title: Selective use of recombinant human erythropoietin in pregnant patients with severe anemia or nonresponsive to iron sucrose alone.
abstract: OBJECTIVE
  To evaluate the effectiveness of a stepwise use of recombinant human erythropoietin (rhEPO) in pregnant patients with severe anemia or nonresponsive to intravenously administered iron only.
  
  
  METHODS
  All subjects had iron deficiency anemia, i.e., a hemoglobin (Hb) level <10.0 g/dl and ferritin < or =15 microg/l. Patients with an Hb level > or =9.0 g/dl and <10.0 g/dl received 200 mg iron sucrose intravenously twice weekly. If response to therapy was poor, patients additionally received 10,000 U rhEPO twice weekly. Patients with an Hb level <9.0 g/dl primarily received iron sucrose and rhEPO likewise.
  
  
  RESULTS
  Of the 84 patients, 59 had a baseline Hb level between 9.0 and 9.9 g/dl, of whom 32 responded poorly, thus receiving additional rhEPO. Twenty-five patients had a baseline Hb level <9.0 g/dl. The overall Hb level after therapy was 11.0 g/dl (+/-0.5, range 10.0-12.6 g/dl). Mean duration of therapy was 3.5 weeks (7 infusions).
  
  
  CONCLUSIONS
  This study shows an effective treatment regimen for patients with various degrees of anemia in pregnancy. Iron sucrose is a safe and effective treatment option. In cases of severe iron deficiency anemia or poor response to parenteral iron therapy additional administration of rhEPO might be considered. However, the mechanism for not responding to intravenous iron therapy despite iron deficiency anemia still remains unclear to a large extent.
authors.affiliation: Feto-Maternal Hematology Group, Division of Obstetrics, Department of Obstetrics and Gynecology, University Hospital Zurich, Zurich, Switzerland. alexander.krafft@usz.ch
authors.forename: Alexander
authors.initials: A
authors.lastname: Krafft
authors.forename: Gabriela
authors.initials: G
authors.lastname: Bencaiova
authors.forename: Christian
authors.initials: C
authors.lastname: Breymann
mesh_terms: D000328:Adult; D000740:Anemia / Q000188:drug therapy*; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D005290:Ferric Compounds / Q000627:therapeutic use*; D000077605:Ferric Oxide, Saccharated; D005937:Glucaric Acid; D006801:Humans; D007501:Iron / Q000097:blood; D011247:Pregnancy; D011994:Recombinant Proteins / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005290:Ferric Compounds; D011994:Recombinant Proteins; D004921:Erythropoietin; D007501:Iron; D000077605:Ferric Oxide, Saccharated; D005937:Glucaric Acid