Use of alternative methods in the treatment of anemia in pregnant women – prospective observational study
Abstract
Objectives: Anemia in pregnant women is a common condition, diagnosed when the concentration of hemoglobin falls below 11 g/dL. Taking into consideration the accounts of nephrologists about good results of treatment of secondary anemia using erythropoietin in patients with renal failure, we tried to use EPO to cure anemia in pregnant women. The aim of the study was to evaluate the results of EPO treatment on pregnant women diagnosed with iron deficiency anemia, as well as possible side effects. Material and methods: The study consisted of 25 patients: Group I — treated with iron supplement administered parenterally — Ferrum Lek every two days intramuscularly. Group II — treated with recombinant human erythropoietin — 1000 j intravenously every three days, with oral iron sup- plements. Results: After a week of treatment the positive response was higher in the second group (92.3% in II, vs 33.3% in I, p < 0.005). The average increase of hemoglobin and RBC was significantly higher in II group. An increase in hemoglobin did not correlate with the age of women (r = 0.07) or with the duration of pregnancy (r = 0.08). However, a negative correlation was found between basic hemoglobin level and its increase after treatment (r = 0.602). Conclusions: EPO administered with the oral dose of iron in pregnant women with anemia caused by iron deficiency shows higher effectiveness than the use of iron preparations parenterally. The usage of EPO during pregnancy is not related to any dangerous side effects for the mother or fetus.
Keywords: pregnancyanemiaerythropoetin
References
- Falkowska A, Ostrowska L. Niedokrwistość u kobiet ciężarnych. Nowa Medycyna. 2010; 17(3): 96–103.
- Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity 2011. http://apps.who.int/iris/bitstream/10665/85839/3/WHO_NMH_NHD_MNM_11.1_eng.pdf..
- Pietrzak B, Seremak-Mrozikiewicz A, Marciniak B, et al. Niedokrwistość z niedoboru żelaza w położnictwie i ginekologii. Ginekologia i Perinatologia Praktyczna. 2016; 1: 115–121.
- Vora M, Gruslin A. Erythropoietin in obstetrics. Obstet Gynecol Surv. 1998; 53(8): 500–508.
- Kowalska-Kańka A, Maciejewski T, Niemiec KT. The role and regulation of secretion of erythropoietin in pregnancy. Med Wieku Rozwoj. 2013; 17(3): 270–275.
- Korycka A, Szmigielska- Kapłon A, Robak T. Erythropoiesis stymulating proteins and their role in the treatment of neoplastic disorders anemia. Acta Haematologica Polonica. 2006; 37(1): 37–45.
- Sifakis S, Angelakis E, Vardaki E, et al. Erythropoietin in the treatment of iron deficiency anemia during pregnancy. Gynecol Obstet Invest. 2001; 51(3): 150–156.
- Breymann C, Visca E, Huch R, et al. Efficacy and safety of intravenously administered iron sucrose with and without adjuvant recombinant human erythropoietin for the treatment of resistant iron-deficiency anemia during pregnancy. Am J Obstet Gynecol. 2001; 184(4): 662–667.
- Krafft A, Bencaiova G, Breymann C. Selective use of recombinant human erythropoietin in pregnant patients with severe anemia or nonresponsive to iron sucrose alone. Fetal Diagn Ther. 2009; 25(2): 239–245.
- Kashiwagi M, Breymann C, Huch R, et al. Hypertension in a pregnancy with renal anemia after recombinant human erythropoietin (rhEPO) therapy. Arch Gynecol Obstet. 2002; 267(1): 54–56.
- Fisher JW. Erythropoietin: physiology and pharmacology update. Exp Biol Med (Maywood). 2003; 228(1): 1–14.
- Wågström E, Akesson A, Van Rooijen M, et al. Erythropoietin and intravenous iron therapy in postpartum anaemia. Acta Obstet Gynecol Scand. 2007; 86(8): 957–962.
- Meyer JW, Eichhorn KH, Vetter K, et al. Does recombinant human erythropoietin not only treat anemia but reduce postpartum (emotional) distress as well? J Perinat Med. 1995; 23(1-2): 99–109.
- Schneider H, Malek A. Lack of permeability of the human placenta for erythropoietin. J Perinat Med. 1995; 23(1-2): 71–76.
- Malek A, Sager R, Eckardt KU, et al. Lack of transport of erythropoietin across the human placenta as studied by an in vitro perfusion system. Pflugers Arch. 1994; 427(1-2): 157–161.
- Ji YQ, Zhang YQ, Li MQ, et al. EPO improves the proliferation and inhibits apoptosis of trophoblast and decidual stromal cells through activating STAT-5 and inactivating p38 signal in human early pregnancy. Int J Clin Exp Pathol. 2011; 4(8): 765–774.
- Hershkovitz R, Ohel I, Sheizaf B, et al. Erythropoietin concentration among patients with and without preeclampsia. Arch Gynecol Obstet. 2005; 273(3): 140–143.
- Resch BE, Gaspar R, Sonkodi S, et al. Vasoactive effects of erythropoietin on human placental blood vessels in vitro. Am J Obstet Gynecol. 2003; 188(4): 993–996.
