scholarly journals Management of Severe Iron Deficiency Anemia in the Pediatric Emergency Department: A Comparison of IV Iron Vs Transfusions

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 2011-2011
Author(s):  
Matthew Speckert ◽  
Lana Ramic ◽  
Nicholas Mitsakakis ◽  
Mira Liebman ◽  
Elaine W. Leung
Keyword(s):  
Emergency Department ◽  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Pediatric Emergency ◽  
Iron Sucrose ◽  
Deficiency Anemia ◽  
Pediatric Emergency Department ◽  
Iv Iron ◽  
Parenteral Iron

Abstract Introduction: Severe iron deficiency anemia (IDA) is a problem that often presents to the pediatric emergency department (ED). Recently published ASH-ASPHO Choosing Wisely recommendations suggest avoidance of transfusion in hemodynamically stable, asymptomatic children with IDA 1. Little is known about the use of parenteral iron in this pediatric setting. Methods: We undertook a retrospective review of patients with severe IDA treated in the pediatric ED at the Children's Hospital of Eastern Ontario (CHEO) from September 2017 to June 2021. During this period there were an estimated 75000 patients seen annually. Patients with severe IDA were defined as those presenting with hemoglobin (Hb) less than <70 g/L and low mean corpuscular volume. Results: There were 56 patients that met this criterion with presenting Hb ranging from 17-69 g/L (IQR 41- 62). Median age at presentation was 3.75 yrs (IQR 1.68- 15.5), with a bimodal peak at age 1 yr and again in the teen years (Fig 1). 42 (75%) patients were female. The most common causes of IDA were nutritional and heavy menstrual bleeding. 14 (24.6%) received packed red blood cell (PRBC) transfusion with or without parenteral iron (iron sucrose), and 11 (19.3%) were treated with parenteral iron alone. Almost all (55, 98.2%) were prescribed oral iron supplementation. The lower the presenting Hb, the more likely that transfusion or parenteral iron was used as initial therapy (Fig 2). 19 (33.9%) patients were admitted to hospital and 37 (66.1%) were discharged home from the ED. Nine recipients of parenteral iron alone had follow-up at CHEO, six had follow-up within 10 days with Hb increases of at least 20 g/L and all nine patients had follow-up by day 41 showing increases ranging from 20-97 g/L. Three recipients of parenteral iron alone had presenting Hb <30 g/L and by 9 days following ED encounter all three had increased their Hb by at least 20 (20-32) g/L. Three patients were discharged from ED after IV iron, and none presented to the ED again. Six recipients of PRBCs had follow up within 10 days showing Hb increase ranging from 33-62 g/L, only five had follow-up by day 41 showing increases of 42-79 g/L. Five patients received >1 transfusion, and transfused volumes ranged from 5-25 mL/kg. Minor infusion reactions occurred in 2 (17%) recipients of parenteral iron, and no patient was suspected to have anaphylaxis. Four (28.5%) patients experienced minor transfusion reactions to packed cells. One recipient of multiple PRBC transfusions had transfusion-associated cardiac overload (TACO) requiring ICU admission. Conclusions: This study demonstrates that patients with severe IDA can be safely and effectively managed in the ED setting with parenteral iron therapy alone without PRBC transfusion. The use of parenteral iron avoids the potential short and long-term complications associated with transfusion, whilst ensuring rapid restoration of iron stores without the tolerability issues associated with oral iron. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare. OffLabel Disclosure: IV iron sucrose is indicated for treatment of iron deficiency in patients 2 and older with CKD. The use of it outside of this context would be considered off label.

Iron Dextran Versus Iron Sucrose for Non-Hemodialysis Adult Outpatients with Iron Deficiency Anemia: Assessment of Safety and Feasibility for A Randomized Controlled Trial

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 2107-2107
Author(s):  
Martha L Louzada ◽  
Cyrus C. Hsia ◽  
Fiona Ralley ◽  
Janet Martin ◽  
Sarah Connelly ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Iron Sucrose ◽  
Adult Patients ◽  
Deficiency Anemia ◽  
Iron Dextran ◽  
Iv Iron ◽  
Time Required ◽  
Lost To Follow Up

Abstract Abstract 2107 Introduction: Iron deficiency is the most common cause of anemia worldwide affecting 50% of children under 5 years of age and 25% of women under the age of 50 (11% in the USA) worldwide. Standard treatment is oral iron supplementation, however this route of administration is associated with several adverse drug reactions (ADRs), the most common being epigastralgia and constipation leading to lack of compliance or dose reduction in 30% of patients. Intravenous (IV) iron is an alternative treatment for patients intolerant or non-responsive to oral formulations. Of the two most common formulations available in Canada, IV iron dextran is less expensive but may be associated with more overall ADRs compared to IV iron sucrose. Methods: We conducted a single centre, double-blinded pilot RCT to assess the feasibility of a full RCT to compare ADRs between iron dextran and iron sucrose in non-hemodialysis and IV iron treatment naïve adult patients with iron deficiency anemia. The incidence of immediate (during outpatient hospital visit) and delayed (within 24 hours after patient discharged) ADRs for each iron formulation were compared. Baseline characteristics of participants were analyzed by means of descriptive statistics. Demographic and clinical characteristics of study participants were evaluated by adverse reaction status. They were compared using a two-sample t-test for continuous variables and a two-way contingency table using Chi square or Fisher's exact test for categorical variables, as appropriate. Patients were contacted 24 hours after discharge to answer a standardized questionnaire. Assessment of ADRs and severe ADRs were done using the standardized World Health Organization and International Conference on Harmonisation definitions. Grading of severity was done independently by three individuals from an independent Drug Safety Monitoring Board. Results: 143 adult patients with iron deficiency anemia were were approached and erolled in the study between January 2008 and January 2009 (100% enrolment). Baseline characteristics of patients is depicted in Table 1. All patients received IV iron (73 iron dextran and 70 iron sucrose) and none were lost to follow-up. Immediate ADRs were similar between the two study arms; iron dextran 8/73 (11%) and iron sucrose 5/70 (7%), p=0.568. The average additional nursing time required to manage immediate ADRs was approximately 30 minutes. Delayed ADRs approached statistical significance with a higher rate of ADRs in the iron sucrose group [ iron dextran 9/73 (12%) and iron sucrose 18/70 (26%), p=0.0541]. Details in Table 2. Four patients were considered to have serious adverse reactions (shortness of breath, bronchospasm and diaphoresis). Two form each study arm. Conclusions: A RCT to compare adverse drug reaction rates between iron dextran and iron sucrose in non-hemodialysis adult patients with iron deficiency anemia is feasible. In our pilot study we were able to get 100% enrolment rate, in a timely fashion with no patients lost to follow up. The design of the study with a one point in time evaluation and a short follow up that did not require extra hospital visits and blood tests were probably attractive features that maximized patient participation. The incidence and severity of ADRs to both IV iron preparations studied were similar with greater than 25% of patients experiencing either immediate or delayed ADRs. However, a striking higher rate of delayed ADRs, albeit not severe, was slightly more pronounced in patients receiving iron sucrose therapy. The elevated level of ADRs to IV iron suggests the need for alternative formulations and a full RCT to compare the rate of ADRs between iron preparations is warranted. The choice of IV iron formulation in the adult non-hemodialysis population should take into account factors other than cost of the medication such as incidence and severity of ADRs, extra time required by Healthcare professionals, and patient preferences. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Management of postpartum iron deficiency anemia: review of literature

2018 ◽  
Vol 8 (1) ◽  
pp. 338
Author(s):  
Mohamed Saber ◽  
Mohamed Khalaf ◽  
Ahmed M. Abbas ◽  
Sayed A. Abdullah
Keyword(s):  
Iron Deficiency ◽  
Blood Transfusion ◽  
Iron Deficiency Anemia ◽  
Iron Sucrose ◽  
Deficiency Anemia ◽  
Ferric Carboxymaltose ◽  
Allogenic Blood Transfusion ◽  
Iron Dextran ◽  
Peripheral Tissues ◽  
Iv Iron

Anemia is a condition in which either the number of circulating red blood cells or their hemoglobin concentration is decreased. As a result, there is decreased transport of oxygen from the lungs to peripheral tissues. The standard approach to treatment of postpartum iron deficiency anemia is oral iron supplementation, with blood transfusion reserved for more server or symptomatic cases. There are a number of hazards of allogenic blood transfusion including transfusion of the wrong blood, infection, anaphylaxis and lung injury, any of which will be devastating for a young mother. These hazards, together with the national shortage of blood products, mean that transfusion should be viewed as a last resort in otherwise young and healthy women. Currently, there are many iron preparations available containing different types of iron salts, including ferrous sulfate, ferrous fumarate, ferrous ascorbate but common adverse drug reactions found with these preparations are mainly gastrointestinal intolerance like nausea, vomiting, constipation, diarrhoea, abdominal pain, while ferrous bis-glycinate (fully reacted chelated amino acid form of iron) rarely make complication. Two types of intravenous (IV) preparations available are IV iron sucrose and IV ferric carboxymaltose. IV iron sucrose is safe, effective and economical. Reported incidence of adverse reactions with IV iron sucrose is less as compared to older iron preparations (Iron dextran, iron sorbitol), but it requires multiple doses and prolonged infusion time. Intramuscular iron sucrose complex is particularly contraindicated because of poor absorption. It was also stated that when iron dextran is given intravenously up to 30% of patients suffer from adverse effects which include arthritis, fever, urticaria and anaphylaxis.

scholarly journals A COMPARATIVE STUDY OF INTRAVENOUS IRON SUCROSE VERSUS ORAL IRON THERAPY IN IRON DEFICIENCY ANEMIA DURING POSTPARTUM PERIOD

2021 ◽  
Vol 5 (12) ◽  
Author(s):  
Satish Kumar
Keyword(s):  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Serum Ferritin ◽  
Intravenous Iron ◽  
Hemoglobin Level ◽  
Oral Iron ◽  
Iron Sucrose ◽  
Deficiency Anemia ◽  
Iron Group ◽  
Iv Iron

Introduction: Anemia is the commonest major contributing factor in maternal mortality and morbidity in developing countries and according to World Health Organization (WHO) criteria, it contributes to 20% of maternal deaths. Anemia in pregnancy defined as hemoglobin level <11 gm/dl (7.45 mmol/L) and hematocrit less than 33% (WHO). Aim: To compare the efficacy of oral iron ferrous sulphate therapy with intravenous iron sucrose therapy in the treatment of iron deficiency anemia during postpartum period. Material & Methods: This was a prospective randomized comparative clinical trial single center study conducted on 200 postpartum women aged >18 years (after normal delivery or LSCS) within 10 days of delivery with Hb level more or equal to 6 gm/dl but less than 10 gm/dl were included in the study. This was a one year study conducted during 1st December 2018 to 30th November 2019. Results : There was a significant increase in the hemoglobin level in both the groups i.e. in IV iron group, from 8.26 ±1.03gm/dl on day 1 to 11.62±0.94gm/dl on day 45 as compared to oral iron group, from 8.24±1.09gm/dl on day 1 to 11.07±1.14gm/dl on day 45; and serum ferritin level from 41.69±40.45ng/ml on day 1 to 77.34±41.60ng/ml on day 45 in IV iron group as compared to the oral iron group from 22.20±8.82ng/ml on day 1 to 31.72±9.72 ng/ml on day 45. So, there was a rapid increase in both hemoglobin and serum ferritin levels in IV iron group as compared to the oral iron group. Conclusion: Intravenous iron sucrose administration increases the hemoglobin level and serum ferritin more rapidly in compare to the oral intake of ferrous sulphate in women with iron deficiency anemia in postpartum women in our study. Keywords: Iron deficiency anemia, Intravenous iron sucrose, Serum ferritin, Maternal mortality.

scholarly journals Effect of Maintenance Intravenous Iron Treatment on Erythropoietin Dose in Chronic Hemodialysis Patients: A Multicenter Randomized Controlled Trial

2020 ◽  
Vol 7 ◽  
pp. 205435812093339
Author(s):  
Paweena Susantitaphong ◽  
Monchai Siribumrungwong ◽  
Kullaya Takkavatakarn ◽  
Kamonrat Chongthanakorn ◽  
Songkiat Lieusuwan ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Serum Ferritin ◽  
Resistance Index ◽  
High Serum ◽  
Deficiency Anemia ◽  
Functional Iron Deficiency ◽  
Iv Iron ◽  
Low Serum

Background: There is no consensus on intravenous (IV) iron supplement dose, schedule, and serum ferritin target in functional iron deficiency anemia to maintain optimum target levels of iron stores by several guidelines. Objective: To examine the effect of IV iron supplementation to different targets of serum ferritin on erythropoietin dose and inflammatory markers in chronic hemodialysis (HD) patients with functional iron deficiency anemia. Design: A multicenter, randomized, open-label study. Setting: In a developing country, Thailand. Patients: Chronic HD patients with functional iron deficiency anemia. Measurements: Erythropoietin resistance index, high-sensitivity C-reactive protein, and fibroblast growth factor 23. Methods: Two hundred adult chronic HD patients with transferrin saturation less than 30% and serum ferritin of 200 to 400 ng/mL were randomized 1:1 to maintain serum ferritin 200 to 400 ng/mL (low-serum ferritin group, N = 100) or 600 to 700 ng/mL (high-serum ferritin group, N = 100). During a 6-week titration period, participants randomized to the high-serum ferritin group initially received 600 mg IV iron (100 mg every week), while the participants in the low-serum ferritin group did not receive IV iron. During the 6-month follow-up period, the dose of IV iron was adjusted by protocol. Results: The mean dose of IV iron was 108.3 ± 28.2 mg/month in the low-serum ferritin group and 192.3 ± 36.2 mg/month in the high-serum ferritin group. The mean serum ferritin was 367.0 ± 224.9 ng/mL in the low ferritin group and 619.6 ± 265.2 ng/mL in the high ferritin group. The erythropoietin resistance index was significantly decreased in the high-serum ferritin group compared to the low-serum ferritin group after receiving IV iron in the 6-week titration period (mean difference: −113.43 ± 189.14 vs 41.08 ± 207.38 unit/week/g/dL; P < .001) and 3-month follow-up period (mean differences: −88.88 ± 234.43 vs −10.48 ± 217.75 unit/week/g/dL; P = .02). Limitations: Short follow-up period. Conclusion: Maintaining a serum ferritin level of 600 to 700 ng/mL by IV iron administration of approximately 200 mg per month as a maintenance protocol can decrease erythropoietin dose requirements in chronic HD patients with functional iron deficiency anemia. Trials registration: The study was registered with the Thai Clinical Trials Registry TCTR20180903003.

scholarly journals Parenteral Iron Sucrose Therapy for Moderate and Severe Iron-Deficiency Anemia in Pregnancy

2016 ◽  
Vol 22 (3) ◽  
pp. 125
Author(s):  
Sertac Esin ◽  
Bülent Yırcı ◽  
Tuğba Zengin ◽  
Serdar Yalvaç ◽  
Ömer Kandemir
Keyword(s):  
Iron Deficiency ◽  
Hypersensitivity Reaction ◽  
Iron Deficiency Anemia ◽  
Intravenous Iron ◽  
Pregnant Patient ◽  
Iron Sucrose ◽  
Deficiency Anemia ◽  
Parenteral Iron ◽  
The Mean ◽  
The Difference

<p><strong>Objective:</strong> Parenteral iron therapy for iron deficiency anemia is gaining popularity due to its fast and impressing action. However, effectiveness and safety of iron sucrose in pregnant patient population is less clear. In this study, we aimed to review our intravenous iron sucrose use in pregnant patients.</p><p><strong>Study Design:</strong> The medical records of all anemic pregnant patients hospitalized for parenteral iron sucrose therapy were reviewed retrospectively.</p><p><strong>Results:</strong> The results of 117 pregnant women were available. Thirty-one (26.5%) and 86 (73.5%) of the patients were in the 2<sup>nd</sup> and 3<sup>rd</sup> trimester of the pregnancy, respectively. Four (%3.4) of the patients had severe and 113 (%96.6) of the patients had moderate anemia. The median gestational age for iron sucrose administration was 31.1 weeks (26.8-34.3). The mean hemoglobin, hematocrit and ferritin levels before and after delivery were 10.8±1.3 gr/l; 9.9±1.3 gr/l, 33.5±4.0; 30.8±4.0 and 89.6±0.7 μg/L; 98.1±0.9 μg/L, respectively. All but 2 (1.8%) patients had elevated hemoglobin levels after iron sucrose therapy. When hemoglobin and hematocrit levels were compared between before iron sucrose therapy and before delivery, there was a 2.8 g/l and 7.8 % increase in the mean hemoglobin and hematocrit levels, respectively and the difference was statistically significant (<em>p</em>= 0.001 and <em>p</em>=0.001, respectively). Five patients (4.3%) reported mild hypersensitivity reaction to intravenous iron in the form of mild itching at the infusion site. No severe or life-threatening hypersensitivity reaction was reported.</p><strong>Conclusion:</strong> In this study, we found out that intravenous iron sucrose therapy for iron deficiency anemia is feasible, effective and has a good safety profile.

Safety Profile of Iron Carboxymaltose, a New High Dose Intravenous Iron in Patients with Iron Deficiency Anemia.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 3739-3739 ◽  
Author(s):  
Melvin H. Seid ◽  
Antoinette Mangione ◽  
Thomas G. Valaoras ◽  
Lowell B. Anthony ◽  
Charles F. Barish
Keyword(s):  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Study Drug ◽  
Test Dose ◽  
Serum Phosphate ◽  
Iron Sucrose ◽  
Deficiency Anemia ◽  
Drug Event ◽  
High Dose ◽  
Iv Iron

Abstract Currently available IV iron agents pose substantial safety and practical challenges to effective management of iron deficiency anemia. Iron dextran administration requires a test dose and carries the risk of anaphylaxis. Non-dextran-containing IV iron agents (iron sucrose and ferric gluconate) do not require a test dose nor have this safety issue, but pose some practical challenges. These agents are FDA approved only for chronic kidney disease indications and require repeated administration of small doses (125 mg of iron as ferric gluconate over 10 minutes, 200 mg of iron as iron sucrose over 2–5 minutes, or 300–400 mg of iron as iron sucrose over 1.5 to 2.5 h). Accordingly, in a multicenter, randomized, blinded, placebo-controlled, crossover trial we assessed the safety of iron carboxymaltose, a new, investigational non-dextran IV iron complex that allows for rapid administration of high doses of iron. Five-hundred and eighty four (584) iron deficiency anemia patients received either a blinded dose of IV iron carboxymaltose (15 mg/kg up to a maximum of 1000 mg in NS) or placebo over 15 minutes on Day 0. On Day 7, patients were crossed over to receive either placebo or iron carboxymaltose utilizing the same dosing as Day 0. We recorded all adverse events and classified as an adverse drug event (ADE) any that was considered by the investigator as being possibly or probably related to study drug. The mean dose of iron carboxymaltose administered was 962 (+ 88) mg. No CTC Grade 4 or 5 or serious ADE were reported and no subject discontinued from study drug due to an ADE. No clinically important differences in vital signs or physical exams were noted between subjects treated with iron carboxymaltose and placebo. During the post dose 24-h and 7-d treatment period, ADEs reported by >1% of patients in either treatment were higher in patients after receiving iron carboxymaltose than in patients after receiving placebo. The 24-h period events included nausea (2.1% iron carboxymaltose vs. 1.1% placebo), headache (2.0% vs. 1.3%), and dizziness (1.3% vs. 0.2%). The 7-d period events included nausea (2.5% iron carboxymaltose vs. 1.1% placebo), ALT increased (1.3% vs. 0.2%), AST increased (1.3% vs. 0%), headache (2.9% vs. 1.4%), dizziness (1.6% vs.0.2%) and rash (1.1% vs. 0.2%). The majority of the ADEs were classified by the investigator as mild to moderate. No ADE consistent with a hypersensitivity reaction was reported. One patient experienced a transient, asymptomatic, CTC Grade 1 decrease in BP (from 132/85 to 95/68 mmHg) which resolved spontaneously. CTC Grade 3 ADEs were reported in 4 patients after receiving iron carboxymaltose (headache and asymptomatic decrease in serum phosphate) and 5 patients (rash, creatinine increase and asymptomatic decrease in serum phosphate) after receiving placebo. We conclude that rapid administration of high dose iron carboxymaltose (15 mg/kg for maximum of a 1,000 mg over 15 minutes) is well tolerated and associated with minimal risk of ADE in a large cohort of patients with iron deficiency anemia.

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