II. Indications
- Severe Iron Deficiency Anemia and iron malabsorption
- Chronic bleeding not corrected by other means
- Oral iron not tolerated
- Severe Anemia and refusal of Blood Transfusion
III. Preparations
- Sodium Ferric Gluconate (Ferrlecit)
- Dosing: 125 mg (10 ml) of 62.5 mg/5 ml solution diluted in 100 ml saline
- May give weekly IV for 8 weeks (total: 1 gram)
- Much safer than Iron Dextran
- Test dose recommended with 2 ml diluted in 50 ml saline infused over 1 hour prior to first infusion
-
Iron sucrose (Venofer)
- Much safer than Iron Dextran (no test dose needed)
- Dosing: 100 mg (20 ml) IV of 20 mg/ml solution for 5 doses over 2 week period (1-3 times per week)
- Ferumoxytol (Feraheme)
- Single infusion given over 5 minutes supplies 510 mg elemental iron per 17 ml solution
- May repeat in 3-8 days for second injection
- U.S. FDA black box warning for serious Allergic Reactions (monitor for Hypersensitivity, Hypotension)
- Ferric Carboxymaltose (Injectafer)
- Available as 750 mg/15 ml solution
- Monitor for Hypersensitivity
- Variable Blood Pressure effects with Hypertension in 3.8% and Hypotension in 1% of patients
- Dosing
- Weight >50 kg (110 lb): Give 750 mg (15 ml) in 2 doses at 7 days apart
- Weight <50 kg (110 lb): Give 15 mg/kg in 2 doses at 7 days apart
- Iron Dextran (Imferon, Dexferrum, Infed)
- High rate of serious reaction (requires test dose of 0.5 ml one hour before infusion)
- Replaced by newer agents (e.g. Ferrlecit, Feraheme, Venofer)
- Intramuscular or Intravenous
- Available as 50 mg/ml
- Dose based on estimated iron deficits
IV. Precautions
- Intravenous Iron must be started very slowly
- Avoid in patients with acute or chronic infections
V. Efficacy
- Hemoglobin increased 2 g/dl (NNT 5)
- Red Blood Cell Transfusion avoided (NNT 36)
- Oral iron is as effective as Parenteral Iron in preventing Blood Transfusion and mortality
- Oral iron is preferred in those without significant malabsorption or other barriers to oral ingestion
- Mounsey (2022) Am Fam Physician 106(2): 191-2 [PubMed]
VI. Adverse Effects
- Skin staining at site of Intramuscular Injection
- Consider Z-tract injection technique
- Severe pain at injection site
- Infection Risk (NNH: 62)
- Delayed reaction (24-48 hours after administered)
- Myalgias and Arthralgias
- Headache
-
Anaphylaxis
- Occurs in 0.61% of patients given Iron Dextran
- Occurs in 0.04% of patients given ferric gluconate