For more than 50 years, iron dextran has been the mainstay of parenteral iron therapy in the united states. The use of parenteral iron therapy for the treatment of. Iron is an essential element and its balance must be maintained for proper physiologic functioning. Iron dextran is the only parenteral iron product that can also be administered by the intramuscular route. Need for parenteral iron therapy after bariatric surgery.
Iron supplements are necessary when the following lab values are abnormal. Oral and parenteral iron preparations in pregnancy free download as powerpoint presentation. The median interval to parenteral iron therapy after bariatric surgery was 42. Parenteral iron administration coverage in nondialysis usage.
In 1947, nissim 7 introduced iron saccharide for iv injection and concluded that this form of iron was safer and more suitable for parenteral administration. Safety, therapeutic effectiveness, and cost of parenteral iron therapy. Prior to its use as an adjunct to erythropoietin therapy in dialysis patients, however, it was considered dangerous therapy. The interval to parenteral iron therapy was calculated from the date of bariatric surgery to the date of the first parenteral iron replacement therapy table 2 and fig. Patients receiving regular parenteral iron therapy require monitoring of hematologic parameters and iron indices hb, hct, tsat, and ferritin sufficient iv iron should be administered to maintain tsat between 20% and 50%. Coverage also includes for parenteral iron in iron deficiency anemia. Iron supplement oral route, parenteral route description. Iron therapy should be withheld in patients with tsat. Oral and parenteral iron preparations in pregnancy iron.
Intravenous iron is indicated as a source of iron replacement in iron deficiency anemia if the patient. There is uncertainty about whether iv iron should be used rather than oral iron. Hb levels are extracted from the complete blood count test. Original article from the new england journal of medicine parenteral iron therapy with special reference to a new preparation for intramuscular injection logo32 logo40. In addition, there are less obvious conditions that warrant parenteral iron therapy. Ferritin and other hematological parameters in pregnant women. Dec 04, 2010 in 1947, nissim 7 introduced iron saccharide for iv injection and concluded that this form of iron was safer and more suitable for parenteral administration.
The use of parenteral iron in the treatment of anemia in patients with chronic kidney disease has become routine. Free fe is a potential toxin andor carcinogen, leading to the production of hydroxide radicals and stimulating the growth of transformed cells by inhibiting the defence system. Treatment of iron deficiency anemia associated with. Nevertheless, failure of oral therapy is to be expected in certain clinical situations. There are currently 3 parenteral iron preparations available, including iron dextran, sodium ferric gluconate, and iron sucrose. Oral iron is the preferred, and safest, firstline therapy for most patients with iron deficiency anaemia but many users experience gastrointestinal side effects and compliance with treatment is poor. When the body does not get enough iron, it cannot produce the number of normal red blood cells needed to keep you in good health.
Intravenous iv iron is given under supervision in hospitals. Parenteral iron therapy with special reference to a new. Parenteral iron therapy is occasionally necessary for patients intolerant or unresponsive to oral iron therapy, for receiving recombinant erythropoietin therapy, or for use in treating functional iron deficiency. One advantage of parenteral iron is that iron stores are rapidly repleted, which may take months to achieve with oral iron therapy. In order to determine iron deficiency, it is recommended to obtain baseline labs before beginning iron therapy. Hb parenteral therapy of iron deficiency are intolerance of the orally administered salts, gastrointestinal disease, need to create iron stores to protect against future bleeding, and poor absorption of oral iron. The risk for developing reactions to parenteral iron infusion can be attenuated if patients are carefully selected. Parenteral iron therapy options wiley online library.
Therapeutic management of ida is focused primarily on repletion of. Parenteral iron therapy in pregnancy dawson 1965 bjog. Pdf update on parenteral iron therapy researchgate. Comparing the sfgc group to the historic iron dextran group, there was a significantly higher incidence of drug intolerance events 0. There are now three parenteral iron products available. This condition is called iron deficiency iron shortage or iron deficiency anemia. Original article from the new england journal of medicine parenteral iron therapy with special reference to a new preparation for intramuscular injection. Medicare also covers iron sucrose injection as a first line treatment of iron deficiency anemia when furnished intravenously to patients undergoing chronic hemodialysis who are receiving supplemental erythropoietin therapy. However, oral iron dose may be reduced with no effect on its efficacy while decreasing side effects and patient discontinuation rates. Dexferrum iron dextran injectafer ferric carboxymaltose feraheme ferumoxytol. Parenteral versus oral iron for treatment of iron deficiency.
Some 30% of preoperative patients have been observed to be anemic, and this anemia is associated with increased perioperative complication rates, including that of blood transfusion which has itself serious risks associated. To provide clinicians with evidencebased guidance for iron therapy dosing in patients with iron deficiency anemia ida, we conducted a study examining the benefits of a higher cumulative dose of intravenous iv iron than what is typically administered. Parenteral iron dextran is efficacious and safe for iron repletion in patients with iron deficiency anemia. Compared with oral iron supplements, parenteral iron is associated with a more rapid rise in serum ferritin and hemoglobin and improved maternal fatigue scores in the postpartum period. In situations where a rapid repletion of ferritin is required i.
The purpose of this study is to summarize our institutions experience with parenteral iron therapy over a 5year period, with a focus on comparative safety profiles. Intravenous iron therapy in patients with iron deficiency anemia. Parenteral iron therapy replenishes iron stores quicker and is better tolerated than oral therapy. This parenteral iron calculator uses the patient weight and haemoglobin level to compute the iron deficit. Parenteral iron therapy in children with iron deficiency. A high intake of antacids or other substances that bind. Indications for iv iron therapy in iron deficiency anaemia ida where oral iron therapy may be impractical or insufficient due to gi intolerance, noncompliance, malabsorption or gastric surgery. Intravenous iron therapy venofer or feraheme or iron. The dose is 125 mg elemental iron per 10 ml either by iv infusion or slow iv injection. Oral iron is the standard therapy, but there is a problem of adherence due the gastrointestinal side effects. Indeed, it is now the recommended mode of iron delivery in dialysis patients resulting in up to a 75% reduction in epo requirements. Pdf parenteral iron therapy for treatment of moderate to. Iron dextran was the first parenteral iron preparation available in the united states and is supported with the most clinical experience with regard to intravenous iron therapy.
Parenteral iron therapy in the treatment of iron deficiency anemia during pregnancy journal of the college of physicians and surgeons pakistan 2015, vol. Iron can be taken orally by mouth or injected intravenously via a vein. Parenteral iron therapy in cancerassociated anemia. Iron deficiency can make anaemia worse, and reduce response to drugs that stimulate erythropoietin production. The selected cases demonstrated stainable iron in the pattern characteristic of prior parenteral iron therapy, as described in a previous report. Parenteral iron produces therapeutic responses similar to those of oral iron. Evidence that stainable bone marrow iron following. While parenteral iron provides a more rapid therapeutic response than oral iron, it can cause adverse effects including allergic reactions. Intravenous administration purpose to assure the safe. Pdf parenteral iron therapy in the treatment of iron.
Intravenous iron therapy venofer or feraheme or iron dextran. Iron supplements are used to treat iron deficiency and irondeficiency anemia. The established indications for intravenous iron therapy were adapted from wintrobes clinical hematology 1999. Hemodialysis, which chronically results in significant blood loss, may necessitate the use of parenteral iron therapy to restore the hemoglobin level. Iron sucrose can be administered with or without erythropoietin to raise hemoglobin levels and may be used in cases of oral iron therapy intolerance or ineffectiveness. Comparative studies of oral versus parenteral iron therapy have concluded that the parenteral route is superior in dialysis patients.
It is preferred whenever they presented with failure to oral iron or increased demands despite oral iron therapy. Parenteral versus oral iron therapy for adults and. Parenteral iron dextran is efficacious and safe for iron repletion in patients with irondeficiency anemia. The burden of iron deficiency anaemia during pregnancy and postpartum continues to remain high especially in india. Oral and parenteral iron preparations in pregnancy obstetrics. There is flexibility in terms of the measurement unit for the variables used.
Iron dextran was approved by the fda prior to 1982. Parenteral iron therapy for treatment of moderate to. Feraheme, injectafer, and monoferric are medically necessary when the. Update on parenteral iron therapy article pdf available in nutrition in clinical practice 184. We first individually analyzed 5 clinical studies, averaging the total iron deficit across all patients utilizing a. However, recent information related to the role of oxidants and iron in the pathophysiology of disease has raised new concerns about parenteral iron beyond the risk of anaphylaxis 2. For assessment of storage iron, aspirate smears were stained with prussian blue. Parenteral iron therapy is as effective but somewhat more dangerous and considerably more expensive than oral therapy. It can be given at high doses 20 mgkg in a single visit no upper dose limit. Toxicity of parenteral iron dextran therapy sciencedirect. The possible occurrence of severe adverse reactions emphasizes the. Challenges to treatment include gastrointestinal side effects and non compliance to oral iron therapy. However, pain on injection, staining of the skin, unpredictabledelivery,andabsorptionofironmakethe intramuscular route undesirable.
Coverage for parenteral iron in iron deficiency anemia ida. Oral iron replacement therapy is a simple, inexpensive treatment, but is. The possible occurrence of severe adverse reactions emphasizes the need for close medical observation. Available parenteral iron therapy options include iron dextran, iron gluconate, and iron sucrose. When oral supplementation has been tried and the patient has demonstrated significant gastrointestinal distress whereas compliance with an oral regimen is no longer feasible. Blood loss, a major cause of iron deficiency, is highly prevalent e. Iron isomaltoside trade name monofer is a newer formulation of parenteral iron that has a matrix structure that results in very low levels of free iron and labile iron. The main criterion is that other causes of anemia have also been investigated, such as vitamin b 12 or folate deficiency.
Tolerability and efficacy of parenteral iron therapy in. Hypersensitivity reactions are less common with iron sucrose compared to other parenteral iron products, such as iron dextran. In october 2009, the food and drug administration expanded its existing black box warning that cautioned practitioners to administer a test dose first because of the risk of anaphylactic, often fatal adverse reactions. Thirtyeight children received iron sucrose for nonrenal indications, with iron deficiency refractory to oral iron therapy, with iron malabsorption or dependence on parenteral nutrition, 7. Intravenous iron therapy in patients with iron deficiency. Intravenous iron therapy has more advantages, therefore, intravenous iron therapy is the best treatment for pregnant women during the third trimester. Conclusion parenteral iron therapy should be considered in a group of children with iron deficiency anemia who fail to respond to oral iron preparations due to malabsorption, intolerance or poor compliance. Therapeutic management of ida is focused primarily on repletion of iron stores 1 4. Oral iron preparations are efficacious but poorly tolerated due to nonabsorbed iron mediated gi side effects. Iron is a mineral that the body needs to produce red blood cells. Anemia is common in pregnancy and iron deficiency is the most common cause.
Jan 17, 2019 the burden of iron deficiency anaemia during pregnancy and postpartum continues to remain high especially in india. Pdf safety, therapeutic effectiveness, and cost of. The preexisting iron levels may be reduced by 50% within one week of erythropoietin therapy. Parenteral iron may be considered in select clinical situations for the treatment of postpartum anemia. Parenteral iron therapy parenteral fe circumvents the natural regulatory mechanism to deliver nonproteinbound fe. Parenteral iron seems to be an alternative and it is well known since 1960 3. The availability of newer, safer parenteral iron therapy choices further. Guidelines for the management of iron deficiency anaemia. An area of increasing interest for parenteral iron therapy is in the perioperative sphere. The first parenteral iron preparations to be used clinically in the early.
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