Essentials

Intravenous iron added to erythropoiesis stimulating agents (ESAs) increased the haematopoietic response and reduced the need for blood transfusions in patients with chemotherapy-induced anaemia, according to results of a recent meta-analysis.

Although use of intravenous iron therapy – with or without ESA – is increasingly common for treatment of patients with anaemia, knowledge of its potential benefit is not yet widespread.

Treatment for iron deficiency in patients with heart disease (of any type) is often complex, due to multiple co-morbidities and concomitant therapies. The ultimate aim is to restore healthy iron metabolism and turnover in patients with heart disease to improve morbidity, mortality and quality of life1.

Intravenous iron therapy

Although chronic heart failure can be successfully managed, the clinical outcome for many patients is still poor. This indicates the importance of identifying and treating co-morbid factors that independently accelerate disease progression.  Iron deficiency is linked to both disease severity and mortality in patients with chronic heart disease, and its correction has been shown to elicit a significant improvement in cognitive, symptomatic and exercise performance1,2.

The physiological consequences of chronic heart failure are multi-faceted, with several tightly controlled and inter-related processes disturbed. Erythropoiesis and hepcidin-regulated iron transport are just two processes involved in iron homeostasis that are detrimentally altered in patients with chronic heart failure and ultimately contribute to the development of functional iron deficiency1.

In non-anaemic menstruating women with unexplained fatigue and ferritin levels below 50 μg/L, 12 weeks of oral iron therapy resulted in a significant reduction in symptoms of fatigue, and improvements in biological markers, including haemoglobin, ferritin and soluble transferrin. However, no significant improvements of other measured indicators of quality of life other than fatigue were seen1.

Iron deficiency is associated with a range of symptoms that are not only detrimental to women’s quality of life, but may also have a negative impact on clinical outcomes, including the health and wellbeing of offspring in the case of pregnant women1. When severe, iron deficiency can result in iron deficiency anaemia, which has a negative effect on patient vitality that is comparable with chronic diseases including clinical depression and chronic kidney disease (see figure below).

Levels of plasma iron available to be utilised by the body are maintained within a tight range under normal circumstances by controlling the rate of iron absorption and storage1. However, there are a number of different factors that can lead to disruption of the iron balance in obstetrics and gynaecology patients (see figure below).

Figure 2. Why patients seen by obstetricians and gynaecologists become iron deficient2

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