From the Guidelines
The recommended dose of iron for an intravenous iron transfusion in adults with iron deficiency anemia is 1,000 to 2,000 mg of elemental iron, usually administered over one or more sessions, with a preference for formulations that can replace iron deficits with 1 or 2 infusions, as seen in the most recent study 1.
Key Considerations
- The specific dosing depends on the patient's weight, hemoglobin level, and the severity of iron deficiency, with a minimum of 500–1000 mg considered in some cases 1.
- Common IV iron preparations include iron sucrose (Venofer), ferric carboxymaltose (Injectafer), ferumoxytol (Feraheme), and iron dextran (INFeD), each with its own dosing regimen, such as ferric carboxymaltose given as two 750 mg doses separated by at least 7 days 1.
- Before receiving IV iron, patients typically undergo blood tests to confirm iron deficiency, including serum ferritin, transferrin saturation, and complete blood count.
Administration and Monitoring
- IV iron is generally reserved for patients who cannot tolerate oral iron supplements, have not responded adequately to oral therapy, have severe anemia, or need rapid iron repletion.
- The body uses this supplemental iron to produce hemoglobin, the oxygen-carrying component of red blood cells, thereby improving oxygen delivery to tissues and resolving symptoms of anemia, with an expected increase in hemoglobin of at least 2g/dL within 4 weeks of treatment 1.
From the FDA Drug Label
2 DOSAGE AND ADMINISTRATION
- 1 Recommended Dosage Recommended Dosage for Treatment of Iron Deficiency Anemia For patients weighing 50 kg or more, the recommended dosage is: Injectafer 750 mg intravenously in two doses separated by at least 7 days for a total cumulative dose of 1,500 mg of iron per course In adult patients, Injectafer 15 mg/kg body weight up to a maximum of 1,000 mg intravenously may be administered as a single-dose per course.
The recommended dosage of iron for an iron transfusion for someone with iron deficiency anemia is:
- 1,500 mg of iron per course for patients weighing 50 kg or more, administered as 750 mg intravenously in two doses separated by at least 7 days.
- 15 mg/kg body weight up to a maximum of 1,000 mg intravenously as a single-dose per course for adult patients. 2
From the Research
Iron Transfusion Dosage
The dosage of iron for an iron transfusion in someone with iron deficiency anemia can vary depending on the specific treatment and patient needs.
- The study 3 evaluated the efficacy and cardiovascular safety of ferric carboxymaltose (FCM) versus iron sucrose in patients with iron-deficiency anemia and non-dialysis-dependent chronic kidney disease (NDD-CKD). The study used two doses of FCM 750 mg in one week, or iron sucrose 200 mg administered in up to five infusions in 14 days.
- Another study 4 investigated the safe dose of intravenous iron sucrose in patients with renal failure. The study found that 200-mg and 300-mg doses of IV iron sucrose administered over 2 hours appear to be safe, while the incidence of adverse events with the 400-mg and 500-mg doses administered as a 2-hour infusion seems too high to recommend their routine use.
- A more recent study 5 compared the efficacy and cost-effectiveness of intravenous ferric carboxymaltose versus iron sucrose in adult patients with iron deficiency anemia. The study did not specify the exact dosage used, but found that ferric carboxymaltose was more cost-effective than iron sucrose.
Treatment Options
Different treatment options are available for iron deficiency anemia, including oral iron supplements and intravenous iron transfusions.
- A study 6 compared the tolerability and efficacy of ferrous versus ferric iron formulations for the treatment of iron deficiency. The study found that slow-release ferrous sulphate preparations remain the established and standard treatment of iron deficiency.
- Another study 7 compared the effect of ferrous sulfate with iron polysaccharide complex on hemoglobin concentration in infants and children with nutritional iron-deficiency anemia. The study found that ferrous sulfate resulted in a greater increase in hemoglobin concentration at 12 weeks.
Dosage Considerations
When considering the dosage of iron for an iron transfusion, it is essential to take into account the individual patient's needs and medical history.
- The study 3 found that two 750-mg infusions of FCM are a safe and effective alternative to multiple lower dose iron sucrose infusions in NDD-CKD patients with iron-deficiency anemia.
- The study 4 found that the 200-mg and 300-mg doses of IV iron sucrose administered over 2 hours appear to be safe, while the incidence of adverse events with the 400-mg and 500-mg doses administered as a 2-hour infusion seems too high to recommend their routine use.