الفهرس 
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Abstract
Anemia is a condition in which either the number of circulating red blood cells or their hemoglobin concentration is decreased. As a result, there is decreased transport of oxygen from the lungs to peripheral tissues (Dalal et al., 2012).
The Centers for Disease Control and Prevention (1998) defined anemia as hemoglobin (Hb) less than 11 g/dl in first and third trimester and less than 10.5 g/dl in second trimester. WHO defines anemia as hemoglobin concentration less than 11 g/dl and a hematocrit < 0.33 (World Health Organisation, 2011).
During pregnancy average requirements are: basal iron (280 mg), expansion of red cell mass (570 mg), transfer to fetus (200-350 mg), for placenta (50-150 mg), blood loss at delivery (100-250 mg). After deducting iron conserved by amenorrhoea (240-480 mg), an additional 500-600 mg is required in pregnancy or 4-6 mg/ day of absorbed iron. As absorption is less than 10% (3-4% in low bio-availability diets), for a minimum of 4-6 mg absorption, at least 40-60 mg of iron should be available in the diet (Dalal et al., 2012).
Diet alone cannot supply such amounts of iron making iron supplementation a necessity in all pregnant women. Iron can be supplemented by mouth, intramuscular or intravenous injection. Alternatively, blood transfusion and recombinant erythropoietin are used (Sharma, 1998).
Iron requirement cannot be met by oral route in the majority of patients because of limited absorption, bioavailability and compliance. In addition, oral iron therapy is further complicated by the adverse effects of pregnancy on the gastrointestinal tract. Thus, parenteral iron supplementation has quite rightly grown in popularity over the past few decades (Dalal et al., 2012).
Parenteral administration by intramuscular injection is a painful alternative with a variable degree of efficacy. Studies have stressed that intramuscular therapy should be discouraged because of its adverse effects which include pain, irregular absorption, staining and malignancy (Al-Momen et al., 1996). Intramuscular iron sucrose complex is particularly contraindicated because of poor absorption. It was also stated that when iron dextran is given intravenously up to 30% of patients suffer from adverse effects which include arthritis, fever, urticaria and anaphylaxis (Auerbach et al., 1988).
It has been shown that intravenous iron as compared to oral iron therapy gave a significantly higher rate of rise in Hb level in addition to other indices of iron status such as ferritin, transferrin and zinc protoporphyrin levels (Singh et al., 1998).
This study is a prospective non-blinded randomized controlled trial which was conducted at Ain Shams University Maternity Hospital. The study included 240 pregnant women suffering from iron deficiency anemia who were recruited from antenatal care outpatient clinic. The patients were randomized into 2 groups to either receive oral iron or total dose infusion.
The aim of the study was to evaluate the effect of iron supplementation using oral route in comparison with total dose infusion of low molecular weight iron dextran in management of iron deficiency anemia during pregnancy.
In the present study the difference between the oral and total dose infusion (TDI) group as regards the median of age, body mass index (BMI), parity and gestational age was statistically non significant.
The oral group showed a significant rise in all parameters of anemia with the median of hemoglobin level was 8.3 versus 8.9 versus 9.5 mg/dl), and of hematocrit was 28 versus 29.7 versus 30.2 g/dl at baseline versus week 4 versus week 8 respectively, also the median serum ferritin showed a significant rise at week 8 (27.3 versus 13.6 ng/ml at baseline). While the change in total iron binding capacity (TIBC) between week 8 and base line was -23.6 µg/dl which was non significant.
Furthermore, the study showed that in the TDI there was a significant rise in all parameters of anemia with the median of hemoglobin level was 8.3 versus 9.7 versus 9.8 mg/dl, and of hematocrit was 27.8 versus 30.6 versus 31.8 g/dl at baseline versus week 4 versus week 8 respectively, also the median serum ferritin showed a significant rise at week 8 (31.8 versus 20.4 ng/ml at baseline). While the change in TIBC between week 8 and base line was -53 µg/dl, which was also significant.
In the present study, there was significantly higher rise in the hemoglobin level, serum ferritin and TIBC among TDI as compared to oral group while the change in hematocrit showed a non-significant difference between both groups.
As regards patients compliance, a total of 18 patients (15%) were lost to follow up in the oral group versus 11 patients (9.2%) in the TDI group, this difference was non significant statistically.
As regards adverse effects, in the oral group 5 women had GIT upset while there was allergy to the drug in 5 women among TDI group.
The total cost of treatment for a single patient was 100 LE in oral group compared to 200 LE in TDI group with a highly significant statistical difference between both groups. Cost effectiveness analysis showed that extra 2,400 Egyptian pounds will be spent to save one patient from having anemia (low Hb <10 g/dl) after 8 weeks from treatment with TDI.