A stain on iron therapy

Abstract

Iron staining is an unwanted and in some cases permanent adverse effect of intravenous iron administration. Cosmetically unacceptable staining may cause distress and have psychological implications for the patient. There should be a suitable indication for parenteral iron therapy. Patients must be advised of the risk of harm and give their informed consent before receiving parenteral iron. Strategies to minimise the risks of staining with intravenous iron include appropriate cannulation and close monitoring of the infusion. Stop the infusion if there are signs of extravasation. Laser therapy may be a treatment option in cases of persistent discolouration due to iron staining. is limited in practice, 3 but the injection can be given into an unexposed site. However, administration at an unexposed site is not necessarily possible when giving iron intravenously. A rise in reports of iron staining 6-10 may correspond with the increasing use of intravenous iron in clinical practice. 6-13 Minimising harm Specific definitive risk factors for extravasation of intravenous iron have not been published. The principles for minimising the harm associated with intravenous iron preparations have been adapted from those applied to intramuscular iron (Box 1). 5 They include a good infusion technique (Box 2). REFERENCES SELF-TEST QUESTIONS True or false? 1. Extravasation of intravenous iron leads to skin necrosis 2. The skin staining from intravenous iron usually resolves in one week

Skin Staining Following Intravenous Iron Extravasation in a Patient With Chronic Kidney Disease: A Case Report

“…There are no published trials or guidelines available to direct management of skin staining secondary to iron infusions, which is potentially irreversible. 17 A few cases of spontaneous remission have been reported. 18 Topical therapies, lymphatic drainage, and massage have been tried without success.…”

“… 20 The patient’s individual skin type may influence the success of laser treatment. 17 The type of iron used or the timeline to start laser treatment have not been reported as important determinant of therapy efficacy. Our patient was referred to dermatology and offered laser therapy but decided to not pursue this treatment.…”

Questions and answers on iron deficiency treatment selection and the use of intravenous iron in routine clinical practice

“…2. Tattooing: Staining can occur from iron either within the vein itself or more significantly from extravasation of iron, leading to tattooing [68]. In preparation, ensure patients are well hydrated and warm before attempting the intravenous cannula (a large hot drink is an easy solution).…”

“…Tattooing: Staining can occur from iron either within the vein itself or more significantly from extravasation of iron, leading to tattooing [ 68 ].…”

Non-anaemic iron deficiency

“…The intravenous preparations available are ferric carboxymaltose, ferric derisomaltose, iron polymaltose and iron sucrose. The use of intravenous iron should be limited because of its adverse effects, including permanent skin staining, 24 hypophosphataemia and rarely anaphylaxis. 25 , 26 Intravenous iron should be avoided if there is active systemic infection to avoid any possibility that iron may promote microbial growth and disrupt immune responses.…”