From the Guidelines
Intravenous iron, including Cosmofer (iron dextran), is associated with an increased risk of infection, as evidenced by a systematic review and meta-analysis of 154 randomized clinical trials 1. The relationship between Cosmofer and infection is a critical consideration in clinical practice, particularly in patients with underlying conditions that may predispose them to infections.
- The increased risk of infection with intravenous iron is thought to be related to iron's role as a growth factor for bacteria, potentially enhancing bacterial virulence and impairing immune cell function when present in high concentrations.
- Patients receiving Cosmofer should be monitored for signs of infection, including fever, chills, or worsening of existing infections.
- If infection is suspected during Cosmofer treatment, consider temporarily postponing further doses until the infection resolves.
- Patients with active infections should generally have their iron therapy delayed until the infection is controlled.
- Healthcare providers should perform a risk-benefit assessment before administering Cosmofer to patients with ongoing infections, weighing the potential benefits of treating anemia and reducing blood transfusion requirements against the increased risk of infection, as suggested by the study published in JAMA Network Open 1.
- While using Cosmofer, maintain good infection prevention practices, including proper hand hygiene and aseptic technique during administration. The dosing regimen for Cosmofer typically involves calculating the cumulative iron deficit based on hemoglobin levels and body weight, with doses often administered as either a single infusion or divided into weekly infusions depending on the total iron requirement.
From the Research
Relationship Between Cosmofer (Iron Dextran) and Infection
- The administration of intravenous iron, including Cosmofer (iron dextran), has been associated with adverse outcomes in infections 2.
- However, the current evidence does not show a cause-and-effect relationship between intravenous iron administration and an increased susceptibility to infection in hemodialysis patients 3.
- It is biologically plausible that intravenous iron therapy and/or iron deficiency influence infection risk, as iron plays a vital role in pathogen reproduction and host immunity 4.
- The relationship between intravenous iron administration and infections is complex, and the potential advantages of total dose infusion (TDI) are highlighted 2.
- In the absence of an urgent clinical need, intravenous iron therapy should be avoided in patients with active infection 4.
- Iron metabolism and immunity are closely interconnected, and host-driven iron withdrawal inhibits the growth of pathogens in acute infection 5.
- The use of intravenous iron in the presence of infection creates a clinical dilemma, and the best available evidence should be considered to guide clinical decision making 6.