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Ovid: Oxford Handbook of Dialysis

Editors: Levy, Jeremy; Morgan, Julie; Brown, Edwina Title: Oxford Handbook of Dialysis, 2nd Edition Copyright ©2004 Oxford University Press > Table of Contents > Part 8 – Complications of ESRD: anaemia > Intravenous iron Intravenous iron

  • Efficacious in all studies in increasing Hb, increasing ferritin and transferrin saturation index, and reducing EPO requirements.
  • Potential concerns about iron overload, infection, and cardiac dysfunction have not been realized.
  • Iron should be withheld if ferritin >800 ng/ml to avoid iron overload.
  • Increased risk of infection probably not of great significance, but IV iron should not be given while infection present because of theoretical risk that neutrophil function may be adversely affected.
  • Macrocytosis developing during the use of IV iron may reflect the development of folate deficiency.
  • Needs go be given with care to avoid adverse reactions:
    • Free iron reaction:
      • symptoms include hypotension, nausea, vomiting, sweating, back pain, pruritis, and a sudden feeling of being unwell;
      • owing to either the effect of iron overload or the result of infusing IV iron too rapidly;
      • can be treated if necessary with intravenous hydrocortisone and piriton.
    • Anaphylaxis:
      • symptoms include laryngeal oedema, erythema, urticaria, palpitations, collapse, loss of consciousness;
      • risk very low, but all nurses giving IV iron should be trained in resuscitation, and adrenaline (epinephrine), piriton, hydrocortisone, and resuscitation equipment should be immediately available.

Three preparations are available: iron III hydroxide sucrose complex (also known as iron saccharate), sodium ferric gluconate, and iron dextran. Most regimens using intravenous iron initially aim to correct iron deficiency, and then to maintain iron stores using smaller or less frequent doses.

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