Revista Brasileira de Hematologia e Hemoterapia (Jun 2007)
Avaliação da eficácia do uso intravenoso de sacarato de hidróxido de ferro III no tratamento de pacientes adultos com anemia ferropriva Evaluation of the efficacy of intravenous iron III-hydroxide saccharate for treating adult patients with iron deficiency anemia
Abstract
O objetivo desse estudo foi avaliar a eficácia do uso intravenoso de sacarato de hidróxido de ferro III no tratamento de pacientes adultos com anemia ferropriva. No período de janeiro de 2003 a dezembro de 2005, estudamos cinqüenta pacientes com anemia ferropriva que apresentaram intolerância e/ou resposta inadequada ao tratamento com ferro por via oral e/ou valor de hemoglobina inferior a 7,0 g/dL. Os principais exames laboratoriais realizados foram: hemograma completo, contagem de reticulócitos, ferro sérico, capacidade total de ligação de ferro e ferritina sérica. Os pacientes receberam uma dose semanal de 200 mg de sacarato de hidróxido de ferro III diluído em 250 mL de soro fisiológico a 0,9%, administrado por via intravenosa em trinta minutos. O tratamento foi realizado até a obtenção do valor de hemoglobina igual ou maior que 12,0 g/dL para mulheres e 13,0 g/dL para homens, ou até a administração da dose total de ferro parenteral recomendada para cada paciente. A idade mediana dos cinqüenta pacientes estudados foi de 45 anos, variando entre 28 e 76 anos; quarenta (80,0%) eram do sexo feminino. A causa mais comum de anemia ferropriva no sexo feminino foi sangramento uterino anormal observado em 25/40 pacientes (62,5%) e, no sexo masculino, gastrectomia parcial em 7/10 (70,0%). Vinte e quatro (48,0%) pacientes foram incluídos nesse estudo por falta de resposta à terapia com ferro oral, 22 (44,0%) por intolerância ao ferro oral e quatro (8,0%) por hemoglobina The objective of this study was to evaluate the efficacy of intravenous iron III-hydroxide saccharate to treat adult patients with iron deficiency anemia. Between January 2003 and December 2005 we studied 50 patients with iron deficiency anemia who presented intolerance or inadequate response to oral iron therapy, or hemoglobin level < 7 g/dL. The main laboratory tests performed were: complete blood cell count, reticulocyte count, serum iron, total iron-binding capacity and serum ferritin. The patients received a weekly dose of 200 mg of iron diluted in 250 mL of 0.9% sodium chloride solution administered intravenously during 30 minutes. It was performed until a hemoglobin level = 12.0 g/dL for women or13.0 g/dL for men was reached or completing the administration of the total dose of parenteral iron recommended for each patient. The median age of the patients studied was 45 years (age range from 18 to 76). Forty out of 25 patients (80%) were women. The most common cause of iron deficiency anemia was abnormal uterine bleeding observed in 62.5% of female patients (25 out of 40) and partial gastrectomy in 70% of male patients (7 out of 10). Twenty-four (48%) patients were included in this study due to a lack of response to oral iron therapy, 22 (44%) showed intolerance to oral iron and 2 (8%) presented with a hemoglobin level < 7.0 g/dL. The mean hemoglobin and ferritin values were 8.48 g/dL and 4.65 ng/mL (pretreatment) and 12.34 g/dL and 93.20 ng/mL (post-treatment) (p<0.001), respectively. The average increase of hemoglobin was 3.61 g/dL and 4.83 gdL for women and men, respectively. Correction of anemia was obtained in 26 out of 40 female patients (65%) and in 9 out of 10 male patients (90%). Six patients received blood transfusions before starting intravenous iron treatment. None of the 50 studied patients needed red blood cell transfusions during or after completing the treatment. The use of intravenous iron III-hydroxide saccharate is an efficacious and safe option in the treatment of adult patients with iron deficiency anemia who lack satisfactory response to oral iron therapy. This treatment option should be considered mainly in patients with severe anemia in order to obtain rapid increases in the hemoglobin levels and to avoid blood transfusions.
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