From the Guidelines
Intravenous (IV) iron infusion is recommended for patients with iron deficiency anemia who cannot tolerate oral iron supplements, have not responded adequately to oral iron therapy, or have conditions that impair oral iron absorption, such as inflammatory bowel disease or after bariatric surgery, as stated in the 2024 clinical practice update on management of iron deficiency anemia 1.
Key Indications for IV Iron Infusion
- Patients who cannot tolerate oral iron or have not responded to oral iron therapy
- Conditions that impair oral iron absorption, such as inflammatory bowel disease or after bariatric surgery
- Severe anemia or need for rapid iron repletion
Administration and Monitoring
IV iron formulations, such as iron sucrose, ferric carboxymaltose, ferumoxytol, and iron dextran, vary in dose and frequency of administration, with some allowing for single-dose administration 1. Before initiating IV iron, patients should have confirmed iron deficiency with laboratory tests showing low ferritin and/or transferrin saturation. Administration should occur in settings where potential side effects, including infusion reactions, hypophosphatemia, and rarely anaphylaxis, can be managed 1.
Management of Infusion Reactions
Most infusion reactions are complement activation–related pseudo-allergy, which can be managed by stopping the infusion and restarting at a slower rate, or using corticosteroids for more severe reactions 1. Anaphylaxis due to IV iron is exceedingly rare, occurring with less than 1:200,000 administrations 1.
From the FDA Drug Label
Injectafer is 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. adult patients who have non-dialysis dependent chronic kidney disease • iron deficiency in adult patients with heart failure and New York Heart Association class II/III to improve exercise capacity.
IV iron infusion is recommended for patients with iron deficiency anemia who:
- Have intolerance to oral iron
- Have an unsatisfactory response to oral iron
- Are adult patients with non-dialysis dependent chronic kidney disease
- Are adult patients with heart failure and New York Heart Association class II/III to improve exercise capacity 2 2 Key points to consider:
- Dosage: varies based on patient weight and medical condition
- Administration: intravenously, either as an undiluted slow intravenous push or by infusion
- Contraindications: history of hypersensitivity to Injectafer or any of its components
From the Research
Indications for IV Iron Infusion
IV iron infusion is recommended for patients with iron deficiency anemia in the following situations:
- When oral iron preparations are ineffective or cannot be used 3
- In cases of chronic inflammatory conditions, perioperative settings, and disorders associated with chronic blood loss 3
- For patients with intolerance or unresponsiveness to oral iron 4
- When rapid correction of the iron deficit is required, as indicated by the European drug label 4
- In patients with inflammation, when iron-deficiency is suspected as an cause of anemia, despite normal serum ferritin levels 4
Patient Selection
The selection of patients for IV iron infusion should be based on individual evaluation, considering factors such as:
- Presence of inflammation 3
- Time available for iron replenishment 3
- Anticipated risk of side-effects or intolerance 3
- Severity of anemia and iron deficiency 5, 4
Treatment Targets
The main treatment target for IV iron is an improvement of the quality of life, with hemoglobin serving as a surrogate marker 4. The goal is to correct the total iron deficit, which can be achieved with single or repeated doses of IV iron, depending on the specific formulation 4.
Safety Considerations
IV iron therapy is associated with a risk of severe infusion reactions, although modern preparations have improved safety profiles 4, 6. Hypophosphatemia is a specific side effect of ferric carboxymaltose, and cardiovascular safety has not been identified as a concern 6. Monitoring and management of potential side effects are crucial for the safe administration of IV iron 6.