Aim: Iron polymaltose infusions are increasingly prescribed in the management of iron deficiency but the efficacy of premedication to prevent complications of infusion remains uncertain. In order to simplify our infusion protocol, we retrospectively reviewed our experience of patients receiving iron polymaltose infusion to assess its safety profile, identify risk factors for adverse reactions and evaluate the efficacy of premedication in preventing adverse reactions. Methods: We conducted a retrospective review of 300 patients who received iron infusions at Alfred Health (including The Alfred, Caulfield Hospital and Sandringham Hospital) between April 2010 and April 2011. Patients were identified via pharmacy dispensing records during the study period regardless of inpatient or day procedure admission status. Data collected from scanned medical records included: gender, body weight, iron dose, compliance to current guideline, units of blood received, serum iron levels, haemoglobin levels, premedications given/charted, duration of infusion, and any adverse effects that occurred. Results: From April 2010 to April 2011, 300 patients who received an iron infusion were reviewed. Mean age was 64 years (range: 19-100), with balanced sex distribution (male:female = 148:152). The existing protocol was followed in 90.3% of the patients; however, premedications (cetirizine and hydrocortisone) were given to only 76.25% patients. Only three (1%) patients developed anaphylaxis, but other side effects included headache (1.4%), rash (1%), chest pain (1%) and fever (0.3%). All three patients who developed anaphylaxis had received premedication. Most side effects occurred within 30-60 min of commencing the infusion, with a mean infusion rate of 117 mL/h. Conclusion: Iron polymaltose infusions are generally well tolerated and serious adverse reactions are rare. As a result of this audit, we have modified our guidelines to minimise the use of premedications and to rationalise the monitoring of patients receiving iron infusions. Further research to identify specific risk factors for adverse reactions may allow more targeted use of premedications to prevent specific side effects. Reducing the use of premedication and focusing attention to potential side effects during the 60 min after commencement of infusion could improve efficiency, reduce cost and minimise the inconvenience associated with iron infusions.
- Adverse reactions
- Iron polymaltose infusion