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IV iron improved feeling of fatigue in premenopausal women with low serum ferritin concentration
Krayenbuehl P. Blood. 2011;doi:10.1182/blood-2011-04-346304.
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The administration of intravenous iron improved self-reported fatigue in a group of 90 premenopausal women with low serum ferritin concentration, particularly those with levels less than 15 ng/mL.
A randomized, double blind, placebo-controlled study was conducted to investigate the effect of IV iron on women complaining of fatigue who also had serum ferritin levels of 50 ng/dL or less, and hemoglobin levels of at least 120 g/L. Enrolled women were randomly assigned to receive either 800 mg IV iron (n=43) or IV placebo (n=47).
At baseline, 6 weeks and 12 weeks, fatigue was measured using the Brief Fatigue Inventory questionnaire, and change in fatigue was measured using the Short Performance Inventory questionnaire. Median fatigue score at baseline was 4.5 on a 10-point scale.
There was a nonsignificant difference in fatigue scores after 6 weeks, with the iron group reporting a 1.1-point decrease and the placebo group a 0.7-point decrease. However, improvement in fatigue as measured by the Short Performance Inventory was significantly different; 65% of the iron-treated women reported an improvement in fatigue at 6 weeks vs. 40% of the placebo group (P=.002).
The researchers also conducted a subgroup analysis using the WHO cut-off for iron deficiency of 15 ng/mL serum ferritin concentration. In this group, the median fatigue score decreased by 1.8 points among women receiving iron compared with 0.4 among women given placebo (P=.005). Further, 82% of women given iron reported an improvement in fatigue compared with 47% of the placebo group (P=.03).
We have long known that symptoms of iron deficiency are present before anemia occurs. The same applies to the MCV, which lags well behind the hemoglobin level in IDA. While our method of administering IV iron (a single one hour infusion of LMW iron dextran)is different from the authors of this superbly done study are to be congratulated for being the first to show this in a prospective, randomized, difficult to perform double blind study. They did not mention symptoms such as pagophagia and other forms of pica and restless legs syndrome that disappear immediately after the first iron infusion but they convincingly proved the nearly toxicity free experience of IV iron in improving patients' quality of life. Estimates are that up to 70% of patients to whom oral iron is prescribed are non-adherent. Those of us who investigate the benefits of IV iron owe these authors a debt of gratitude.
Michael Auerbach, MD, FACP
Clinical professor
of medicine
Georgetown University School of Medicine
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