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



      To compare the incidence of repeated red blood cell (RBC) transfusion in anemic gynecologic cancer patients receiving platinum-based chemotherapy comparing intravenous and oral iron.

      Materials and methods

      Forty-four anemic gynecologic cancer patients (hemoglobin level below 10 mg/dl) who required RBC transfusion were stratified and randomized according to baseline hemoglobin levels and chemotherapy regimen. Study group received 200 mg of intravenous iron sucrose and control group received oral ferrous sulphate 600 mg/day. RBC transfusion requirement in the consecutive cycle of chemotherapy was the primary outcome. Quality of life was evaluated by validated Thai version of the Functional Assessment of Cancer Therapy–Anemia (FACT-An).


      In a total of the 44 patients, there were 22 patients in each group. Five patients (22.7%) in the study group and 14 patients (63.6%) in the control group required RBC transfusion in consecutive cycle of chemotherapy (p=0.01). No significant difference in baseline hemoglobin and hematocrit levels was demonstrated in both groups. Significantly higher mean hemoglobin and hematocrit levels after treatment were reported in the study group (10.0±0.8 g/dl and 30.5±2.4%) than the control group (9.5±0.9 g/dl and 28.4±2.7%). No significant change of total FACT-An scores was noted between before and after treatment in both groups. No serious adverse events were reported and there was no significant difference among adverse events between both groups.


      Intravenous iron is an alternative treatment for anemic gynecologic cancer patients receiving platinum-based chemotherapy and reduces the incidence of RBC transfusion without serious adverse events.


      To read this article in full you will need to make a payment


      Subscribe to Gynecologic Oncology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Cella D.
        Factors influencing quality of life in cancer patients: anemia and fatigue.
        Semin. Oncol. 1998; 25: 43-46
        • Clarke H.
        • Pallister C.J.
        The impact of anaemia on outcome in cancer.
        Clin. Lab. Haematol. 2005; 27: 1-13
        • Birgegard G.
        • Aapro M.S.
        • Bokemeyer C.
        • Dicato M.
        • Drings P.
        • Hornedo J.
        • et al.
        Cancer-related anemia: pathogenesis, prevalence and treatment.
        Oncology. 2005; 68: 3-11
        • Weiss G.
        • Goodnough L.T.
        Anemia of chronic disease.
        N. Engl. J. Med. 2005; 352: 1011-1023
        • Groopman J.E.
        • Itri L.M.
        Chemotherapy-induced anemia in adults: incidence and treatment.
        J. Natl. Cancer Inst. 1999; 91: 1616-1634
        • Auerbach M.
        Should intravenous iron be the standard of care in oncology?.
        J. Clin. Oncol. 2008; 26: 1579-1581
        • Wilson J.
        • Yao G.L.
        • Raftery J.
        • Bohlius J.
        • Brunskill S.
        • Sandercock J.
        • et al.
        A systematic review and economic evaluation of epoetin alpha, epoetin beta and darbepoetin alpha in anaemia associated with cancer, especially that attributable to cancer treatment.
        Health Technol. Assess. 2007; 11 (iii-iv): 1-202
        • Bennett C.L.
        • Silver S.M.
        • Djulbegovic B.
        • Samaras A.T.
        • Blau C.A.
        • Gleason K.J.
        • et al.
        Venous thromboembolism and mortality associated with recombinant erythropoietin and darbepoetin administration for the treatment of cancer-associated anemia.
        JAMA. 2008; 299: 914-924
        • Arcasoy M.O.
        Erythropoiesis-stimulating agent use in cancer: preclinical and clinical perspectives.
        Clin. Cancer Res. 2008; 14: 4685-4690
        • Yellen S.B.
        • Cella D.F.
        • Webster K.
        • Blendowski C.
        • Kaplan E.
        Measuring fatigue and other anemia-related symptoms with the Functional Assessment of Cancer Therapy (FACT) measurement system.
        J. Pain Symptom Manage. 1997; 13: 63-74
        • Ludwig H.
        • Van Belle S.
        • Barrett-Lee P.
        • Birgegard G.
        • Bokemeyer C.
        • Gascon P.
        • et al.
        The European Cancer Anaemia Survey (ECAS): a large, multinational, prospective survey defining the prevalence, incidence, and treatment of anaemia in cancer patients.
        Eur. J. Cancer. 2004; 40: 2293-2306
        • Wojtukiewicz M.Z.
        • Sierko E.
        • Rybaltowski M.
        • Filipczyk-Cisarz E.
        • Staroslawska E.
        • Tujakowski J.
        • et al.
        The Polish Cancer Anemia Survey (POLCAS): a retrospective multicenter study of 999 cases.
        Int. J. Hematol. 2009; 89: 276-284
        • Eichbaum M.H.
        • Weiss L.M.
        • Bruckner T.
        • Schneeweiss A.
        • Sinn H.P.
        • Gebauer G.
        • et al.
        Prognostic impact of hemoglobin levels before and during carboplatin/taxane-based chemotherapy in patients with primary invasive epithelial ovarian cancer.
        Med. Sci. Monit. 2009; 15: CR156-63
        • Bohlius J.
        • Schmidlin K.
        • Brillant C.
        • Schwarzer G.
        • Trelle S.
        • Seidenfeld J.
        • et al.
        Recombinant human erythropoiesis-stimulating agents and mortality in patients with cancer: a meta-analysis of randomised trials.
        Lancet. 2009; 373: 1532-1542
        • Hayat A.
        Safety issues with intravenous iron products in the management of anemia in chronic kidney disease.
        Clin. Med. Res. 2008; 6: 93-102
        • Hedenus M.
        • Birgegard G.
        The role of iron supplementation during epoietin treatment for cancer-related anemia.
        Med. Oncol. 2009; 26: 105-115
        • Candelaria M.
        • Cetina L.
        • Duenas-Gonzalez A.
        Anemia in cervical cancer patients: implications for iron supplementation therapy.
        Med. Oncol. 2005; 22: 161-168
        • Kim Y.T.
        • Kim S.W.
        • Yoon B.S.
        • Cho H.J.
        • Nahm E.J.
        • Kim S.H.
        • et al.
        Effect of intravenously administered iron sucrose on the prevention of anemia in the cervical cancer patients treated with concurrent chemoradiotherapy.
        Gynecol. Oncol. 2007; 105: 199-204
        • Auerbach M.
        • Ballard H.
        • Glaspy J.
        Clinical update: intravenous iron for anaemia.
        Lancet. 2007; 369: 1502-1504
        • Bailie G.R.
        • Clark J.A.
        • Lane C.E.
        • Lane P.L.
        Hypersensitivity reactions and deaths associated with intravenous iron preparations.
        Nephrol. Dial. Transplant. 2005; 20: 1443-1449
        • Lyseng-Williamson K.A.
        • Keating G.M.
        Ferric carboxymaltose: a review of its use in iron-deficiency anaemia.
        Drugs. 2009; 69: 739-756
        • Roungrong J.
        • Teerawattananon Y.
        • Chaikledkaew U.
        Cost-utility analysis of recombinant human erythropoietin in anemic cancer patients induced by chemotherapy in Thailand.
        J. Med. Assoc. Thai. 2008; 91: S119-S125