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intravenous iron Rx

general information

  • there are 3 forms of parenteral iron for use in Australia:
    • iron polymaltose (Ferrum H and Ferrosig)
      • immediate HS reactions are common with iron polymatose - one MUST first use a small test dose
    • iron sucrose (Venofer)
      • PBS usage for the treatment of iron-deficiency anaemia in patients undergoing chronic haemodialysis and who are receiving supplemental erythropoietin therapy
    • iron carboxymaltose (Ferinject)
      • can now be ordered for outpatients on PBS without restriction as it has a shorter administration time of only 15 minutes which is suitable for outpatient Mx 1)
      • patients should be aged 14yrs or older who are not on haemodialysis and who have documented iron deficiency and oral iron not appropriate
      • maximum dose via intravenous infusion of iron carboxymaltose is 1000mg (20mg/kg) in 250mL of sodium chloride 0.9%, over at least 15 minutes. The maximum dose per week is 1000mg.

  • all patients MUST be informed that there is a risk of permanent skin staining from the infusion and consent for this should be documented

potential indications

  • intolerance of, poor compliance or inadequate response to oral iron Rx
  • malabsorption conditions
  • high iron dose needed (eg. haemodialysis (use repeated small iv doses and if anaphylaxis to iron polymaltose, one can use iron sucrose with PBS authority), ongoing blood loss)
  • chronic renal failure with iron deficiency states

the more common contraindications

  • anaemia not caused by iron deficiency
  • iron overload (eg. haemochromatosis, haemosiderosis)
  • 1st trimester pregnancy
  • ferritin > 500mcg/litre
  • transferrin saturation > 40%
  • Osler-Rendu-Weber syndrome
  • chronic polyarthritis
  • asthma
  • infectious renal complaints in acute phase
  • uncontrolled hyperparathyroidism
  • decompensated cirrhosis
  • infectious hepatitis
  • severe inflammation or infection of the kidney or liver (due to iron accumulating in inflamed tissues)
  • specific to iron polymaltose (Ferrum H):
    • HS to iron III hydroxide polymaltose complex
  • specific to iron sucrose (Venofer):
    • HS to Venofer or its inactive constituents
  • specific to ferric carboxymaltose (FCM):
    • HS to FCM or its inactive constituents
    • age < 14yrs
    • haemodialysis patients
    • NB. may cause transient hypophosphataemia

general procedure for iv iron polymatose or iron sucrose infusion administration

  • ensure emergency resuscitation facilities and medical officer are available in case immediate HS reactions occur
  • patients on dialysis are generally given infusions on specific days of the week (often Wed/Thurs) to help with accurate monthly blood results.
  • total adult dose is usually 100mg of either iron polymatose or iron sucrose
    • haemodialysis patients receiving ESA with ferritin < 200mcg/litre and transferrin saturation < 40% are usually given weekly doses for 2 months then repeat iron studies
    • haemodialysis patients receiving ESA with ferritin 200-400mcg/litre and transferrin saturation < 40% are usually given fortnightly doses for 2 months then repeat iron studies
    • haemodialysis patients receiving ESA with ferritin 400-500mcg/litre and transferrin saturation < 40% are usually given monthly doses for 2 months then repeat iron studies
    • haemodialysis patients NOT receiving ESA are usually given 10 doses given over 10 sequential haemodialysis treatments.
    • peritoneal dialysis and CKD patients are usually given 1g iv iron polymatose or 500mg iv iron sucrose
  • infusion is usually given via venous bubble trap
  • test dose is usually 25mg iron polymaltose or 20mg iron sucrose diluted in 0.9% saline given over 1 minute (polymaltose), or over 15min (sucrose)
  • test dose is then flushed with 10ml 0.9% saline
  • if no adverse reactions after 30min observations, the remaining dose is infused over 5-10 minutes and then further 5ml 0.9% saline flush is given.
  • iron studies should be taken at least 1 week after a course of doses
iron_infusion.txt · Last modified: 2019/09/04 07:10 by wh