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IV iron therapy reduced need for transfusion, increased infection risk
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IV iron therapy increased hemoglobin concentration and subsequently decreased the risk for allogeneic red blood cell transfusion. However, patients were at increased risk for infection, according to results of a systematic review and meta-analysis.
Although IV iron therapy is increasingly common as treatment for patients with anemia, questions about the benefits and risks of this treatment remain, according to researchers.
The current study included data from 72 randomized, controlled trials that compared IV iron therapy with no iron or oral iron therapy in 10,605 patients treated between 1966 and 2013.
Changes in hemoglobin concentration, need for allogeneic red blood cell transfusion and infection served as primary outcome measures.
Overall results suggested there was an increase in hemoglobin concentration levels (standardized mean difference=6.5 g/L; 95% CI, 5.1-7.9) and a decrease in the need for red blood cell transfusion (RR=0.74; 95% CI, 0.62-0.88) with the use of intravenous iron. This was especially true when IV iron was used with erythroid stimulating agents or in patients with a lower baseline plasma ferritin concentration.
Researchers observed no significant association between the efficacy of IV iron and the dose administered.
Patients who received IV iron therapy were at a significant increased risk for infection when compared with those who received oral iron therapy or no iron supplementation (RR=1.33; 95% CI, 1.10-1.64).
“These findings suggest that intravenous iron might have broad applicability to many patients in hospital, in whom anemia is common,” the researchers wrote. “This benefit is counterbalanced by a potential increased risk for infection. Further randomized, controlled trials of intravenous iron are required to define whether it should be used as a first-line treatment to reduce allogeneic red blood cell transfusions in patients in [the] hospital. Such trials should include well-defined infection endpoints and be adequately powered for important patient-centered endpoints, including mortality and major morbidity.”
Disclosure: Litton reports receiving a supply of an IV iron preparation from Vifor Pharma for a future study.
Perspective
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Harry S. Jacob, MD, FRCPath(Hon)
Despite the lessened risk of anaphylactic reactions attending newer IV iron preparations, we now must take more seriously the side effect of infection propensity. There are only a few situations in which patients are exposed to free, uncomplexed iron. In addition to the iatrogenic one described above, surgeons recognize that iron released after peritoneal bleeds markedly increases the risk for severe infectious peritonitis. Moreover, the rare hereditary condition of atransferrinemia — characterized by uncomplexed iron — usually terminates in fatal infections.
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