Preoperative pharmacological correction of severe anaemia due to uterine fibroids
AbstractContext: Severe anaemia from menorrhagia is a common complication of uterine fibroids. If all patients with such a problem were to accept blood transfusion and if blood transfusion were risk free, then it is the ideal treatment for correcting severe anaemia preoperatively. However, this is not the case and so alternatives have to be sought for those who reject blood transfusion. Treatment with haematinics is one alternative. But views have been expressed that they may not be able to adequately correct severe anaemia in such cases.
Objective: To study the effect of total dose iron-dextran infusion and folic acid with or without a progestogen in the preoperative correction of severe anaemia due to fibroid induced menorrhagia.
Materials and Methods: A prospective interventional study of severely anaemic patients with uterine fibroids who refused pre-operative blood transfusion over a 31-month period. Eligible subjects were given total dose iron-dextran infusions followed by oral folic acid with or without norethisterone. The outcome measures were serial haemoglobin concentrations, rate of rise of haemoglobin concentration, and number of days required to raise the haemoglobin concentration to 10 grams/dl. Data analysis was by means of simple percentages and descriptive statistics.
Results: Eight patients were treated. The initial haemoglobin concentrations in the eight patients ranged from 5.7 to 6.9 g/dl while final ones prior to surgery ranged from 9.0 to 11.0g/dl. The eight patients reported subjective improvement (felt stronger) within 24 hours of receiving iron-dextran infusion. It was possible to operate on all of the patients within 3 weeks of administering iron-dextran infusion and folic acid. One patient had maculopapular skin rashes on the third day after the total dose iron-dextran infusion. No intraoperative or postoperative problems were encountered.
Conclusions: Iron-dextran as a total dose infusion followed by oral folic acid and a progestogen (if necessary) is a useful alternative to multiple blood transfusions in the pre-operative correction of severe anaemia due to uterine fibroids.
Keywords: preoperative correction, anaemia, menorrhagia, uterine fibroids
Tropical Journal of Obstetrics and Gynaecology Vol. 23(1) 2006: 44-47
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