Is intravenous (IV) iron infusion indicated for a patient with depleted iron stores, as evidenced by a low ferritin level?

IV Iron Infusion for Ferritin Level of 19

IV iron infusion is indicated for a patient with a ferritin level of 19 ng/mL, as this represents absolute iron deficiency requiring prompt correction. 1

Diagnosis of Iron Deficiency

A ferritin level of 19 ng/mL indicates depleted iron stores and absolute iron deficiency:

• In otherwise healthy individuals, absolute iron deficiency is defined as serum ferritin levels < 12 ng/mL and transferrin saturation (TSAT) < 16% 1
• For adults, a ferritin cut-off of 30 μg/L is appropriate to diagnose iron deficiency 2
• Some evidence suggests the physiologic ferritin "cutoff" should be 50 ng/mL, indicating that current reference ranges may lead to underdiagnosis of iron deficiency, especially in women 3

Treatment Algorithm for Iron Deficiency

First-line approach:

• For most patients with iron deficiency, oral iron therapy is the initial treatment 2
• However, IV iron is indicated as first-line therapy in cases of:
  • Severe iron deficiency (as indicated by ferritin of 19 ng/mL) 4
  • Intolerance to oral iron 5
  • Unsatisfactory response to oral iron 5
  • Conditions with impaired oral iron absorption 4

When to choose IV iron over oral iron:

• Ferritin < 30 ng/mL with symptoms of iron deficiency 2
• Need for rapid repletion of iron stores 4
• Conditions where oral iron is ineffective (inflammatory bowel disease, gastric bypass, heavy uterine bleeding) 4

IV Iron Administration Guidelines

For patients with iron deficiency anemia:

• For patients weighing ≥50 kg: Administer 750 mg IV iron in two doses separated by at least 7 days (total 1,500 mg) 5
• For patients weighing <50 kg: Administer 15 mg/kg body weight IV in two doses separated by at least 7 days 5
• Alternative for adults: Single dose of 15 mg/kg up to maximum of 1,000 mg 5

Safety Considerations

• Monitor patients for 30-60 minutes after infusion for potential hypersensitivity reactions 1, 5
• Serious hypersensitivity reactions are rare with newer IV iron formulations (0.1% in clinical trials) 5, 4
• Newer IV iron formulations (ferric carboxymaltose, iron sucrose) have better safety profiles than older preparations 4, 6
• Check serum phosphate levels in patients requiring repeat courses of treatment, as hypophosphatemia can occur 5

Monitoring Response to Treatment

• Repeat basic blood tests (hemoglobin, ferritin, TSAT) 8-10 weeks after treatment to assess response 2
• Successful treatment should result in:
  • Increase in hemoglobin (approximately 1-2 g/dL) 5, 7
  • Normalization of ferritin levels (>100 ng/mL) 5
  • Improvement in TSAT 5, 7

Cautions and Contraindications

• IV iron is contraindicated in patients with history of hypersensitivity to the specific IV iron product 5
• Use with caution in patients with active infection 1
• Avoid iron overload by not administering IV iron to patients with ferritin >500-800 ng/mL 1

In conclusion, with a ferritin level of 19 ng/mL indicating clear iron deficiency, IV iron infusion is an appropriate and effective treatment option that will rapidly correct the deficiency and improve clinical outcomes.