Background: The aim of this study was to compare the efficacy, safety and achievement of the target hemoglobin level (Hb ≥10 g/dl) in patients with preoperative anemia due to menorrhagia who received intravenous iron sucrose compared with oral iron protein succinylate for anemia management. Methods: Seventy-six patients with Hb levels <9.0 g/dl who were scheduled to undergo surgical treatment were randomized to receive either intravenous iron sucrose (based on the calculated total iron deficit divided into 2 ampoule infusions intravenously 3 times a week, beginning 3 weeks before surgery) or oral iron (80 mg/day of oral iron protein succinylate daily). Results: The intravenous iron group had higher increases in Hb (3.0 vs. 0.8 g/dl; p < 0.0001) and ferritin levels (170.1 vs. 4.1 μg/l; p < 0.0001) than the oral iron group. Achieving the target Hb was also higher in the intravenous iron group than in the oral iron group (76.7 vs. 11.5%; p < 0.0001). There were tolerable adverse events in both groups. Conclusion: Preoperative intravenous iron sucrose administration is more effective than oral iron and is as safe as oral iron therapy in the correction of preoperative anemia due to menorrhagia.

Keywords:
Intravenous iron therapy, Iron deficiency anemia, Menorrhagia, Oral iron
1.
Cole SK, Billewicz WZ, Thomson AM: Sources of variation in menstrual blood loss. J Obstet Gynaecol Br Commonw 1971;78:933–939.
2.
Hallberg L, Hogdahl AM, Nilsson L, Rybo G: Menstrual blood loss – a population study. Variation at different ages and attempts to define normality. Acta Obstet Gynecol Scand 1966;45:320–351.
3.
Oehler MK, Rees MC: Menorrhagia: an update. Acta Obstet Gynecol Scand 2003;82:405–422.
4.
Coulter A, Peto V, Jenkinson C: Quality of life and patient satisfaction following treatment for menorrhagia. Fam Pract 1994;11:394–401.
5.
Shaw RW, Brickley MR, Evans L, Edwards MJ: Perceptions of women on the impact of menorrhagia on their health using multi-attribute utility assessment. Br J Obstet Gynaecol 1998;105:1155–1159.
6.
Kuriyan M, Carson JL: Anemia and clinical outcomes. Anesthesiol Clin North Am 2005;23:315–325, vii.
7.
Carson JL, Terrin ML, Jay M: Anemia and postoperative rehabilitation. Can J Anaesth 2003;50:S60–S64.
8.
Liguori L: Iron protein succinylate in the treatment of iron deficiency: controlled, double-blind, multicenter clinical trial on over 1,000 patients. Int J Clin Pharmacol Ther Toxicol 1993;31:103–123.
9.
Coplin M, Schuette S, Leichtmann G, Lashner B: Tolerability of iron: a comparison of bis-glycino iron II and ferrous sulfate. Clin Ther 1991;13:606–612.
10.
Farley PC, Foland J: Iron deficiency anemia. How to diagnose and correct. Postgrad Med 1990;87:89–93, 96, 101.
11.
Al RA, Unlubilgin E, Kandemir O, Yalvac S, Cakir L, Haberal A: Intravenous versus oral iron for treatment of anemia in pregnancy: a randomized trial. Obstet Gynecol 2005;106:1335–1340.
12.
Bhandal N, Russell R: Intravenous versus oral iron therapy for postpartum anaemia. BJOG 2006;113:1248–1252.
13.
Schroder O, Mickisch O, Seidler U, de Weerth A, Dignass AU, Herfarth H, Reinshagen M, Schreiber S, Junge U, Schrott M, Stein J: Intravenous iron sucrose versus oral iron supplementation for the treatment of iron deficiency anemia in patients with inflammatory bowel disease – a randomized, controlled, open-label, multicenter study. Am J Gastroenterol 2005;100:2503–2509.
14.
Auerbach M, Ballard H, Trout JR, McIlwain M, Ackerman A, Bahrain H, Balan S, Barker L, Rana J: Intravenous iron optimizes the response to recombinant human erythropoietin in cancer patients with chemotherapy- related anemia: a multicenter, open-label, randomized trial. J Clin Oncol 2004;22:1301–1307.
15.
Charytan C, Levin N, Al-Saloum M, Hafeez T, Gagnon S, Van Wyck DB: Efficacy and safety of iron sucrose for iron deficiency in patients with dialysis-associated anemia: North American clinical trial. Am J Kidney Dis 2001;37:300–307.
16.
Perewusnyk G, Huch R, Huch A, Breymann C: Parenteral iron therapy in obstetrics: 8 years experience with iron-sucrose complex. Br J Nutr 2002;88:3–10.
17.
Sifakis S, Angelakis E, Papadopoulou E, Stratoudakis G, Fragouli Y, Koumantakis E: The efficacy and tolerability of iron protein succinylate in the treatment of iron-deficiency anemia in pregnancy. Clin Exp Obstet Gynecol 2005;32:117–122.
18.
Beshara S, Lundqvist H, Sundin J, Lubberink M, Tolmachev V, Valind S, Antoni G, Langstrom B, Danielson BG: Pharmacokinetics and red cell utilization of iron(III) hydroxide-sucrose complex in anaemic patients: a study using positron emission tomography. Br J Haematol 1999;104:296–302.
19.
Bastani B, Rahman S, Gellens M: Lack of reaction to ferric gluconate in hemodialysis patients with a history of severe reaction to iron dextran. ASAIO J 2002;48:404–406.
20.
Faich G, Strobos J: Sodium ferric gluconate complex in sucrose: safer intravenous iron therapy than iron dextrans. Am J Kidney Dis 1999;33:464–470.
21.
Macdougall I, Bailie G, Richardson D, Tanner J, Gagnon SP: Worldwide safety profile of iron sucrose injection (Venofer): analysis of 1,044,477 patients from 1992 to 2001. J Am Soc Nephrol 2001;2001:333A.
22.
Alexander DA, Naji AA, Pinion SB, Mollison J, Kitchener HC, Parkin DE, Abramovich DR, Russell IT: Randomised trial comparing hysterectomy with endometrial ablation for dysfunctional uterine bleeding: psychiatric and psychosocial aspects. BMJ 1996;312:280–284.
23.
Thornton EW, McQueen C, Rosser R, Kneale T, Dixon K: A prospective study of changes in negative mood states of women undergoing surgical hysterectomy: the relationship to cognitive predisposition and familial support. J Psychosom Obstet Gynaecol 1997;18:22–30.
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2009
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