2.11.5. Post-natal FBC day 1 and iron replenishment as above.

2.12. Parenteral iron therapy (Ferinject)

2.12.1. Is proven to increase Hb faster than oral iron and replenish iron stores faster when compared with oral iron therapy (Bhandal 2005, Wyk 2007, Breymann 2007).

2.12.2. Fewer postpartum blood transfusions are reported in a large group treated with IV iron antenatally (Reveiz 2007).

2.12.3. Ferinject is an intravenous iron preparation providing slow release of bioavailable iron for uptake by the reticuloendothelial cells and little risk of release of free iron. Hence there is no need for a test dose.

2.12.4. An erythropoietic response is seen in a few days with an increase in reticulocyte count and ferritin level (iron store) returns to normal in 1-2 weeks.

2.12.5. Doses of up to 1000mg iron can be administered in a single infusion. Maximum dose is 1000mg per week.

2.12.6. Indications for parenteral iron therapy include:

• Iron deficiency anaemia (Hb <120g/L and ferritin <30mcg/L) which has not improved despite oral iron therapy.
• Severe anaemia <70g/L from 28 weeks gestation, or postnatally.
• Intolerance to oral iron.
• Proven malabsorption (e.g. coeliac disease, IBD, short bowel syndrome).
• Iron deficiency in late gestation (>34/40).

2.13. Contraindications

2.13.1. Previous Hypersensitivity To IV Iron.

2.13.1.1. Acute infection/inflammation. This is a relative contraindication. Do not delay IV antibiotics for Ferinject: if IV antibiotics are indicated then administer these first. The decision to give Ferinject is to be made on a case-by-case basis. Caution is advised in severe infection; however, iron deficiency is also a risk factor for maternal infection. Allogeneic blood transfusion is also a risk factor.

2.13.2. First trimester of pregnancy.

2.14. IV Iron – Ferinject 1000mg in 20ml vial for slow IV infusion. (Unless body weight <35kg, then dose = 500mg).

Anaemia and iron deficiency: Diagnosis and Treatment throughout Pregnancy, Labour and Postpartum Period Clinical Guideline V4.3