Treatment for women with postpartum iron deficiency anaemia.

Systematic review of randomized trials in women with postpartum iron deficiency anaemia, generally defined as haemoglobin below 12 g/dL within 6 weeks after delivery. The included active-arm populations were mostly women enrolled 24 to 72 hours postpartum with haemoglobin below 10 g/dL, and study settings included single-centre and multicentre trials.

Erythropoietin was evaluated in multiple postpartum regimens, usually combined with iron and sometimes folic acid. Active arms included single-dose or short-course subcutaneous or intravenous EPO, such as 300 U/kg once, 300 U/kg daily for 4 days, 200 IU/kg/day for 15 days, 10,000 IU i.v. at 24 hours, and 20,000 units as a single dose; comparator arms received iron alone, iron plus folate, or placebo.

Overall, erythropoietin with iron showed limited but generally favourable effects on haematologic recovery, while evidence for clinically important outcomes remained sparse. In Meyer 1995, i.v. EPO versus placebo increased haemoglobin by 0.40 g/dL within 2 weeks (95% CI -0.26 to 1.06) and haematocrit by 1.60% (95% CI -0.42 to 3.62). Pooled EPO plus iron versus iron suggested fewer blood transfusions (RR 0.20, 95% CI 0.01 to 3.92) and more lactation at discharge (RR 1.90, 95% CI 1.21 to 2.98), but the transfusion result was imprecise and most outcomes were laboratory-based. The review concluded that more high-quality trials are needed, especially for clinically relevant outcomes and safety.

Evidence was limited to small trials with heterogeneous EPO schedules, routes, and co-treatments. Most outcomes were haematologic rather than patient-important clinical endpoints, and follow-up was short. Key safety and resource-use outcomes were underpowered, and no randomized evidence for blood transfusion as a treatment was identified.