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Introduction
Iron deficiency anaemia (IDA) is common during pregnancy and the postpartum period, affecting up to 30 per cent of women in the developed world and 50 per cent of women in the developing world (Bencaiova et al., 2012). This is due to increased iron demands during pregnancy to support expanded maternal plasma volume, as well as the growing foetus and placenta (Gautam et al., 2008). Such detrimental effects for the pregnant woman include fatigue, depression and impaired cognitive performance, which can be further aggravated by intrapartum blood loss (Beard et al., 2005; Haider et al., 2013). Maternal anaemia can also affect the growing foetus, causing intrauterine growth restriction, preterm labour and neonatal anaemia, thereby negatively affecting child health outcomes (Congdon et al., 2012; Scholl, 2011). Oral iron is considered the first supplement of choice. However, a long course is required to replace iron stores, and this is not recommended for pregnant patients with severe anaemia (Daniilidis et al., 2018).
An alternative treatment option is an intravenous (IV) iron infusion known as ferric carboxymaltose. This is a dextran-free iron supplement useful to correct IDA rapidly and is considered relatively safe for both mother and foetus in second and third trimesters of pregnancy (Daniilidis et al., 2018; Govindappagari and Burwick, 2018; Qassim et al., 2018). Given its efficacy and safety profile, ferric carboxymaltose will continue to be utilised to correct IDA. A rare but known side effect of ferric carboxymaltose is skin staining (Baird-Gunning and Bromley, 2016) due to extravasation of iron molecules into soft tissue (Raulin et al., 2001). Such staining may be potentially permanent, unacceptable for some patients and responds variably to laser treatment (Raulin et al., 2001).
Over nine months, two such incidences occurred in our maternity unit. Although cases of skin staining have been reported in the literature (Lim et al., 2008; Pérez-Pevida and Kamocka, 2018; Thompson et al., 2014), our search revealed no cases of skin staining among pregnant and postpartum women. Considering the aesthetic repercussions for patients and potential medicolegal implications, a quality improvement project was developed, in order to implement a safe and effective iron infusion protocol, to prevent future skin staining.
Background of the problem
Iron...