From the Guidelines
Intravenous (IV) iron is generally contraindicated in patients with active sepsis. The administration of IV iron during active infection, particularly sepsis, should be avoided due to several important physiological concerns. Iron serves as a growth factor for many pathogens, and providing additional iron during an active infection could potentially worsen the infection by supporting bacterial growth. During infection, the body naturally sequesters iron as a defense mechanism to limit bacterial proliferation, a process known as nutritional immunity. Additionally, IV iron can potentially enhance oxidative stress and inflammation, which are already heightened during sepsis.
Some key points to consider when evaluating the use of IV iron in patients with sepsis include:
- The potential for IV iron to increase the risk of infection, although this risk was not observed in critical care patients in a meta-analysis 1
- The limited clinical relevance of increased hemoglobin concentrations achieved with IV iron therapy, with a mean increase of only +0.31 g/dL 1
- The risk of anaphylactic reactions associated with IV iron, with varying incidence rates depending on the specific iron formulation used 1
- The lack of significant effects on length of critical care stay or mortality in studies conducted in critical care patients, likely due to insufficient power 1
From a clinical perspective, it's recommended to postpone IV iron therapy until the infection has been adequately treated and the patient has recovered from sepsis. Once the infection is controlled and the patient is stable, iron therapy can be reconsidered if iron deficiency anemia is present. The timing of reintroduction should be determined on a case-by-case basis, considering the patient's overall clinical status, hemoglobin levels, and iron parameters.
From the Research
Intravenous Iron in Sepsis
- There is no direct evidence in the provided studies to suggest that intravenous (IV) iron is contraindicated in patients with sepsis 2, 3, 4, 5, 6.
- However, a study on iron homeostasis and disorders in sepsis suggests that iron metabolism is altered during sepsis, and iron retention may have protective effects, but an increase in labile iron may cause oxidative injury and cell death 2.
- Another study on iron deficiency and iron deficiency anemia mentions that intravenous iron is increasingly utilized to correct iron deficiency, but it does not specifically address the use of IV iron in sepsis patients 3.
- The other studies focus on the diagnosis and treatment of iron deficiency anemia in various contexts, including inflammatory bowel disease and perioperative settings, but do not provide direct evidence on the use of IV iron in sepsis patients 4, 5, 6.
Key Findings
- IV iron is effective in correcting iron deficiency anemia in various patient populations, including those with inflammatory bowel disease and perioperative patients 3, 5, 6.
- The use of IV iron may be associated with a higher response rate compared to oral iron, but the certainty of this finding is low due to risk of bias and inconsistency 6.
- There is a need for further research to investigate the use of IV iron in specific patient groups, including those with sepsis, to fill the current evidence gap 6.