Retrospective Review of Total-Dose Iron Dextran in Iron-Deficiency Anemia of Chronic Disease and Relevance to Blood Transfusion Requirements: An Individual Institution Experience

Background: Erythrocyte stimulating agents, iron replacement, and blood transfusions are options in the treatment of chronic anemia. Patients with iron deficiency anemia who cannot tolerate or unable to absorb oral iron may receive intravenous iron. Recent studies have been conducted proving the effectiveness of total-dose low molecular weight iron dextran for the treatment of chronic anemia. Low molecular weight iron dextran (Infed) is FDA approved for to treat iron-deficient anemia and is generally safe and effective. Low molecular weight iron dextran was chosen for this review due to decrease in reported adverse reactions in the literature as compared to high molecular weight iron dextran. Iron dextran may be administered as total dose infusion in one dose, whereas other forms of IV iron require multiple doses for iron replacement. Blood conservancy programs are evaluating ways to reduce blood transfusion requirements due to limitations of available blood supply, transfusion reactions, fluid restrictions and iron overload. We report a retrospective review of the St Joseph/Candler Health System (SJCHS) experience with total dose iron dextran (Infed).

Methods: September 2006 to September 2007, 181 adult patients with anemia of chronic disease that were treated with iron dextran (Infed) were identified. Inclusion criteria were patients with anemia of chronic disease, to include hematological and non-hematological malignancies, iron dextran infusion greater than 200mg and anemia defined as hemoglobin level ≤10.5g/dl. A total of 54 patients met the inclusion criteria. There were 27 patients in the study group, which was identified as patients who received total-dose iron dextran (Infed), 27 patients in the control group, which was identified as patients who received a transfusion and no IV iron. Patients that received epoetin were excluded from the review. Age, gender, height, weight, diagnosis, tests of iron status (serum ferritin concentration, transferrin concentration/TIBC, serum iron, and transferrin saturation), CBC, vitamin B12 level, temperature, blood pressure, dose of iron dextran, number of transfusions, and signs or reports of adverse reactions was recorded. All uses of premedication and medications to treat adverse reactions were recorded.

Results: In the iron group 85.2%(23/27) did not require blood transfusion. In the transfusion group 70.4%(19/27) required only one transfusion and reached an adequate hemoglobin response. The p-value was 0.19. The average dose of iron dextran(Infed) was 1000mg. The average number of transfusion at treatment failure was 2.25 in the Infed group and 2 in the transfusion alone group. Average hemoglobin prior to iron infusion was 8.8 and prior to initial transfusion was 7.54. Infed patients that were transfused has an average hemoglobin of 8.1 prior to transfusion and 2nd transfusion patients (transfusion alone arm) had a hemoglobin of 8.29 when transfused a second time. No patients in either group had reports of adverse reactions. However, in the screening phase of the study 9 out of 181 patients (4.9%) had a documented adverse reaction to the iron test dose. All of these patients may have received Dexferrum, not Infed, and were excluded from the review. In the iron group 44.4% of patients had a hemoglobin(HgB) response greater than or equal to 10gm/dL. In the transfusion group 48.1% of patients had a hemoglobin response of greater than or equal to 10gm/dL. The p-value was 0.78.

Conclusion: Total-dose iron dextran was equally effective at reducing the incidence of transfusion compared to the transfusion control group. Both groups were equally effective at achieving a hemoglobin of greater that or equal to 10 gm/dL. This review should result in increased use of total-dose iron dextran in patients with chronic anemia without iron overload, decreased the number of transfusions by using total-dose iron dextran when appropriate, and increased awareness of intravenous iron replacement therapy.