Læknablaðið : fylgirit - 01.05.1978, Page 76

O. Strandberg, M. D. , Department of Rheuma-
tology, Danderyd Hospital, Sweden.
Elisabeth Wijnbladh, M. D., Saltsjöbaden
Hospital, Stockholm, Sweden.
FerastralW, Astra 2152, is a sterile solution
of a complex of iron and a sorbitol glueonic acid
polymer, containing 50 mg Fe+++/ml. The
preparation can be used in relatively large doses
(500 mg) with 3-7 day's interval (Andersson,
Grafford, 1975, Swedberg, 1975).
In this study, 15 patients with moderate
anaemia and subnormal MCHC were treated with
Ferastral. In all the patients inflammatory
processes, in most cases active rheumatoid
arthritis, was the underlying cause. Diagnostic
criteria according to American Rheumatism
Association were fulfilled. Concomitant therapy
consisted of usual anti-inflammatory drugs, such
as salicylates, indomethacin, naproxene, and in
some cases very low doses of penicillamine.
Local therapy with corticosteroids íh very small
doses was also used in some cases. The
corticosteroid doses thus given were too small
to affect the haematopoetic system (Strandberg,
1966).
The total doses in mg were estimated by
multiplying the haemoglobin deficit in mg/100 ml.
by 225 (Brown & Moore, 1956) plus 500 mg for
the iron stores. Another method to estimate
the expected total iron dose to be given is to
multiply desired haematocrit rise by 100 (Mc
Curdy, 1970).
The total doses given ranged between 1250 mg
and 3500 mg, the major part of the patients
receiving about 2000 mg. It was given in single
doses of 500 mg with an interval of about one
week. 3 patients received lower single doses
of 250 and 100 mg.
Laboratory methods:
Haemoglobin was determined by the cyan
methaemoglobin method. Erythrocytes were
counted in a Coulter counter, and the packed cell
volume was determined after 5 minutes centrifuga-
tion in a haematocrit centrifuge. Serum iron
concentration was determined according to Heil-
meyer and Plötner (1937) and UIBC according to
Cartwright and Wintrobe (1949). Agarose gel
electrophoresis according to H Johansson (1972).
Serum albumin concentration according to Doumas
(1971) and haptoglobin (Tai-ukoski, 1966) were
determined with chemical methods. Alpha-1-
FERESTRAL IN THE
TREATMENT OF PATIENTS WITH
INF LAMMATORY ANAEMIA
trypsine, orosomucoid, C'3, C’4 complement
fractions, immune globulins G, A, M and trans-
ferrin were determined with electro immune
assay (Laurell 1972).
R esults :
The haemoglobin data during the observation
period and at least 6 weeks after the start of
the trial - the majority of the patients were
followed for 8-12 weeks - have been tabulated
in every detail, but are not discussed in detail.
The statistical treatment of the pertinent data
are tabulated (table 2). Every patient served
as in its own control and the t-value for the
differences between the means for 4 and 8 weeks
and the means at the beginning of treatment were
calculated.
The haemoglobin concentration rose after 8
weeks significantly (P < 0.001) from 109.2 to
122.6 g/1.
Although the means for the packed cell volumes
displayed a rising tendency, the differences 4 and
8 weeks after the last injection were not statisti-
cally significant.
The erythrocyte count rose from 4.06 to 4.24
x 106/mm3 (0.1 > P > 0.01).
The MCHC means rose from 317 to 334 g/1
(0.01> P> 0.001) at 8 weeks and after 4 weeks
from 317 to 324 (0.1 > P > 0.01).
The mean serum iron concentration beginning
with 40.4 mg/100 ml rose to 68.9 (0. 01 > P>
0.001).
The UIBC decreased from 279.3 to 171.8 mg/ml
(0.01> P> 0.001). In the small series of trans-
ferrin determinations, the same tendency as for
UBBC was obtained. The mean decreased from
1.95 to 1.40 g/1 after 8 weeks (0.1 > P> 0. 01).
No changes were obtained in the agarose
electrophoresis pattern, nor in the serum protein
components. Only C’4 showed slightly rising
tendency, from 0.16 to 0.20 g/1 (0.1> P > 0. 01).
Liver and kidney tests were followed during the
test period, without changes (Add. No. 8).
Side effects:
A brownish discolouration at the injection site
was observed in 8/17 patients receiving this iron
74