From the Guidelines
Ferumoxytol (Feraheme) is recommended for this case of iron deficiency anemia due to menorrhagia, with a total dose of 1020 mg administered as a single infusion over 30 minutes. Given the severity of the anemia (hemoglobin of 8 g/dL) and critically low iron studies (ferritin 4 ng/mL, iron 17 μg/dL, iron saturation 4%), IV iron is preferred over oral supplementation for faster repletion 1. The use of Feraheme offers advantages of fewer infusions compared to other IV iron formulations, and its administration has been shown to be safe and effective when given as a single 1020 mg dose over 30 minutes 1.
Some key points to consider when administering Feraheme include:
- Monitoring patients for hypersensitivity reactions for at least 30 minutes following infusion 1
- Notifying radiologists if an MRI is planned within 8 weeks of administration, as Feraheme can interfere with MRI interpretation 1
- Concurrent treatment of the underlying menorrhagia is essential for long-term management
- Patients typically see improvement in hemoglobin levels within 2-4 weeks after completing the infusions
- A follow-up complete blood count and iron studies should be performed 4-8 weeks after treatment to assess response 1
It's also important to note that while other IV iron formulations are available, Feraheme has been shown to have a similar safety profile to other formulations, with a low incidence of serious adverse events 1. However, the unique considerations of Feraheme, such as its use as an MRI contrast agent, should be taken into account when selecting an IV iron formulation 1.
From the FDA Drug Label
Feraheme is indicated for the treatment of iron deficiency anemia (IDA) in adult patients: • who have intolerance to oral iron or have had unsatisfactory response to oral iron or • who have chronic kidney disease (CKD). The recommended dose of Feraheme is an initial 510 mg dose followed by a second 510 mg dose 3 to 8 days later.
The patient has iron deficiency anemia with a hemoglobin of 8, ferritin of 4, and iron saturation of 4. The recommended dose of Feraheme is an initial 510 mg dose followed by a second 510 mg dose 3 to 8 days later.
- Key considerations:
- Administer Feraheme as an intravenous infusion over at least 15 minutes
- Monitor for signs and symptoms of hypersensitivity reactions during and for at least 30 minutes following Feraheme infusion
- Evaluate the hematologic response at least one month following the second Feraheme infusion 2
From the Research
Iron Deficiency Anemia and Menorrhagia
- Iron deficiency anemia is a common condition that can be caused by heavy menstrual bleeding, also known as menorrhagia 3.
- Menorrhagia can lead to iron deficiency anemia, which can cause symptoms such as fatigue, hair loss, and restless legs 3.
- The diagnosis of iron deficiency anemia can be confirmed by low serum ferritin levels, which is the most efficient test for diagnosis 3.
Treatment of Iron Deficiency Anemia
- Iron replacement can be done orally or intravenously, depending on the severity of the condition and the patient's response to treatment 3.
- Intravenous iron infusion is a common treatment for iron deficiency anemia, especially in patients who do not respond to oral iron supplements or have severe iron deficiency anemia 4, 5.
- A study found that patients with heavy menstrual bleeding and iron deficiency anemia preferred single-dose intravenous iron infusion, which can improve their quality of life and adherence to treatment 6.
Relationship between Menorrhagia, Iron Deficiency, and Anemia
- There is a strong association between heavy menstrual bleeding and iron deficiency anemia, with women who experience heavy menstrual bleeding being more likely to have iron deficiency anemia 7.
- A study found that 30.9% of exercising females of reproductive age reported heavy menstrual bleeding, and those who reported heavy menstrual bleeding were more likely to have a history of iron deficiency or anemia 7.
- Iron deficiency anemia can have a significant impact on quality of life, and early diagnosis and treatment are essential to prevent long-term complications 6.