What are the criteria for inpatient intravenous (IV) iron infusions?

From the Guidelines

Inpatient iron infusions are indicated for patients with severe iron deficiency anemia, defined as hemoglobin levels below 8-9 g/dL, or those with symptomatic anemia, active bleeding, or conditions that impair oral iron absorption, and should be administered with caution and monitoring for infusion reactions, as recommended by recent guidelines 1.

Criteria for Inpatient Iron Infusions

The criteria for inpatient iron infusions include:

• Hemoglobin levels below 8-9 g/dL
• Symptomatic anemia, such as fatigue, dyspnea, or tachycardia
• Active bleeding with iron deficiency
• Malabsorption disorders, such as celiac disease or inflammatory bowel disease
• Patients undergoing certain surgeries where rapid correction is needed

Intravenous Iron Preparations

Common intravenous iron preparations include:

• Iron sucrose (Venofer), typically dosed at 200-300 mg per infusion
• Ferric carboxymaltose (Injectafer), dosed at up to 750-1000 mg per infusion
• Low molecular weight iron dextran (LMWID), which can be given as a total dose infusion of 1000 mg in 1 hour, as recommended by recent guidelines 1

Administration and Monitoring

Patients should be monitored for infusion reactions, which can range from mild flushing to severe hypersensitivity reactions. LMWID should be administered as a 1000 mg infusion in 250 mL of normal saline, with monitoring for infusion reactions, as recommended by recent guidelines 1. Iron infusions work by bypassing the gastrointestinal tract, allowing for direct delivery of iron to transferrin and the reticuloendothelial system, resulting in more rapid correction of iron stores and hemoglobin levels than oral supplementation.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Criteria for Inpatient Iron Infusions

The decision to administer inpatient iron infusions is based on several factors, including:

• The presence of iron deficiency anemia that is severe or has not responded to oral iron therapy 2, 3
• The need for rapid correction of iron deficit, particularly in patients with inflammation or those who require quick improvement in their quality of life 2, 4
• The presence of conditions that make oral iron therapy ineffective or impractical, such as chronic inflammatory diseases, perioperative settings, or disorders associated with chronic blood loss 3
• The patient's hemoglobin level, with more severe anemia (e.g., Hb < 7.0 g/dL) potentially requiring inpatient management 4

Indications for Intravenous Iron

Intravenous iron is indicated for the treatment of iron deficiency anemia when:

• Oral iron preparations are ineffective or cannot be used 2, 3
• Rapid correction of iron deficit is required, such as in patients with severe anemia or those undergoing surgery 2, 4
• There is a high risk of side effects or intolerance to oral iron therapy 3

Dosing Considerations

The dosing of intravenous iron should be based on the patient's individual iron deficit, which can be calculated using a modified Ganzoni formula 5. A cumulative dose of 1500 mg of intravenous iron may be more effective than a dose of 1000 mg in achieving iron repletion and reducing the need for retreatment 5.

Safety and Side Effects

Intravenous iron therapy is generally safe, but it can be associated with side effects such as infusion reactions, hypophosphatemia, and complement activation-related pseudo-allergy 2, 6. These side effects can be managed with appropriate monitoring and intervention.