Intravenous Iron Supplementation in Pregnant Women with Sickle Cell Disease: Case Series
Authors: Farooqui Ayesha , Farooqui Marwah 
Published: June 2024

Abstract

Presentation Date: 6/8/2024
Presentation Start Time: 6:00:00 PM

Background
Iron deficiency during pregnancy leads to increased maternal illness, low birth weight, prematurity, and intrauterine growth restriction. Pregnant women with sickle cell disease (SCD) are also at high risk for similar adverse outcomes. Although SCD is known for iron overload related to transfusion burden and ongoing hemolysis, a few patients with SCD do experience iron deficiency particularly the non-HbSS subtype group. Managing iron status in pregnant women with SCD is crucial. This case series aim is to examine the impact of intravenous (IV) iron supplement on pregnancy outcomes in four pregnant women with SCD.

Methods
Data was collected on four pregnant women with SCD anemia who received IV iron in a period of six months at a single institution. The data assessed included pre-and-post IV iron administration of hemoglobin levels, ferritin levels, transferrin saturation (TSAT), as well as gestational term, fetal birth weight, and APGAR scores.

Results
In our case series, three out of the four patients who received IV iron supplementation had HbSC. One patient has HbSS, this patient had short pregnancy intervals with three pregnancies in less than three years. All patients who received IV iron had a ferritin level of &lt; 20ng/mL prior to infusion, and TSAT was &lt; 20% prior to infusion. Two of the four patients delivered at full term (&gt;38 weeks gestation). The patient with HbSS subtype has a miscarriage and one patient is currently pregnant in her 3rd trimester.
Two patients completed a full course of IV iron, while two patients did not complete the full course due to medical noncompliance. Among the patients who completed the full course, one had a fetal birth weight of 4.0kg with APGAR scores of 9 and 9 at one- and five-minute intervals, respectively. The other patient who could not complete a full course due to medical noncompliance, had a fetal birth weight of 2.94kg and APGAR scores of 8 and 9 at one-and five-minute intervals, respectively. The patient with HbSS type SCD who did not complete the course experienced a miscarriage.
Overall, hemoglobin levels improved for three of the four patients who received iron supplementation, except for one patient who received IV iron sucrose. This patient is currently pregnant and has noted an improvement in energy levels after receiving IV iron.

Conclusions
Our case series highlight that pregnant women with SCD can become iron deficient and require iron infusion. Traditionally, the Ganzoni equation for iron deficiency anemia is utilized to calculate the iron deficit for dosing iron. This equation is based on the baseline hemoglobin. However, in patients with hemoglobinopathies, the baseline hemoglobin is inherently low without a specific target hemoglobin. Consequently, this formula is not applicable for accurately determining iron deficit for dosing iron in this patient population. Further studies are needed to establish alternative methods for calculating iron deficit needs in the SCD patient population. Adequate iron stores improve fetal outcomes in the general population and most likely in the SCD patient population as evidenced by our case series. Therefore, it is necessary to adequately manage iron deficiency in this high-risk population.