From the Research
Yes, injectable iron, specifically intravenous (IV) iron formulations, can be used to treat iron deficiency anemia in patients with thrombocytosis, but caution is warranted. Common IV iron preparations include iron sucrose (Venofer), ferric carboxymaltose (Injectafer), ferumoxytol (Feraheme), and iron dextran (INFeD) 1. Dosing varies by preparation: iron sucrose typically 200-300 mg per session, ferric carboxymaltose 750-1000 mg per dose, ferumoxytol 510 mg per dose, with total dosing based on the patient's iron deficit.
When administering IV iron to patients with thrombocytosis, careful monitoring is essential as iron infusions could theoretically exacerbate the elevated platelet count. The underlying cause of thrombocytosis should be determined before treatment, as reactive thrombocytosis (secondary to iron deficiency) may actually improve with iron repletion, while primary thrombocytosis (from myeloproliferative disorders) requires different management 2. Patients should be monitored for infusion reactions, and the first dose should be given in a controlled setting with appropriate emergency equipment available. Iron parameters including ferritin, transferrin saturation, and complete blood counts should be checked before treatment and periodically afterward to assess response.
Key considerations in the management of anemia in patients with thrombocytosis include:
- Determining the underlying cause of thrombocytosis to guide treatment decisions
- Careful monitoring for potential complications of IV iron therapy, such as infusion reactions and exacerbation of thrombocytosis
- Individualization of treatment based on patient-specific factors, such as iron deficiency and overall health status
- Consideration of alternative therapies, such as oral iron supplements or erythropoiesis-stimulating agents, in patients who are not candidates for IV iron therapy 3, 4.
Overall, the use of IV iron formulations to treat iron deficiency anemia in patients with thrombocytosis requires careful consideration of the potential benefits and risks, as well as close monitoring and individualization of treatment.