Can I administer iron carboxymaltose (inj FCM) to an anemic patient with fever?

Can I Give Inj FCM if Patient Has Fever in Anaemic Patient?

You should use ferric carboxymaltose (FCM) with caution in an anemic patient with fever, and treatment should be stopped if there is ongoing bacteremia. 1

Key Guideline Recommendations on Infection and Fever

The European Society of Cardiology guidelines explicitly address this clinical scenario:

• Use FCM with caution in patients with acute or chronic infection 1, 2
• Treatment with FCM should be stopped in patients with ongoing bacteremia 1, 2
• The decision to use FCM in the presence of infection should be according to the opinion of the treating physician 1

Clinical Approach to the Febrile Anemic Patient

Before administering FCM, you must determine the source and severity of the fever:

• If bacteremia is confirmed or suspected → Do NOT give FCM until infection is controlled 1
• If fever is from a non-infectious cause (e.g., inflammatory condition, drug fever) → FCM may be considered with appropriate monitoring 1
• If fever is from a mild, localized infection without bacteremia → Clinical judgment is required, but caution is advised 1

Important Safety Considerations

Absolute Contraindications (Do Not Give FCM)

• Hypersensitivity to FCM or its excipients 1, 2
• Known serious hypersensitivity to other parenteral iron products 1, 2
• Anemia not attributed to iron deficiency 1, 2
• Evidence of iron overload or disturbances in iron utilization 1, 2
• Hemoglobin >15 g/dL 1, 3, 4

Additional High-Risk Situations Requiring Caution

• Patients with known drug allergies, especially those with history of severe asthma, eczema, or atopic allergies (increased risk of hypersensitivity reactions) 1, 2
• Patients with immune or inflammatory conditions such as systemic lupus erythematosus or rheumatoid arthritis (increased risk of hypersensitivity reactions) 1, 2

Practical Clinical Algorithm

Step 1: Assess the fever

• Obtain blood cultures if bacteremia is suspected 1
• Identify the source of fever (infectious vs. non-infectious) 1

Step 2: Decision point

• If bacteremia confirmed or highly suspected → Defer FCM until infection controlled 1
• If fever from non-infectious cause → Proceed with caution, ensure monitoring capabilities 1
• If mild localized infection without systemic involvement → Use clinical judgment, consider deferring 1

Step 3: If proceeding with FCM

• Ensure administration occurs where staff are trained and equipped to monitor for and manage hypersensitivity reactions 1
• Observe patient for adverse effects for at least 30 minutes following IV injection 1, 3

Administration Details When Appropriate

• FCM should be diluted in 100 mL of normal saline and infused over 20-30 minutes 3
• Maximum recommended cumulative dose is 1000 mg of iron per week 1
• FCM can be given as undiluted slow bolus injection (100 mg/min) or as infusion 1

Common Pitfall to Avoid

The most critical error is administering IV iron to a patient with active bacteremia. This can potentially worsen the infection, as iron is essential for bacterial growth and can impair immune function. Always ensure adequate infection workup before proceeding with FCM in any febrile patient. 1