From the Guidelines
Iron therapy is not recommended for anemia with chronic disease and active lung infection, unless there is concurrent iron deficiency, due to the increased risk of infection associated with intravenous iron administration. This is based on a systematic review and meta-analysis of 154 randomized clinical trials that included 32,762 participants, which found that intravenous iron was associated with an increased risk of infection 1. In patients with anemia of chronic disease (ACD) and active lung infection, the primary focus should be on treating the underlying infection, as resolving the infection will often improve the anemia.
Key considerations in managing anemia with chronic disease and active lung infection include:
- Treating the underlying lung infection as the primary focus
- Assessing iron stores and confirming true iron deficiency alongside ACD, if present
- Using oral ferrous sulfate 325 mg daily or every other day for iron supplementation, if warranted
- Avoiding intravenous iron preparations during active infection, unless severe cases with confirmed iron deficiency and ineffective or poorly tolerated oral therapy
- Monitoring complete blood count and iron studies to assess response to treatment of the underlying infection before considering iron supplementation.
The potential benefits of treating anemia and reducing blood transfusion requirements must be balanced with the increased risk of infection associated with intravenous iron administration, as suggested by the study published in JAMA network open 1.
From the Research
Anemia with Chronic Disease and Active Lung Infection
- Anemia is a critical issue for patients with chronic diseases, including those with active lung infections, as it can reduce patients' quality of life and increase morbidity and mortality 2.
- Iron therapy may be beneficial for patients with anemia of chronic disease, including those with active lung infections, as it can help restore effective red cell production 2, 3.
- However, iron therapy can also have negative effects, such as stimulating the proliferation of unwanted cells and catalyzing the formation of toxic radicals, which can lead to tissue damage or promote cardiovascular events 3.
Iron Therapy for Anemia with Chronic Disease
- Intravenous iron should be considered for patients with anemia of chronic disease, including those with active lung infections, as it can be given safely and has limited efficacy with oral iron 2, 4.
- Iron sucrose is an established, effective, and well-tolerated treatment for iron-deficiency anemia in patients with chronic conditions, including those with active lung infections 5, 4.
- The use of iron sucrose has been shown to rapidly increase hemoglobin, ferritin, and transferrin saturation levels, with an acceptable safety profile 4.
Specific Considerations for COPD Patients
- Iron deficiency is common in COPD patients, but is rarely investigated or treated 6.
- Correction of iron deficiency in COPD patients with erythropoiesis stimulating agents and intravenous iron can improve anemia, iron deficiency, and may improve dyspnea 6.
- The prevalence and treatment of anemia and iron deficiency in COPD patients, particularly those with active lung infections, require further study 6.