Use of intravenous iron in cyanotic patients with congenital heart disease and/or pulmonary hypertension

Autor: Aleksander Kempny, Rafael Alonso-Gonzalez, Stephen J. Wort, Laura C. Price, Lorna Swan, Maurice Beghetti, C Blanche, Konstantinos Dimopoulos, Aitor Uribarri
Rok vydání: 2018
Předmět:
Male
Heart disease
Hyperviscosity
030204 cardiovascular system & hematology
Ferric Compounds
0302 clinical medicine
Erythropoiesis
030212 general & internal medicine
Heart Defects
Ferric Compounds/administration & dosage/adverse effects
ddc:618
Hematologic Tests
biology
Iron Deficiencies
Middle Aged
Rash
Hematologic Tests/methods
Treatment Outcome
Polycythemia/diagnosis/etiology/therapy
Administration
Hypertension
Cardiology
Administration
Intravenous
Female
medicine.symptom
Drug Monitoring
Intravenous
Cardiology and Cardiovascular Medicine
Drug Monitoring/methods
Adult
Heart Defects
Congenital
medicine.medical_specialty
Hypertension
Pulmonary
Iron
Congenital/blood/complications
Polycythemia
Pulmonary hypertension
03 medical and health sciences
Internal medicine
medicine
Humans
Erythropoiesis/drug effects
Maltose
Congenital heart disease
Aged
Retrospective Studies
Maltose/administration & dosage/adverse effects/analogs & derivatives
Cyanosis
Transferrin saturation
business.industry
Eisenmenger syndrome
Pulmonary/blood/complications
medicine.disease
United Kingdom
Ferritin
Iron/administration & dosage/adverse effects/deficiency
biology.protein
Hematinics
Hematinics/administration & dosage/adverse effects
business
Zdroj: International Journal of Cardiology, Vol. 267 (2018) pp. 79-83
ISSN: 1874-1754
0167-5273
Popis: Background Secondary erythrocytosis is common in patients with cyanosis secondary to congenital heart disease (CHD) and/or pulmonary hypertension (PH). This compensatory mechanism aims at increasing oxygen delivery to the tissues, but it requires adequate iron stores. Optimal methods of iron supplementation in this setting remain controversial, with fears of excessive erythropoiesis and hyperviscosity symptoms. We describe our experience using intravenous ferrous carboxymaltose. Methods and results 142 consecutive cyanotic patients were treated over 5.7 years (201 administrations). Mean age was 51.3 ± 17.6 years and 55 (38.7%) were male. Eisenmenger syndrome (ES) was present in 41 (28.8%), other pulmonary arterial hypertension (PAH) related to CHD (PAH-CHD) in 27 (19.0%), cyanotic CHD without PAH in 16 (11.3%) and PH without CHD in 58(40.8%). Baseline haemoglobin (Hb) concentration was 14.6 ± 3.0 g/dL and haematocrit 0.45 ± 0.09. A 500 mg dose of intravenous (IV) iron carboxymaltose was given in 163 (81.1%) of administrations and a 1000 mg dose in 37 (18.4%). A significant improvement in average Hb, haematocrit, ferritin and transferrin saturation was observed after a median follow-up of 100.0 [70.0–161.0] days (p ≤ 0.0001 for all). There were no cases of excessive erythropoiesis resulting in new hyperviscosity symptoms and/or requiring venesection. A minor transient rash was observed in 2 patients and one patient experienced an air embolus causing a transient ischemic attack. Conclusions Intravenous ferrous carboxymaltose appears to be safe in iron deficient patients with cyanosis due to CHD and/or PH, as long as care is taken to avoid air emboli. Further randomised studies are needed to confirm the safety and efficacy of intravenous iron in this setting.
Databáze: OpenAIRE
Externí odkaz: