What injectable iron formulations can be used to treat anemia in patients with thrombocytosis?

From the Guidelines

Injectable iron formulations such as iron sucrose, ferric carboxymaltose, iron dextran, ferumoxytol, and iron isomaltoside can be used to treat anemia in patients with thrombocytosis, with iron sucrose and ferric carboxymaltose being preferred options due to their favorable safety profiles. When considering treatment options, it is essential to weigh the benefits and risks of each formulation. According to a study published in the American Journal of Hematology 1, six different IV iron preparations are currently available, including low molecular weight (LMW) iron dextran, iron gluconate, iron sucrose, ferumoxytol, ferric carboxymaltose, and iron isomaltoside. Some key points to consider when administering these medications to patients with thrombocytosis include:

• Careful monitoring is essential as intravenous iron can potentially stimulate platelet production
• A test dose is recommended before the first full dose, particularly with iron dextran which carries a higher risk of hypersensitivity reactions, as noted in the study 1
• Treatment should be accompanied by regular monitoring of hemoglobin, ferritin, transferrin saturation, and platelet counts to assess response and detect any worsening of thrombocytosis
• The dosing regimen may vary depending on the specific formulation used, with iron sucrose typically administered at 200-300 mg per session and ferric carboxymaltose administered at 750-1000 mg per dose. Overall, the goal of treatment is to rapidly replenish iron stores, bypassing the impaired oral absorption often seen in patients with inflammatory conditions that can accompany thrombocytosis, while minimizing the risk of adverse reactions.

From the FDA Drug Label

INDUCTAFER® (ferric carboxymaltose injection), for intravenous use Initial U.S. Approval: 2013 INDICATIONS AND USAGE Injectafer is an iron replacement product indicated for the treatment of: • iron deficiency anemia (IDA) in: adult and pediatric patients 1 year of age and older who have either intolerance or an unsatisfactory response to oral iron.

The ferric carboxymaltose (IV) formulation can be used to treat anemia in patients with thrombocytosis, as there is no direct contraindication for its use in patients with thrombocytosis in the provided drug labels 2. However, it is essential to note that the labels do not explicitly address the use of ferric carboxymaltose in patients with thrombocytosis.

• The dosage recommendations for ferric carboxymaltose (IV) are as follows:
  • For patients weighing 50 kg or more: 750 mg intravenously in two doses separated by at least 7 days for a total cumulative dose of 1,500 mg of iron per course.
  • For adult patients weighing 50 kg or more, an alternative dose of 15 mg/kg body weight up to a maximum of 1,000 mg intravenously may be administered as a single-dose per course.
• Key considerations for administration include monitoring for signs and symptoms of hypersensitivity reactions, symptomatic hypophosphatemia, and hypertension following each administration 2.

From the Research

Injectable Iron Formulations for Anemia Treatment

• Ferric carboxymaltose is an injectable iron formulation that can be used to treat anemia in patients with thrombocytosis, as it has been shown to be effective in reducing the rate of blood transfusion in refractory anemia patients 3.
• The use of ferric carboxymaltose has been studied in various patient populations, including those with iron deficiency anemia or iron deficiency without anemia, and has been found to be safe and effective in achieving target ferritin levels and improving hemoglobin values 4, 5.
• Compared to oral iron, ferric carboxymaltose has been shown to have a faster and more significant increase in hemoglobin levels, making it a viable option for patients who are unresponsive to oral iron therapy 6.

Safety and Efficacy Considerations

• The safety profile of ferric carboxymaltose has been evaluated in several studies, and it has been found to have a low incidence of adverse events, with no significant difference in safety compared to other intravenous iron preparations 4, 6.
• The use of ferric carboxymaltose has been associated with improved clinical symptoms and quality of life in patients with iron deficiency anemia, making it a valuable treatment option for patients with thrombocytosis 5.

Treatment Guidelines

• The dosage and administration of ferric carboxymaltose vary depending on the patient's iron deficiency status and medical history, and should be determined by a healthcare professional 4.
• Patients with thrombocytosis should be closely monitored for any changes in their condition, and their treatment plan should be adjusted accordingly 7.