Ferric carboxymaltose (Ferinject®) associated hypophosphataemia: case report illustrating the need for increased awareness to minimise incidence and risk

Abstract

Ferric carboxymaltose (Ferinject®) is an infusion administered for the treatment of iron deficiency anaemia. A number of previous case reports have shown the occurrence of hypophosphataemia after Ferinject® treatment, supposedly managed though high dose phosphate therapy. This case report highlights the risk associated with, and futility of, managing this adverse effect through high dose phosphate infusion. A review of the available literature suggests that if hypophosphataemia develops as a result of Ferinject®, through upregulation of the renal protein Fibroblast Growth Factor-23, it cannot be readily reversed and on average persists for circa 50 days. Acute medical units should be aware of this – likely underreported – adverse effect, and avoid treating these hypophosphataemic patients with high dose phosphate since it can compound symptoms.

Osteomalacia as a Complication of Intravenous Iron Infusion: A Systematic Review of Case Reports

“…Twenty‐eight case reports were included, ( 11‐38 ) reporting 30 cases. The vast majority ( n = 26) were single case reports, (11‐13,15‐30,32‐38 ) and two manuscripts reported two cases. ( 14,31 ) The case reports were published between 1993 and 2020.…”

“…( 11,13,14,16,18‐20,23,24,26‐32,34,36,38 ) Because we only included case reports that reported signs or symptoms of osteomalacia associated with hypophosphatemia, the follow‐up was long enough in all cases. ( 11‐38 ) Finally, we considered that enough details were reported in 21 of the 30 cases. ( 12‐16,18‐20,22‐24,26‐29,32,34,36‐38 )…”

“…The initial selection process resulted in 4097 hits, and after duplicates were excluded, 3850 unique references were assessed, 128 underwent full‐text assessment, and 28 were included in this review. ( 11‐38 )…”

“…In 10 patients, vitamin D levels were reported to be low, (12,15,16,19,22,23,27,30,34,36) whereas it was reported as normal in 11 patients (13,14,20,21,24,25,28,29,32,33) and not reported in 9 (11,17,18,26,31,35,37,38) ). Eleven case reports reported low levels of 1,25OHD, (13,14,20,22,24,27,(29)(30)(31)34,37) whereas 6 reported normal levels.…”

Immediate Postoperative Single-Dose Intravenous Ferric Carboxymaltose After Autologous Free-Flap Breast Reconstruction: A Prospective Cohort Study With Propensity Score Matching

“…These ndings suggest that IV-FCM would be more bene cial if the injection is performed 1-4 weeks before the operation. However, outpatient-based injection of IV-FCM does not provide adequate scope for post-injection monitoring and management of possible side effects [21]. Therefore, we performed IV-FCM injection immediately after transferring the patient from the post-anesthesia care unit to the ward, where the nursing staff could monitor the patient, and the attending physicians could rapidly treat any adverse effect.…”