Intravenous iron as a transfusion alternative

Intravenous iron has been used extensively in nephrology for decades. However, the rare but serious reactions associated with high-molecular-weight iron dextran administration have resulted in largely unjustified fears over its use, thus limiting its application in other indications. In Europe, and more recently in the USA, the availability of several iron formulations that are safe and effective – iron sucrose, ferric gluconate and low-molecular-weight iron dextran – has extended the use of intravenous iron to a number of medical settings. Although oral iron continues to be widely used in the correction of iron-deficiency anemia, it cannot cover the needs of all patients. It is slow-acting and not always well absorbed or well tolerated because of gastrointestinal disturbances. It takes weeks for oral iron to raise the hemoglobin level and months to replenish iron stores. Intravenous iron given to anemic iron-deficient patients can raise the hemoglobin level in a few days and can replenish iron stores in a few weeks. Furthermore, it has been shown to correct the anemia of chronic disease when used in combination with exogenous erythropoietin. With some preparations, the total iron deficit can be corrected with one infusion, making the treatment more cost-effective by eliminating repeat visits. Intravenous iron has contributed to decreasing the need for transfusions and to reducing the doses of erythropoiesis-stimulating agents necessary to correct anemia in nephrology, in obstetrics and gynecology, in patients with cancer undergoing chemotherapy, and in surgery and orthopedics. The safety and ease of administration of the new iron preparations continues to expand the application of intravenous iron to new areas