Safety of Oral and Intravenous Iron

DeLoughery, Thomas G.

doi:10.1159/000496966

Cited by 90 publications

(90 citation statements)

References 40 publications

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“…It was used to rapidly correct the body iron levels and to improve hematopoiesis whenever important bleeding was anticipated or arose. Therefore, perioperative transfusion requirements and complication occurrences were reduced, improving the overall outcome of patients with chronic comorbidities [ 9 , 10 ].…”

Section: Resultsmentioning

confidence: 99%

“…As we previously emphasized, the perioperative period raised problems through the fact that there is no time to correct the iron deficiency with oral supplementation and many patients had zero response to these therapies due to the underlying comorbidities. Poor gastrointestinal tolerance led to the necessity of new intravenous product use in surgical patients, with a better tolerance profile, fewer adverse reactions, and rapid capacity of correcting iron deficiency [ 10 , 29 , 30 ].…”

Section: Resultsmentioning

confidence: 99%

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Incidence of Iron Deficiency and the Role of Intravenous Iron Use in Perioperative Periods

et al. 2020

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Iron deficiency is a major problem in worldwide populations, being more alarming in surgical patients. In the presence of absolute iron deficiency (depletion of body iron), functional iron deficiency (during intense bone marrow stimulation by endogenous or exogenous factors), or iron sequestration (acute or chronic inflammatory conditions), iron-restricted erythropoiesis can develop. This systemic review was conducted to draw attention to the delicate problem of perioperative anemia, and to provide solutions to optimize the management of anemic surgical patients. Systemic reviews and meta-analyses, clinical studies and trials, case reports and international guidelines were studied, from a database of 50 articles. Bone marrow biopsy, serum ferritin levels, transferrin saturation, the mean corpuscular volume, and mean corpuscular hemoglobin concentration were used in the diagnosis of iron deficiency. There are various intravenous iron formulations, with different pharmacological profiles used for restoring iron. In surgical patients, anemia is an independent risk factor for morbidity and mortality. Therefore, anemia correction should be rapid, with parenteral iron formulations—the oral ones—being inefficient. Various studies showed the safety and efficacy of parenteral iron formulations in correcting hemoglobin levels and decreasing the blood transfusion rate, the overall mortality, the postoperative infections incidence, hospitalization days, and the general costs.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Incidence of Iron Deficiency and the Role of Intravenous Iron Use in Perioperative Periods

et al. 2020

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“…Oral iron intolerance was stated as a reason for intravenous iron prescription by some obstetricians. Although oral iron treatment strategies were not addressed in this survey, it is important to highlight the recently recognised role of ‘risk mitigation’ strategies used to improve tolerance and compliance, including reduced dose elemental iron, intermittent dosing, and avoidance of twice daily dosing [ 13 ]. The recently published British Society of Haematology guidelines outline the strategies that can be used to reduce symptoms of oral iron and lead to improve compliance and hence correction of iron deficiency anaemia [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…Rates of intravenous iron use more than doubled in Australian women of reproductive age between 2014 and 2017 [ 9 , 12 ] which has been attributed to greater recognition of the adverse effects of oral iron and the “ease” of intravenous iron administration [ 13 ]. A recent meta-analysis suggests there may be a decreased need for blood transfusion in women treated with intravenous versus oral iron for IDAP, however the quality of the evidence was rated as low [ 14 ] with many studies of poor quality and not measuring important clinical outcomes [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

The use of intravenous iron in pregnancy: for whom and when? A survey of Australian and New Zealand obstetricians

Smith-Wade

Kidson‐Gerber

Shand

et al. 2020

BMC Pregnancy Childbirth

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Background Iron deficiency anaemia in pregnancy (IDAP) affects 11–18% of Australian pregnancies and is associated with adverse perinatal outcomes. National prescribing data suggests the use of intravenous iron in pregnancy is increasingly common. This study aimed to: 1) Establish the current patterns of intravenous iron use by Fellows of the Royal Australian and New Zealand College of Obstetricians (FRANZCOG) when treating iron deficiency and IDAP including immediately postpartum and; 2) Assess FRANZCOG opinions regarding potential trial of intravenous iron for first-line treatment of IDAP. Methods An online survey of RANZCOG Fellows practicing obstetrics was distributed in September 2018. Results were analysed descriptively and responses compared by clinician demographics using Chi-squared testing. Results Of 484 respondents (21% of FRANZCOG), 457 were currently practicing obstetrics. Most prescribed intravenous iron in pregnancy (96%) and/or postpartum (85%). Most intravenous iron was prescribed for IDAP (98%) rather than iron deficiency without anaemia (53%), and for IDAP most commonly second-line to failed oral iron supplementation and first-line in special circumstances (59%). Intravenous iron prescribing was associated with shorter time since FRANZCOG completion (p = 0.01), public hospital practice (p = 0.008) and higher hospital birth numbers (p = 0.01). Most respondents (90%) would consider a randomised controlled trial of first-line intravenous iron for IDAP, although views on appropriate thresholds differed. Conclusions Almost all respondents prescribed intravenous iron for IDAP, and while mostly used for second-line treatment over half sometimes used it first-line. With accelerating intravenous iron use, further research is required into its optimal use in pregnancy, recognizing important clinical outcomes and cost effectiveness.

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“…Colorectal cancer (CRC) is a major cause of cancer-related mortality worldwide [16] and associated with iron de ciency anaemia (IDA). Oral iron treatment of anaemia may prove inappropriate because colonic iron is implicated in gut mucosal in ammation, CRC growth and stimulation of oxidative stress [17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

Intravenous Iron Therapy Replenishes Iron Stores without Enhancing Tumour Responses in Anaemic Patients with Colorectal Cancer: Comparison with Oral Iron Supplementation.

Al-Hassi

Evstatiev

et al. 2020

Preprint

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Background: Oral iron promotes intestinal tumourigenesis in animal models. In humans, expression of iron transport proteins are altered in colorectal cancer. This study examines whether the route of iron therapy alters iron transport and tumour growth. Methods: Colorectal adenocarcinoma patients with pre-operative iron deficiency anaemia received oral ferrous sulphate (n=15), or intravenous ferric carboxymaltose (n=15). Paired (normal and tumour tissues) samples were compared for expression of iron loading, iron transporters, proliferation, apoptosis, Wnt signalling pathway and microsatellite instability using immunohistochemistry and RT-PCR. Results: Iron loading was increased in tumour and distributed to the stroma in intravenous treatment and to the epithelium in oral treatment. The protein and mRNA expression of iron transporters were increased in tumours compared to normal tissues but there were no significant differences between the treatment groups. However, intravenous iron treatment reduced ferritin mRNA levels in tumours (p<0.001) and successfully replenished body iron stores without increasing tumour growth, DNA damage markers, proliferation or apoptosis compared with oral iron treatment. Conclusion: Iron distribution to non-epithelial cells in intravenous iron treatment suggests that iron is less bioavailable to tumour cells. Therefore, intravenous iron supplementation could be a safer option in the treatment of colorectal cancer patients with iron deficiency anaemia due to the differential compartmentalisation of iron within the intestinal mucosa and its efficiency in replenishing body iron levels without increasing the risk of tumour growth.Trial registration: The study was registered with the Medicines and Healthcare Regulatory Agency, clinical trials.gov (NCT01927328) and EudraCT (2013-000209-22).

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Safety of Oral and Intravenous Iron

Cited by 90 publications

References 40 publications

Incidence of Iron Deficiency and the Role of Intravenous Iron Use in Perioperative Periods

Incidence of Iron Deficiency and the Role of Intravenous Iron Use in Perioperative Periods

The use of intravenous iron in pregnancy: for whom and when? A survey of Australian and New Zealand obstetricians

Intravenous Iron Therapy Replenishes Iron Stores without Enhancing Tumour Responses in Anaemic Patients with Colorectal Cancer: Comparison with Oral Iron Supplementation.

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