Blood transfusion reduction with intravenous iron in gynecologic cancer patients receiving chemotherapy.

Anemia is a common and frequent complication in oncologic patients. It has various underlying causes such as inhibited erythropoiesis by elevated cytokine levels, reduced iron absorption and utilization linked by abnormal hepcidin formation and chemotherapy which might suppress erythropoiesis.

Traditional therapies for anemia in oncologic patients are blood transfusion, erythropoiesis-stimulating agents (ESAs) and oral iron. Concerning iron therapy, there is increasing interest in the use of intravenous iron and the article by Dangsuwan and Manchana shows a positive influence of intravenous iron sucrose on transfusion frequency in gynecologic cancer patients with chemotherapy. The strength lies in the fact that no ESAs were used in the study group and single doses of 200 mg iron sucrose showed already an effect on hemoglobin levels. However, the control group received 600 mg of oral iron daily, which is probably too elevated a dosage regarding optimal absorption and patient compliance. Interestingly, no difference in quality of life assessment was observed. This might be due to the fact that hemoglobin levels around 12 g/dL could not be reached in both groups.

Future studies should consider higher repeated doses of intravenous iron sucrose compared to lower daily oral iron dosages over a longer time period.

– Christian Breymann