Single-dose intravenous iron for iron deficiency: a new paradigm

Abstract

Iron-deficiency anemia is the most common hematologic problem in the world. Although oral iron is often viewed as front-line therapy, extensive published evidence has accumulated that IV iron is superior, in both efficacy and safety, to oral iron in many clinical situations and should be introduced much sooner in the treatment paradigm of iron-deficient patients. In this chapter, we will review the formulations of IV iron that allow total complete replacement doses in 1 or 2 sessions including practical tips for administration. We realize safety concerns abound and therefore will analyze evidence based overstated concerns regarding serious adverse events highlighting unnecessary interventions for minor, self-limiting infusion reactions, which infrequently occur with intravenous iron administration. Recent data for the use of IV iron in a variety of clinic situations will be reviewed including women with heavy uterine bleeding, pregnancy, bariatric surgery, inflammatory bowel disease, and restless legs syndrome. Briefly discussed is the new frontier of IV iron's use in the prevention of acute (high altitude) mountain sickness. It is clear that in many clinical situations IV iron is a new and improved standard of care offering advantages over oral iron in efficacy, toxicity, and convenience to patients and health care providers.

Figure 1.

Effect of daily ferrous sulfate supplementation on the incidence of gastrointestinal side effects in IV iron-controlled randomized control trials. Reprinted from Tolkien et al with permission.

Figure 2.

(A) Minor infusion reaction. (B) After (used with patient’s permission).

Figure 3.

Treatment of iron reactions. Reprinted from Rampton et al with permission.

Figure 4.

Labile iron by iron formulation. Reprinted from Jahn et al with permission.

Figure 5.

Intravenous iron in pregnancy—hemoglobin rise. Reprinted from Wong et al with permission.

Figure 6.

Iron absorption. With permission from Dr. Jerry Spivak, Johns Hopkins University School of Medicine.

Figure 7.

Protective effect of IV iron in preventing acute mountain sickness. Increase in Lake Louise score—a marker of severity of mountain sickness after rapid ascent to 4340 meters. Before ascent, the iron group received 200 mg iron sucrose and placebo normal saline. Difference between groups is significant (P < .05). Reprinted from Talbot et al with permission.