What are the guidelines for qualifying for Intravenous (IV) iron sucrose in Alberta?

Guidelines for Qualifying for IV Iron Sucrose in Alberta

IV iron sucrose therapy in Alberta is indicated for patients with iron deficiency anemia who have failed oral iron therapy, cannot tolerate oral iron, have chronic inflammatory conditions, or require rapid iron repletion. 1

Qualifying Criteria for IV Iron Sucrose

Primary Indications

• Patients intolerant to oral iron therapy (experiencing significant gastrointestinal side effects like constipation, metallic taste, heartburn, or nausea) 1
• Patients not responding adequately to oral iron supplementation despite compliance 1
• Patients with conditions causing impaired iron absorption (celiac disease, post-bariatric surgery) 2
• Patients with ongoing blood loss requiring rapid iron repletion 1

Laboratory Parameters for Qualification

• Hemoglobin < 110 g/L with evidence of iron deficiency 1
• Serum ferritin < 100 ng/mL OR transferrin saturation < 20% 1
• For chronic kidney disease patients, iron should be administered to maintain:
  • Ferritin ≥ 100 ng/mL AND
  • Transferrin saturation percentage ≥ 20% 1

Special Populations

• Chronic kidney disease patients requiring erythropoietin therapy 1
• Patients with chronic inflammatory conditions (inflammatory bowel disease, chronic kidney disease, heart failure, cancer) 2
• Patients with iron-refractory iron deficiency anemia (IRIDA) who partially respond to IV iron 1
• Pregnant women in second and third trimesters with iron deficiency not responding to oral iron 2

Administration Guidelines

Dosing

• Standard dose: 200 mg iron sucrose administered over 10 minutes 1
• Maximum single dose should not exceed 200 mg 1
• For chronic kidney disease patients, dosing may follow these recommendations:
  • Hemodialysis patients: 100 mg weekly or biweekly 1
  • Non-dialysis CKD: similar dosing as needed to maintain target iron indices 1
• Pediatric dosing should be weight-based 1:
  • <10 kg: 25 mg per dose
  • 10-20 kg: 50 mg per dose

  • 20 kg: 100 mg per dose

Safety Considerations

• Resuscitation facilities must be available during administration due to risk of anaphylaxis 1
• Monitor vital signs before, during, and after administration 3
• Serum ferritin levels should be monitored and preferably should not exceed 500 μg/L to avoid iron overload toxicity 1

Monitoring and Follow-up

• Hemoglobin and red cell indices should be monitored at 3-month intervals for the first year after normalization 1
• Iron studies (ferritin, transferrin saturation) should be checked 4-8 weeks after IV iron administration 1
• For CKD patients on maintenance therapy, TSAT and serum ferritin should be monitored every 3 months 1

Efficacy Considerations

• IV iron sucrose typically produces a more rapid increase in hemoglobin than oral iron (2.7 g/dL vs 0.1 g/dL at 5 weeks) 4, 5
• In cancer patients with iron deficiency anemia, IV iron monotherapy can increase hemoglobin by approximately 1.8 g/dL at 5 weeks 6
• For patients with gastrointestinal bleeding, high-dose iron sucrose (7 mg/kg up to 500 mg) has been shown to be safe and effective 3

Common Pitfalls to Avoid

• Administering IV iron without checking baseline iron studies 1
• Continuing IV iron therapy when ferritin exceeds 500 μg/L, which may increase risk of iron overload 1
• Failing to monitor for adverse reactions during administration (arthralgia occurs in approximately 4% of patients) 4
• Administering iron sucrose too rapidly (should be given over at least 10 minutes) 1, 7
• Not considering underlying causes of iron deficiency that require specific treatment 1