role of FCm in correction of maternal anemia

treatment of anemia in pregnancy

1. Ferric carboxymaltose (FCM) In treatment of postpartum anemia (Case Based)

2. Ferric Carboxy Maltose in post partum Anemia FCM is a stable non dextran containing iron formulation that permits the uptake of iron by the reticuloendothelial system with minimal release of free iron The FCM complex has a neutral pH (5.0-7.0) with physiological osmolarity Ideally iron to be deposited in the reticuloendothelial system of the liver and spleen It can therefore provide iron without inducing oxidative stress Initial complete parental iron repletion rapidly improves clinical outcomes Reduce health care visits , the risk of infection & preserve vein integrity & reduce health care resource utilization. Contra Indications- Liver dysfunction , acute or chronic infection, pregnancy in first trimester.

3. Case 1 Patient History: A 32-year-old woman, G3P3 with no past history Chief Complaints: presented with severe postpartum anaemia following a complicated delivery due to postpartum haemorrhage. Lab Investigations: Initial haemoglobin was 6.2 g/dL post-partum Rx Advised: The patient was started on ferrous fumerate 324mg once daily was prescribed for a period of 1 month post blood transfusion. The patient says missed multiple doses of the m edication and post treatment levels of haemoglobin estimation showed 7g/dl . F/U: Patient continued to have severe tiredness and weakness.

4. Treatment & outcome Ferric carboxymaltose infusion was administered By IV drip infusion @ 1000mg diluted in 250ml of 0.9% NS over 15min not more than once a week and not exceeding 0.3ml of FCM(15mg of iron /kg body weight) within two weeks, her haemoglobin levels increased to 11.5 g/dL accompanied by resolution of fatigue and shortness of breath. In this case, due to IV infusion of FCm, an advantage of rapid correction of hemoglobin along with issue of decreased compliance with oral preparations was been achieved with the current line of treatment

5. Case 2 Patient History : A 29-year-old primigravida presented with symptomatic anaemia two weeks postpartum. Chief Complaints: There was excessive complaints of extreme tiredness and weakness even to complete routine tasks and taking care of the child had turned to be a challenge for the mother. Laboratory investigations: revealed iron deficiency with a haemoglobin level of 8.1 g/dL. Rx Advised: The patient was started on ferrous fumerate 324mg once daily was prescribed for a period of 1 month but the drug poorly tolerated due to gastrointestinal side effects. F/U : The patient came back with no improvement in the signs & symptoms but with other features of gastric irritation

6. Treatment & outcome Ferric carboxymaltose infusion was administered as an alternative by IV drip infusion @ 1000mg diluted in 250ml of 0.9% NS over 15min not more than once a week and not exceeding 0.3ml of FCM(15mg of iron /kg body weight) There was a rapid increase in haemoglobin levels to 11.8 g/dL within three weeks, with resolution of symptoms. In this case, treatment with ferric carboxymaltose showed a high level of tolerability of the drug & also there was a rapid improvement in the quality of life of the individual. There was also reduction in active symptoms of anemia with satisfaction by the patient in returning to active care of the child .

7. Case 3 Patient History: A 34-year-old Jehovah’s Witness woman Chief Complaints: presented with severe postpartum anaemia. Due to religious beliefs, blood transfusion was not an option in a Jehovah’s Witness Patient Lab Investigations: Haemoglobin 5.6 g/dL following a caesarean section. The Jehovah’s witnesses believe that the bible prohibits from receiving blood transfusions as these can cause eternal salvation loss. They believe that Jehovah will reject anyone who receives a transfusion. Hence consent was not given by the patient for blood transfusion which forms the first line of treatment in this scenario.

8. Treatment & Outcome Ferric carboxymaltose infusion was administered by IV drip infusion @ 1000mg diluted in 250ml of 0.9% NS over 15min not more than once a week and not exceeding 0.3ml of FCM(15mg of iron /kg body weight) resulting in a gradual increase in haemoglobin levels to 9.3 g/dL within four weeks, accompanied by clinical improvement and avoidance of blood transfusion. In this case, there was a need for effective line of treatment other than blood transfusion. As ferric carboxy maltose infusion is a time tested, safe and reliable alternative for blood transfusion and second line of treatment after blood transfusion in severe anemia, CFM played the best treatment of choice.

9. Case 4 Patient History: A 35-year-old woman with a history of hypertension and type 2 diabetes mellitus, underwent an emergency cesarean section at 38 weeks gestation due to severe preeclampsia. The surgery was complicated by significant intraoperative bleeding, resulting in a blood loss estimated at 1200 ml. Chief Complaints: Despite receiving blood transfusions during the procedure, she continued to experience weakness, fatigue, and shortness of breath in the postpartum period. Vital signs were stable, but she appeared pale and fatigued. Laboratory investigations: revealed a profound drop in her hemoglobin level, indicating severe postpartum anemia exacerbated by her underlying systemic diseases. Her hemoglobin level was found to be 7.5 g/dL Rx Given: Due to the severity of her anemia and her underlying systemic diseases, traditional treatment options such as oral iron supplementation were deemed inadequate to achieve rapid correction of her iron deficiency. Instead, she was initiated on intravenous ferric carboxymaltose therapy. Ferric carboxymaltose was chosen for its ability to rapidly replenish iron stores and its favorable safety profile, even in patients with comorbidities such as hypertension and diabetes mellitus.

10. Treatment & Outcome Ferric carboxymaltose infusion was administered by IV drip infusion @ 1000mg diluted in 250ml of 0.9% NS over 15min not more than once a week and not exceeding 0.3ml of FCM(15mg of iron /kg body weight) Resulted in a steady increase in haemoglobin levels to 10.4 g/dL within six weeks, with improvement in symptoms and avoidance of blood transfusion. In this case of a patient with type 2 Diabetes Mellitus, where the safety profile of the drug to be administered needs to be high, requires the drug to have least interaction with multiple other regular medications taken by the individual. FCM infusion was found to have less drug interactions and caused a rapid improvement in hemoglobin levels showing effectiveness even incases of severe anemia.

11. Case 5 Patient History: A 27-year-old woman presented with postpartum anaemia following a vaginal delivery. The patient had a history of inflammatory bowel disease (IBD) Chief Complaints: The symptoms of the patient was worsening with the fall in hemoglobin levels. Associated breathlessness and tiredness was noted on clinical examination with signs of pedal edema. The cardiac functions of the individual was unremarkable and no signs of cardiac failure. Lab Investigations: revealed haemoglobin 7.3 g/dL, The haemoglobin was10g/dl prior. Rx Given : Due to concerns regarding gastrointestinal absorption of oral iron, ferric carboxymaltose infusion was chosen as first-line therapy.

12. As there was no option of prescription of oral iron preparations in the current scenario options of intravenous iron preparations were automatically considered. Ferric carboxymaltose infusion was administered by IV drip infusion @ 1000mg diluted in 250ml of 0.9% NS over 15min not more than once a week and not exceeding 0.3ml of FCM(15mg of iron /kg body weight) Significant improvement was observed within three weeks, with haemoglobin levels increasing to 11.2 g/dL and resolution of anaemia-related symptoms. Subsequent maintenance therapy with oral iron was well tolerated. In this case, FCM was the drug of choice due to the advantages over other IV preparations. advantages of choosing FCM were high tolerability, durable normalisation, ease of administration of medication, better SAFETY PROFILE AND being COST-EFFECTIVE, Making IT an IDEAL TREATMENT OF CHOICE. Treatment & Outcome

13. Why FCM? RAPID CORRECTION: Ferric carboxymaltose is known for its rapid correction of iron deficiency anemia. This can be particularly advantageous in postpartum women who may require prompt treatment to address symptoms such as fatigue and weakness. SINGLE DOSE ADMINISTRATION: Ferric carboxymaltose can often be administered as a single high-dose infusion, providing convenience for both patients and healthcare providers. This can be beneficial in busy postpartum settings where repeated dosing may not be practical. HIGH TOLERABILITY: Ferric carboxymaltose has been found to be well-tolerated by most patients. Adverse effects such as gastrointestinal upset, common with oral iron supplements, are less frequent with intravenous formulations. This can be especially important in postpartum women who may already be experiencing gastrointestinal issues or discomfort.

14. Advantages of FCM LOWER RISK OF NON-COMPLIANCE: Since ferric carboxymaltose is administered intravenously by healthcare professionals, there is a lower risk of non-compliance compared to oral iron supplements. Postpartum women may find it challenging to adhere to oral iron regimens due to issues such as gastrointestinal side effects or forgetfulness, making intravenous administration a preferred option for some. intravenous iron substitution with ferric carboxymaltose was associated with significantly faster and more durable normalization of haemoglobin and ferritin concentrations, compared with oral iron substitution.

15. Why FCM? Intravenous iron substitution with ferric carboxymaltose can be delivered safely in district hospitals in a resource-limited setting. IMPROVED QUALITY OF LIFE: By rapidly correcting iron deficiency anemia, ferric carboxymaltose can significantly improve the quality of life for postpartum women. Restoring iron levels can alleviate symptoms such as fatigue, weakness, and shortness of breath, allowing women to better care for themselves and their newborns. REDUCTION IN TRANSFUSION REQUIREMENTS: By rapidly replenishing iron stores, ferric carboxymaltose may help reduce the need for blood transfusions in postpartum women with severe anemia, thus minimizing the risks associated with transfusion and conserving blood resources.

16. Why FCM? SAFETY PROFILE: Ferric carboxymaltose has been extensively studied and has demonstrated a favorable safety profile in various patient populations, including postpartum women. Serious adverse events are rare, and the risk of anaphylaxis is low when administered appropriately by trained healthcare professionals EFFECTIVENESS IN SEVERE ANEMIA: Ferric carboxymaltose has shown effectiveness even in cases of severe iron deficiency anemia. This is particularly relevant in postpartum women who may experience significant blood loss during childbirth, leading to severe anemia requiring prompt and effective treatment. CONVENIENT MONITORING: Ferric carboxymaltose treatment typically requires less frequent monitoring compared to oral iron supplementation. This can be advantageous in postpartum care settings where regular follow-up visits may be challenging for new mothers.