SDMS ID: P2010/0322-001 Ref No WACSClinProc1.

11 Title: Replaces: Description: Target Audience: Key Words: Policy Supported: Definitions: The World Health Organisation defines anaemia in pregnant woman as haemoglobin as less than 11g/dl. Purpose: Intravenous iron is indicated for parenteral treatment of iron deficiency in cases where oral iron preparations cannot provided sufficient supplementation or where the administration of oral iron is contraindicated. Iron polymaltose should not be administered in the first trimester of pregnancy. Adverse Reactions Include: Flushing, sweating, chills and fever, chest and back pain. Nausea and vomiting Headache, dizziness Joint and muscle pain, arthralgia Rash, urticaria, angioneurotic oedema Syncope, tachycardia, hypotension, circulatory collapse Bronchospasm with dyspnoea Anaphylaxis. Precautions: Anaphylactic reactions occur within the first several minutes of administration and are generally characterised by sudden onset of respiratory difficulties, tachycardia and hypotension. Adrenaline and facilities for resuscitation must be available at the time of administration. Procedure: Polaramine 2 to 4mg orally is recommended 30 minutes prior to commencing the infusion to reduce the incidence of adverse reactions. The dose of Polymaltose is calculated from the patients booking in weight and haemoglobin (see appendix 1 Iron Polymaltose Dose Calculation Table). The calculated dose is added via a filter needle to 500ml of sodium chloride 0.9%. Infuse using a volumetric pump according to the following guide. Intravenous Iron Infusion Intravenous Iron Infusion WACSClinProc1.11-07 Guideline for administration of intravenous iron infusion Midwives and medical officers, QVMU Iron infusion

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Infusion Rate Time Test Dose If Test Dose Tolerated Balance of Infusion First 10 minutes of infusion Next 50 minutes of infusion Remainder of infusion may be given over 2 to 3 hours Infusion Rate (mL/hour) 30 40 230 Volume to be Infused 5mL 33mL Remainder of infusion

Observations Initial baseline observations. Constant observation by a registered nurse during test dose and until infusion commences. 15 minutely observations for first hour Hourly observations until infusion completed. If at any time during the infusion signs of hypersensitivity reaction or intolerance are detected (eg. hypertension, cardio-vascular instability, shortness of breath or wheeze): Cease the infusion immediately Notify the medical officer Monitor vital signs Initiate resuscitation - airway management/oxygen

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Attachments Attachment 1 Attachment 2

Iron Polymaltose Dose Calculation Table References

Performance Indicators: Evaluation of compliance with guideline to be achieved through medical record audit annually by clinical Quality improvement Midwife WACS Review Date: Annually verified for currency or as changes occur, and reviewed every 3 years via Policy and Procedure working group coordinated by the Clinical and Quality improvement midwife. November 2009 Midwives and medical staff WACS Dr A Dennis Co-Director (Medical) Sue McBeath Co-Director (Nursing & Midwifery) Womens & Childrens Services

Stakeholders: Developed by:

Dr A Dennis Co-Director (Medical) Womens & Childrens Services

Sue McBeath Co-Director (Nursing & Midwifery) Womens & Childrens Services

Date: _________________________

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ATTACHMENT 1 IRON POLYMALTOSE DOSE CALCULATION TABLE

Body Wt

Hb 60g/L
mg iron mL Amps mg iron

Hb 75g/L
mL Amps mg iron

Hb 90g/L
mL Amps mg iron

Hb 105g/L
mL Amps

kg 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90

150 300 500 650 800 950 1250 1350 1500 1600 1700 1800 1900 2000 2100 2250 2350 2450

3 6 10 13 16 19 25 27 30 32 34 36 38 40 42 45 47 49

1.5 3 5 6.5 8 9.5 12.5 13.5 15 16 17 18 19 20 21 22.5 23.5 24.5

150 300 450 550 700 850 1150 1200 1300 1400 1500 1600 1650 1750 1850 1950 2050 2150

3 6 9 11 14 17 23 24 26 28 30 32 33 35 37 39 41 43

1.5 3 4.5 5.5 7 8.5 11.5 12 13 14 15 16 16.5 17.5 18.5 19.5 20.5 21.5

150 250 350 500 600 750 1000 1100 1150 1250 1300 1350 1450 1500 1600 1650 1700 1800

3 5 7 10 12 15 20 22 23 24 26 27 29 30 32 33 34 36

1.5 2.5 3.5 5 6 7.5 10 11 11.5 12 13 13.5 14.5 15 16 16.5 17 18

100 200 300 400 550 650 900 950 1000 1050 1100 1150 1200 1250 1300 1350 1400 1450

2 4 6 8 11 13 18 19 20 21 22 23 24 25 26 27 28 29

1 2 3 4 5.5 6.5 9 9.5 10 10.5 11 11.5 12 12.5 13 13.5 14 14.5

Note: Booking in weight should be used.

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ATTACHMENT 2 REFERENCES Cuervo LG & Mahomed K. Treatments for iron deficiency anaemia in pregnancy. Cochrane Database of Systematic Reviews 2001, Issue 2. Art. No.: CD003094. DOI: 10.1002/14651858.CD003094. Launceston General Hospital Pharmacy 2007 Parenteral Drug Administration Protocols p131-132. MIMS Online Prescribing Information Iron polymaltose complex. Online: http://mims.hcn.net.au/ifmx-nsapi/mimsdata/?MIval=2MIMS_abbr_pi&product_code=288&product_name=Ferrum+H+Injection Royal Hobart Hospital Clinical Practice Guidelines & Protocols 2007 Iron polymaltose infusion guideline Online: http://intra.dhhs.tas.gov.au/dhhs-online/cuesearch.php?f=ii&search=iron+infusion&owner=116 Sigma Pharmaceuticals 2002 Product Information Ferrosig Injection

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