Iron Supplementation in Sepsis

Primary Mechanisms of Harm

Iron supplementation during sepsis increases iron availability for bacterial proliferation, promotes oxidative stress and inflammation, and is associated with increased infection risk and mortality without clear clinical benefits, according to the American College of Physicians 1

The administration of IV iron in critically ill patients is not associated with lower rates of blood transfusion during hospital stays, as recommended by the American College of Physicians 1
IV iron may marginally increase hemoglobin at discharge, but this difference lacks clinical relevance, as stated by the American College of Physicians 1
No significant effects on length of critical care stay or mortality have been observed in adequately powered studies, according to the American College of Physicians 1

Ferritin is an acute phase reactant, and elevated levels during sepsis may reflect inflammation rather than true iron overload, as noted by the National Kidney Foundation 2 and the American Society for Nutrition 3
Hepcidin has proven to be a more reliable indicator of true iron deficiency than transferrin saturation in critically ill patients with variable degrees of inflammation, as stated by the American Society for Nutrition 3
All forms of IV iron may cause acute adverse events, including anaphylactoid reactions, hypotension, shortness of breath, and chills, as warned by the American College of Physicians 1 and the American Academy of Allergy, Asthma, and Immunology 4

Life-threatening/serious acute reactions to IV iron dextran occur in 0.65-0.7% of administrations, as reported by the American College of Physicians 1
IV iron should only be administered by staff trained to manage anaphylactic reactions, with at least 30 minutes of post-infusion observation, as recommended by the American College of Physicians 1 and the American Academy of Allergy, Asthma, and Immunology 4