Role of Parenteral Iron Therapy in Gynaecologic Malignancies: A Review of Literature and Recommendations for Practice in a Cancer Centre in a Developing Country

Abstract

Introduction

Anaemia causes morbidity and mortality in cancer patients with negative impact on treatment outcome and prognosis. It has been a common practice to offer blood transfusion which comes with its own disadvantages. Therefore, alternative strategies are required to obviate the recurrent need for blood transfusion.

Work up of Patient

Currently, the best treatment decisions for anaemia might be based on measurements of serum ferritin (SF), transferrin saturation (TSAT), soluble transferrin receptor (sTfR), ferritin index (FI = sTfR/log SF), hypochromic reticulocytes (CHR) and C-reactive protein (CRP).

Therapies

Parenteral iron therapy has advantages over oral route as compliance is the limiting factor in oral iron therapy and gastro-intestinal side effects are increased by oral route. A patient’s total body iron deficit can be calculated using the Ganzoni formula. Options for use of parenteral iron are iron dextran, iron sucrose and ferric gluconate.

Clinical Trials

There are numerous trials which evaluate parenteral iron in cancer patients, but only a few evaluate them in gynaecologic malignancies. These trials conclude that usage leads to decreased transfusion rate and slow, steady and sustained rise in Hb level.

Treatment Recommendations

Certain recommendations include safe and effective use of parenteral iron. Lowest Hb level for injectable iron should be 10 gm/dl. Post-surgical patients should be haemodynamically stable. Preparations can be given according to individual availability, cost and feasibility.

Conclusion

Parenteral iron therapies improve time to target haemoglobin levels. They decrease need of blood transfusion. We recommend the use of intravenous iron therapy under supervision wherever feasible.

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Amit Choraria helped with concept and design, collection and assembly of data, data analysis and interpretation and wrote, edited and reviewed the manuscript. Avani Tiwari was involved in concept and design, data analysis and interpretation and wrote, edited and reviewed the manuscript. Suman Mittal contributed to concept and design, data analysis and interpretation and wrote, edited and reviewed the manuscript.

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Correspondence to Amit Choraria.

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All above-mentioned authors gave final approval for publication. All above-mentioned authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Corresponding author Amit Choraria takes full responsibility for the work as a whole, including the study design, access to data and the decision to submit and publish the manuscript.

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Choraria, A., Tiwari, A. & Mittal, S. Role of Parenteral Iron Therapy in Gynaecologic Malignancies: A Review of Literature and Recommendations for Practice in a Cancer Centre in a Developing Country. Indian J Gynecol Oncolog 19, 23 (2021). https://doi.org/10.1007/s40944-021-00504-0

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Keywords

  • Parenteral iron
  • Gynaecologic malignancies
  • Injectable iron
  • Intravenous iron