TY - JOUR
T1 - Questions and answers on iron deficiency treatment selection and the use of intravenous iron in routine clinical practice
AU - Richards, Toby
AU - Breymann, Christian
AU - Brookes, Matthew J.
AU - Lindgren, Stefan
AU - Macdougall, Iain C.
AU - McMahon, Lawrence P.
AU - Munro, Malcolm G.
AU - Nemeth, Elizabeta
AU - Rosano, Giuseppe M.C.
AU - Schiefke, Ingolf
AU - Weiss, Günter
N1 - Funding Information:
Outside of this submitted work, TR reports grants, personal fees and non-financial support from Pharmocosmos and Vifor Pharma, grants and personal fees from Acelity, and personal fees from Amgen, Medtronic, and TIASH. TR is a director of The Iron Clinic Ltd and Veincare London Ltd, and vascular lead for 18 Week Support Ltd. CB reports personal fees from Pharmacosmos and Vifor Pharma. MJB reports grants and personal fees from Vifor Pharma and Tillotts Pharma. SL reports personal fees from Pharmacosmos and Vifor Pharma. ICM reports personal fees from Vifor Pharma. LPM reports non-financial support from Vifor Pharma. MGM reports personal fees from Vifor Pharma, Daiichi Sankyo, and American Regent. EN reports stock ownership of Intrinsic LifeSciences and Silarus Therapeutics, and consulting for Vifor Pharma, Ionis Pharmaceuticals, and Protagonist Therapeutics. GMCR has no disclosures to report. IS reports personal fees from Vifor Pharma. GW reports personal fees from Vifor Pharma. No Data Availability Statement for the manuscript.
Publisher Copyright:
© 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
PY - 2021/1/1
Y1 - 2021/1/1
N2 - Iron deficiency is a common cause of morbidity and can arise as a consequence or complication from many diseases. The use of intravenous iron has increased significantly in the last decade, but concerns remain about indications and administration. Modern intravenous iron preparations can facilitate rapid iron repletion in one or two doses, both for absolute iron deficiency and, in the presence of inflammation, functional iron deficiency, where oral iron therapy is ineffective or has not worked. A multidisciplinary team of experts experienced in iron deficiency undertook a consensus review to support healthcare professionals with practical advice on managing iron deficiency in gastrointestinal, renal and cardiac disease, as well as; pregnancy, heavy menstrual bleeding, and surgery. We explain how intravenous iron may work where oral iron has not. We provide context on how and when intravenous iron should be administered, and informed opinion on potential benefits balanced with potential side-effects. We propose how intravenous iron side-effects can be anticipated in terms of what they may be and when they may occur. The aim of this consensus is to provide a practical basis for educating and preparing staff and patients on when and how iron infusions can be administered safely and efficiently.Key messages Iron deficiency treatment selection is driven by several factors, including the presence of inflammation, the time available for iron replenishment, and the anticipated risk of side-effects or intolerance. Intravenous iron preparations are indicated for the treatment of iron deficiency when oral preparations are ineffective or cannot be used, and therefore have applicability in a wide range of clinical contexts, including chronic inflammatory conditions, perioperative settings, and disorders associated with chronic blood loss. Adverse events occurring with intravenous iron can be anticipated according to when they typically occur, which provides a basis for educating and preparing staff and patients on how iron infusions can be administered safely and efficiently.
AB - Iron deficiency is a common cause of morbidity and can arise as a consequence or complication from many diseases. The use of intravenous iron has increased significantly in the last decade, but concerns remain about indications and administration. Modern intravenous iron preparations can facilitate rapid iron repletion in one or two doses, both for absolute iron deficiency and, in the presence of inflammation, functional iron deficiency, where oral iron therapy is ineffective or has not worked. A multidisciplinary team of experts experienced in iron deficiency undertook a consensus review to support healthcare professionals with practical advice on managing iron deficiency in gastrointestinal, renal and cardiac disease, as well as; pregnancy, heavy menstrual bleeding, and surgery. We explain how intravenous iron may work where oral iron has not. We provide context on how and when intravenous iron should be administered, and informed opinion on potential benefits balanced with potential side-effects. We propose how intravenous iron side-effects can be anticipated in terms of what they may be and when they may occur. The aim of this consensus is to provide a practical basis for educating and preparing staff and patients on when and how iron infusions can be administered safely and efficiently.Key messages Iron deficiency treatment selection is driven by several factors, including the presence of inflammation, the time available for iron replenishment, and the anticipated risk of side-effects or intolerance. Intravenous iron preparations are indicated for the treatment of iron deficiency when oral preparations are ineffective or cannot be used, and therefore have applicability in a wide range of clinical contexts, including chronic inflammatory conditions, perioperative settings, and disorders associated with chronic blood loss. Adverse events occurring with intravenous iron can be anticipated according to when they typically occur, which provides a basis for educating and preparing staff and patients on how iron infusions can be administered safely and efficiently.
KW - Anaemia
KW - cardiovascular diseases
KW - chronic
KW - erythrocyte transfusion
KW - inflammatory bowel diseases
KW - infusions
KW - intravenous
KW - iron
KW - iron-deficiency
KW - menorrhagia
KW - pregnancy complications
KW - renal insufficiency
UR - http://www.scopus.com/inward/record.url?scp=85099291148&partnerID=8YFLogxK
U2 - 10.1080/07853890.2020.1867323
DO - 10.1080/07853890.2020.1867323
M3 - Review Article
C2 - 33426933
AN - SCOPUS:85099291148
VL - 53
SP - 274
EP - 285
JO - Annals of Medicine
JF - Annals of Medicine
SN - 0785-3890
IS - 1
ER -