with an excellent profile in clinical use; it can be administered without a test dose.[2] Intramuscular iron sucrose complex is particularly contraindicated because of poor absorption and pain.[7] The all-event reporting rates for iron dextran, sodium ferric gluconate, and iron sucrose were 29.2, 10.5, and 4.2 reports per million.[6] The incidence of serious life-threatening anaphylaxis with iron sucrose is 0.002% versus 0.6%–2.3% and 0.04% with high-molecular-weight iron dextran and ferric gluconate, respectively.[2]

Iron sucrose appears to have a favorable safety profile and is an alternative to other forms of parenteral iron therapy in correction of depletion of iron stores.[6] In our patient, an adverse drug reaction occurs after the complete administration of infusion of iron sucrose. The seriousness of this ADR was evaluated by the clinicians on the basis of its life-threatening nature. The use of the Naranjo probability scale indicated a probable (score = 7) relationship between the reaction and iron sucrose as the causal drug.


  Conclusion Top


Clinicians should be alert to the possibility of this fatal adverse effect in patients receiving parenteral iron sucrose. A health initiative for health-care professional, especially nursing staff, is much required to reduce the number of severe adverse reactions to parenteral iron by rational use of this drug and a mandatory test dose before the first infusion.

Acknowledgment

We express our sincere thanks to the Medical Superintendent, Navodaya Medical College Hospital and Research Center, Raichur, for his valuable help and providing necessary facilities.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
McMahon LP. Iron deficiency in pregnancy. Obstet Med 2010;3:17-24.  Back to cited text no. 1
    
2.
Cançado RD, de Figueiredo PO, Olivato MC, Chiattone CS. Efficacy and safety of intravenous iron sucrose in treating adults with iron deficiency anemia. Rev Bras Hematol Hemoter 2011;33:439-43.  Back to cited text no. 2
    
3.
Mangla M, Singla D. Prevalence of anaemia among pregnant women in rural India: A longitudinal observational study. Int J Reprod Contracept Obstet Gynecol 2016;5:3500-5.  Back to cited text no. 3
    
4.
Suryanarayana R, Chandrappa M, Santhuram AN, Prathima S, Sheela SR. Prospective study on prevalence of anemia of pregnant women and its outcome: A community based study. J Family Med Prim Care 2017;6:739-43.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Prasad KN. Prevalence of anemia among pregnant women-A cross sectional study. Int J Med Sci Public Health 2018;7:1023-6.  Back to cited text no. 5
    
6.
Mishra A, Dave N, Viradiya K. Fatal anaphylactic reaction to iron sucrose in pregnancy. Indian J Pharmacol 2013;45:93-4.  Back to cited text no. 6
[PUBMED]  [Full text]  
7.
Maheswari RU, Veerakumaran R. A study on management of maternal anemia with infusion of intravenous iron sucrose and its outcome in management of anemia. Int J Reprod Contracept Obstet Gynecol 2019;8:39-43.  Back to cited text no. 7
    




 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Case Report
Discussion
Conclusion
References

 Article Access Statistics
    Viewed50    
    Printed0    
    Emailed0    
    PDF Downloaded11    
    Comments [Add]    

Recommend this journal