Iron Deficiency Management

Diagnosis and Assessment

Iron deficiency should be assessed by evaluating serum ferritin and transferrin saturation levels, with functional iron deficiency defined as serum ferritin ≤800 ng/mL with transferrin saturation <20% in patients with chronic inflammatory conditions 1
Assessment frequency should be every 1-3 months in patients requiring iron/ESA therapy, and can be less frequent (yearly) in stable patients with mild anemia 1
Patients with absolute iron deficiency (ferritin <100 ng/mL) and non-inflammatory conditions (CRP <5 mg/L) should be evaluated for iron deficiency 2

Non-dialysis CKD patients can be considered for intravenous iron therapy as initial therapy 1
Cancer patients with chronic inflammatory conditions can benefit from intravenous iron therapy 2, 3
Patients with chronic kidney disease can benefit from intravenous iron therapy 1
Patients with heart failure can be considered for intravenous iron therapy 4

Ferric carboxymaltose can be administered up to 1,000 mg in 15 minutes 2
Iron sucrose can be administered 200-500 mg, with infusion time 30-210 minutes 2
Ferric gluconate can be administered with a maximum dose of 125 mg, with infusion time 60 minutes 2
Iron dextran has variable dosing, with infusion time 240-360 minutes 2
Iron isomaltoside can be administered up to 1,000 mg (20 mg/kg), with infusion time 15 minutes 2

Infusion reactions, including anaphylactoid reactions, hypotension, shortness of breath, and chills, can occur with intravenous iron therapy 1
Increased risk of thrombotic events has been associated with intravenous iron therapy 2
Potential increased risk of infections has been reported, and caution should be used in patients with active infection 1
Serum phosphate levels should be checked in patients requiring repeat courses of treatment, and iron status should be assessed 24-48 hours after iron sucrose or iron gluconate administration, or 1-2 weeks after iron dextran administration 1

Intravenous iron therapy can increase hemoglobin levels and reduce the need for RBC transfusions in patients with inadequate response to oral iron 2
Intravenous iron therapy can increase response to erythropoiesis-stimulating agents (ESAs) 2