Effectiveness of Intravenous Iron Therapy Versus Oral Iron Therapy in Anemia in Burn Patients

Abstract

BACKGROUND: Burn injuries have been noted to cause significant morbidity and mortality, especially in the developing world, the majority of which occur in middle- and low-income countries. Anemia in burn patients refers to the acute drop in hemoglobin concentration immediately after severe burn wounds, during surgical operative procedures in burns and the process of healing and resolution of a burn wound. In acute cases, oral iron supplements are given as a first option, mainly due to its effectiveness and affordability. Intravenous (IV) iron treatment has also been suggested to be safe and cheap alternative, however there is paucity of data comparing the two supplementation methods in raising Hb levels in burn anemic patients. OBJECTIVE: To compare the effectiveness of intravenous iron therapy versus oral iron therapy in raising Hb levels in anemic burn patients. METHODOLOGY: This was a randomized control trial study. A total of 48 burn patients over 18years old with a total burn surface area above 20%, admitted at the KNH burns unit and the plastic surgery ward were randomly divided into two study groups using computer generated random numbers. Group A received intravenous iron and group B received oral iron. All the patients in the two-study group had an informed consent taken, the following data was collected using a data extraction form in a Microsoft Excel database: baseline hemoglobin level before onset of treatment and hemoglobin levels on day 7, day 14 and day 28. It was then exported to a statistical product and service solutions (SPSS) version 24 software for statistical analysis. Data values were expressed in terms of mean and standard deviation. A student's t-test was used to assess statistically significant differences in the hemoglobin levels between two groups and results were presented in

frequency tables, bar charts and pie charts. A p-value <0.05 was considered statistically significant. RESULTS: Of the 48 patients included in the study, 24 received intravenous iron and the other 24 received oral iron treatment. 29 out of the total 48 (60.4%) were male and 19 out of the total 48(39.6%) were female. The mean age was 32.8 years, mean total burn surface area was 28.3%. Throughout the study period, both the patients in the two-study groups showed a slower rate in decrease of their hemoglobin levels. However, the decrease was much slower in patients who received intravenous iron compared to those who received oral iron (p value >0.05). Moreover, the number of patients who required blood transfusion was less in the group who received intravenous iron compared to those who received oral iron supplements. CONCLUSIONS: burns patients in Group A who received intravenous iron were noted to have a slower drop in hemoglobin level compared to those in Group B who received oral iron, also the number of repeated blood transfusions was noted to be lesser in those who received intravenous iron and were associated with minimal complications during the study period. In conclusion, intravenous iron administration is more effective in management of anemia in burns patients compared to oral iron