Impact of Adjunctive Intravenous Iron Therapy on Hemoglobin Recovery in Obstetric Patients: A Retrospective Cohort Study

Background: Postpartum anemia frequently requires packed red blood cell (PRBC) transfusion; however, the contribution of intravenous iron to early hematologic recovery remains uncertain. This study evaluated hemoglobin dynamics following transfusion and the effect of adjunctive intravenous iron therapy. Methods: In this retrospective cohort study, 61 obstetric patients requiring PRBC transfusion were included. Hematologic parameters were assessed at admission, postoperatively, post-transfusion, and at day 7. Patients were stratified according to the administration of intravenous ferric carboxymaltose. Hemoglobin changes and reticulocyte response were analyzed, including a subgroup receiving two PRBC units. Results: Mean hemoglobin decreased from 9.36 ± 1.16 g/dL at admission to 6.33 ± 1.05 g/dL postoperatively, increased to 8.32 ± 0.78 g/dL after transfusion, and reached 8.75 ± 0.97 g/dL at day 7 (p < 0.001). No significant differences between groups were observed before or immediately after transfusion. At day 7, hemoglobin was significantly higher in patients receiving intravenous iron compared with those without supplementation (9.63 ± 1.03 vs. 8.03 ± 0.36 g/dL, p < 0.001). The increase in hemoglobin from post-transfusion to day 7 was greater in the iron group (1.14 ± 0.84 vs. −0.15 ± 0.33 g/dL, p < 0.001), accompanied by a higher reticulocyte response (2.56 ± 0.49% vs. 0.93 ± 0.26%, p < 0.001). Similar findings were observed in the two-unit subgroup. Conclusions: Adjunctive intravenous iron was associated with improved early hemoglobin recovery after transfusion without affecting immediate correction, supporting its clinical use in obstetric patients.