The combined use of erythropoietin and iron preparations for the management of postpartum anemia: a systematic review and meta-analysis

INTRODUCTION: There are limited data on the effectiveness of erythropoietin in combination with oral ferrotherapy for the management of postpartum anemia. OBJECTIVE: To evaluate the efficacy of erythropoietin in combination with oral iron compared with oral ferrotherapy in puerperas with postpartum haemorrhage. MATERIALS AND METHODS: MEDLINE, Scopus, EBSCOhost and 5 other databases (January 1980 to February 2023) were searched for articles on the use of oral iron in combination with and without erythropoietin for the treatment of post-hemorrhagic anemia in puerperas. Primary outcomes: hemoglobin level, hemoglobin increase, hematocrit, number of blood transfusions, secondary outcomes: ferritin level, serum iron, lactation capacity. The analysis was carried out in accordance with the PRISMA guidelines, 2020. RESULTS: 4 studies were analyzed, 198 women were included. When using erythropoietin in combination with oral ferrotherapy, the cumulative value of the increase in hemoglobin concentration after 5 days, 2 weeks of treatment was significantly higher compared with the control group (mean difference [MD]: 11.83 g/L, 95% CI 4.43–19.23; р = 0.002, MD 10.13 g/L, 95% CI 4.97–15.29; р = 0.0001), respectively. The cumulative mean hemoglobin concentration after 40 days of treatment was significantly higher in the erythropoietin group (MD 11.00 g/L, 95% CI 1.70–20.30; р = 0.02). The cumulative mean hematocrit after 2 weeks of treatment was significantly higher in the erythropoietin group (MD 3.35 %, 95% CI 0.31–6.39; р = 0.03). The use of erythropoietin in combination with oral iron reduces the likelihood of blood transfusion (relative risk 0.12, 95% CI 0.02–0.95; р = 0.04). CONCLUSIONS: A faster hematological response was shown with the combined use of erythropoietin with oral ferrotherapy compared with monotherapy with iron preparations in the management of postpartum anemia. Further studies with sufficient sample sizes are required.