|Year : 2020 | Volume
| Issue : 3 | Page : 292-293
Hypersensitivity reaction to iron sucrose in a postpartum woman
Shiv Kumar1, G Madhuri1, D Rita2
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 Submission||31-Jan-2020|
|Date of Decision||22-Feb-2020|
|Date of Acceptance||16-Apr-2020|
|Date of Web Publication||28-Jul-2020|
Dr. Shiv Kumar
Department of Pharmacy Practice, N. E. T Pharmacy College, Raichur, Karnataka
Source of Support: None, Conflict of Interest: None
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 Sep 23];9:292-3. Available from: http://www.ijhas.in/text.asp?2020/9/3/292/290713
| Introduction|| |
Iron deficiency (ID) during pregnancy is highly prevalent worldwide in both developed and developing nations  and the most common cause of anemia. The prevalence in developed countries is 14%, in developing countries, it is 51%, and in India, it varies from 65% to 75%., Moreover, in Karnataka, it is 45.4%. Oral iron supplements are the first choice of treatment of ID anemia for almost all patients because of its cost, safety, and effectiveness, 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. 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|| |
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|| |
Anemia is a global health problem, around 1.62 billion people suffering from anemia in the world. 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.
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. 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.
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. 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.
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. Intramuscular iron sucrose complex is particularly contraindicated because of poor absorption and pain. 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. 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.
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. 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|| |
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.
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
Conflicts of interest
There are no conflicts of interest.
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