From the Guidelines
Ferumoxytol (Feraheme) is the recommended treatment for this patient with iron deficiency anemia due to menorrhagia, given its ability to rapidly replenish iron stores and correct anemia with a total dose of 1,020 mg administered as 1020 mg in a single 30 min infusion, as supported by recent studies 1. The patient's severely low hemoglobin (8 g/dL), iron (17 μg/dL), ferritin (4 ng/mL), and iron saturation (4%) indicate significant iron deficiency requiring prompt treatment. Key benefits of Feraheme include:
- Rapid replenishment of iron stores
- Correction of anemia more quickly than oral iron supplements
- Administration in just one dose, improving compliance
- Low incidence of serious adverse events when administered as a 30-minute infusion 1 Patients should be monitored for hypersensitivity reactions during and for at least 30 minutes after infusion. Additionally, addressing the underlying menorrhagia through gynecological evaluation is essential for long-term management, as noted in recent clinical practice updates 1. After completing the iron infusion course, hemoglobin levels should be rechecked in 4-6 weeks to assess response to therapy. It is also important to note that Feraheme can be used as a magnetic resonance imaging contrast agent, and radiologists should be notified if MRI is planned within 3 months of infusion 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 (menorrhagia) 3, 4.
- Menorrhagia can lead to iron deficiency and iron deficiency anemia, which can negatively impact quality of life 3, 4.
- The relationship between menorrhagia, iron deficiency, and anemia is complex and not fully understood, but it is clear that these conditions are interrelated 5, 3.
Treatment of Iron Deficiency Anemia
- Treatment for iron deficiency anemia typically involves iron supplementation, which can be given orally or intravenously 6, 7.
- Intravenous iron (IVI) is often used to treat iron deficiency anemia in patients with heavy menstrual bleeding, as it can provide faster and more effective relief from symptoms 7.
- However, IVI treatment can be inconvenient and may require multiple infusions, which can impact patients' daily lives and adherence to treatment 7.
Diagnosis and Screening
- Diagnosis of iron deficiency anemia typically involves blood tests to measure hemoglobin, ferritin, and iron saturation levels 6, 5.
- Screening for iron deficiency and anemia is important, especially in women with heavy menstrual bleeding, as these conditions can have significant impacts on quality of life and cognitive function 5, 3.
- Non-invasive screening methods, such as fingerprick blood tests, can be used to identify individuals at risk of iron deficiency and anemia 5.
Patient Perspectives and Preferences
- Patients with iron deficiency anemia and heavy menstrual bleeding often experience significant delays in diagnosis and treatment, which can negatively impact their quality of life 7.
- Patients may prefer single-dose IVI treatment, as it can be more convenient and require fewer infusions 7.
- Patient perspectives and preferences should be taken into account when developing treatment plans and guidelines for iron deficiency anemia and heavy menstrual bleeding 7.