iron replacement therapy
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Introduction
Also see iron supplement.
Complications
- anaphylaxis from IV iron 0.01-0.1%[6]
Management
- total iron replacement (mg of elemental iron)[1]
- blood hemoglobin = 11-13 g/dL: 5000 mg
- blood hemoglobin = 9-11 g/dL: 10,000 mg
- blood hemoglobin = <9 g/dL: 15,000 mg
- iron required for replacement
- oral iron: ~10% of oral iron is absorbed
- ferrous sulfate 324 mg, 65 mg Fe+2, 75 tablets*
- ferrous gluconate 300 mg, 36 mg Fe+2, 140 tablets*
- ferrous fumarate 100 mg, 33 mg Fe+2, 150 tablets*
- iron polysaccharide 150 mg, 150 mg Fe+2, 33 tablets*
- parenteral iron (iron sucrose)
- reserved for patients not candidates for oral therapy
- iron dextran (imferon), 50 mg/mL[3]
- iron sucrose, 20 mg/mL[3]
- four 200-mg infusions of iron sucrose over 2-weeks may reduce fatigue in women with low serum ferritin (< 15 ng/mL) but without anemia
- ferric gluconate 12.4 mg/mL (for dialysis patients)
- ferumoxytol, 30 mg/mL
- ferric carboxymaltose
- IV ferric carboxymaltose reduced subsequent hospitalization in patients with acute heart failure (LVEF < 50%) & iron deficiency[5]
- rarely anaphylaxis will occur with parenteral iron (0.01-0.1%)[6]
- results in fewer transfusions but more infections[2]
- oral iron: ~10% of oral iron is absorbed
- iron absorption
* compensatory response of hepcidin to dose of iron
- absorption of iron is decreased by hepcidin
- blocks transport of iron from intestinal epithelial cells to blood
- hepcidin levels increased 2.7 fold by a dose of 60 mg Fe as FeSO4
- next day aborption of iron decreased 36% after a dose of 60 mg Fe as FeSO4
- BID dosing of iron increases hepcidin levels more than QD dosing
- total dose of iron absorbed was similar whether 2 or 3 doses (60 mg Fe as FeSO4) given within 24 hours (22.6 vs 23.6 mg)
* number of tablets of oral iron needed to replace 5000 mg of iron
Notes
- packed RBC provide 200-250 mg of iron/unit
More general terms
Additional terms
References
- ↑ 1.0 1.1 Geriatrics at your Fingertips, 13th edition, 2011 Reuben DB et al (eds) American Geriatric Society
- ↑ 2.0 2.1 Litton E et al Safety and efficacy of intravenous iron therapy in reducing requirement for allogeneic blood transfusion: systematic review and meta-analysis of randomised clinical trials. BMJ 2013;347:f4822 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23950195 <Internet> http://www.bmj.com/content/347/bmj.f4822
- ↑ 3.0 3.1 3.2 Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015
- ↑ 4.0 4.1 Moretti D et al. Oral iron supplements increase hepcidin and decrease iron absorption from daily or twice-daily doses in iron-depleted young women. Blood 2015 Oct 22; 126:1981 PMID: https://www.ncbi.nlm.nih.gov/pubmed/26289639
- ↑ 5.0 5.1 Slomski A Intravenous Iron Therapy Prevents Heart Failure Rehospitalizations. JAMA. 2021;325(4):334. Jan 26 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33496772 https://jamanetwork.com/journals/jama/fullarticle/2775444
- ↑ 6.0 6.1 6.2 Dave CV et al. Risks for anaphylaxis with intravenous iron formulations: A retrospective cohort study. Ann Intern Med 2022 Mar 29; [e-pub] PMID: https://www.ncbi.nlm.nih.gov/pubmed/35344378 https://www.acpjournals.org/doi/10.7326/M21-4009
- ↑ 7.0 7.1 von Siebenthal HK et al. Effect of dietary factors and time of day on iron absorption from oral iron supplements in iron deficient women. Am J Hematol 2023 Sep; 98:1356. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37357807 https://onlinelibrary.wiley.com/doi/10.1002/ajh.26987
Powers JM, Auerbach M. When taking iron, a glass of orange juice a day keeps anemia away. Am J Hematol 2023 Sep; 98:1354 PMID: https://www.ncbi.nlm.nih.gov/pubmed/37403430 https://onlinelibrary.wiley.com/doi/10.1002/ajh.27017