Hematology and Oncology Book

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Parenteral ironAka: Iron Dextran, Imferon

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  1. Indications
    1. Severe Iron Deficiency Anemia and iron malabsorption
    2. Chronic bleeding not corrected by other means
    3. Oral iron not tolerated
    4. Severe Anemia and refusal of blood transfusion
  2. Preparations
    1. Iron Dextran (Imferon, Dexferrum)
      1. High rate of serious reaction (requires test dose)
      2. Intramuscular or Intravenous
      3. Dose based on estimated iron deficits
    2. Sodium ferric gluconate (Ferrlecit)
      1. Dosing: 125 mg/weekly IV for 8 weeks (total: 1 gram)
      2. Much safer than Iron Dextran (no test dose needed)
    3. Iron sucrose (Venofer)
      1. Much safer than Iron Dextran (no test dose needed)
      2. Dosing: 200 mg IV for 5 doses over 2 week period
  3. Precautions
    1. Intravenous iron must be started very slowly
  4. Adverse Effects
    1. Skin staining at site of intramuscular injection
      1. Consider Z-tract injection technique
    2. Severe pain at injection site
    3. Fever
    4. Delayed reaction (24-48 hours after administered)
      1. Myalgias and arthralgias
      2. Headache
    5. Anaphylaxis
      1. Occurs in 0.61% of patients given Iron Dextran
      2. Occurs in 0.04% of patients given ferric gluconate
  5. References
    1. Killip (2007) Am Fam Physician 75:671
    2. Michael (2002) Kidney Int 61:1830

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