Iron Deficiency Anemia with Menorrhagia: Ferric Carboxymaltose a Safer Alternative to Blood Transfusion

Menstrual disorder accounts for 5%-10% of the women presenting with iron deficiency anemia (IDA) in the perimenopausal age group. Heavy menstrual bleeding in this age group leads to severe anemia and frequently requires blood transfusion which has its own adverse effects. We today have ferric carboxymaltose (FCM) as a safer alternative to blood transfusion.

The objective of the study is to evaluate the safety and efficacy of FCM in treating anemia in patients of menorrhagia. Thus avoiding blood transfusion.

It was an open, single arm observational study including 90 women of age more than 30 years with definitive diagnosis of menorrhagia with IDA and hemoglobin (Hb) levels between 4 gm% and 11 gm%. Intravenous FCM (500-1500 mg) was administered, and the improvement in blood indices was assessed after 3 weeks of total dose infusion. Menorrhagia was controlled by medical treatment till Hb improvement was achieved and definitive surgical intervention was done.

Most of the women were in the age group of 40-50 years. Blood indices measured pre-FCM and 3 weeks post-FCM showed a mean increase in Hb from 8.33 ± 1.10 to 10.89 ± 1.02 with a statistically significant P < 0.01. There was a statistically significant rise of packed cell volume, serum ferritin, and serum iron in the post-FCM blood levels after 3 weeks. No serious life-threatening adverse events were observed after FCM administration.

Intravenous FCM is an effective and a safe treatment option for IDA with a single administration of high dose without serious adverse effects obviating the need for blood transfusion before surgery.