COMPARATIVE EVALUATION OF EFFICACY AND SAFETY OF INTRAVENOUS FERRIC CARBOXYMALTOSE VERSUS IRON SUCROSE COMPLEX FOR THE TREATMENT OF MODERATE GRADE ANEMIA IN POST CAESAREAN SECTION WOMEN: A RANDOMIZED PROSPECTIVE STUDY : Ferric carboxymaltose in postpartum anemia

Objective: Iron deficiency anemia is common in post partem women in India. The present study is aimed at comparing the safety and efficacy of intravenous ferric carboxymaltose with intravenous iron sucrose complex in patients who underwent ceasarean section and having moderate grade anemia in post partem period. Material & methods: A prospective, comparative study was carried out in 100 post caesarean section women with moderate grade anemia (Hb 7-9 gm %) in Gajra Raja Medical College, Gwalior (M.P.) from February 2019 to August 2020. Subjects were randomly allocated to 2 groups namely FCM and ICS, 50 patients in each group. In group FCM, patients were infused with1000mg of Ferric carboxymaltose in a single dose on 4th post operative day. Patients in ISC group were infused with iron sucrose complex 200mg in100 ml normal saline on 3 alternate days on 4th, 6th,  and 8th post operative day.  Mean haemoglobin, (Hb) mean carpuscular volume (MCV), mean carpuscular haemoglobin (MCH), and mean carpuscular haemoglobin concentration (MCHC) were recorded before start of therapy and 15 days after treatment in all study subjects. Mean reticulocyte count was recorded before start of treatment and two days after completion of treatment that is on   6th and 10th  post ceasarean day in FCM and ICS group respectively. Adverse drug reactions were recorded during the study period. Statistical analysis was done using SPSS (Statistical Package for Social Sciences) software. Results: Mean haemoglobin increased by 27% in FCM & by 19 % in ISC group and is significant (*P<0.05) from baseline values. FCM showed significantly (**P<0.01) better response, than ISC group. Mean reticulocyte percent showed significant increase by 120% and 73% in FCM and ISC group respectively from the baseline and change in mean reticulocyte in FCM was significant (***P<0.001) as compared to ISC.  The mean rise in MCV was 12 % and 5% & MCH was by 10% and 1% in FCM & ISC group respectively. FCM groups showed significantly better response (P<0.05) than iron sucrose complex. However, in MCHC there were 7% and 4 % increase in FCM and ISC group respectively and on inter group comparison was not significant. (P>0.05)  Adverse effects noted during the study were mild and responded to symptomatic treatment. Sixteen % of FCM cases and 26% of ISC cases underwent adverse drug reactions that included nausea, vomiting, giddiness and injection site reactions  Conclusion: Ferric carboxymaltose is more efficacious and safer than iron sucrose complex, making it the first line of management in post-partum iron deficiency anemia. &nbsp