Intravenous Iron Sucrose Effective in Children with Iron Deficiency Unresponsive to Oral Iron
According to a study presented at the 51st Annual Meeting and Exposition of the American Society of Hematology in New Orleans, IV iron sucrose is a safe and effective means to treat iron deficiency in children who do not respond to oral iron due to intolerance or poor compliance; cannot absorb oral iron due to a variety of congenital or acquired gastrointestinal disorders; and who have ongoing blood loss making oral supplementation ineffective.
Researchers at the University of Texas Southwestern Medical Center and Children's Medical Center in Dallas made their conclusions after reviewing pharmacy records on all children (</= 18 years of age) who received IV iron sucrose at the Medical Center Dallas between January 1, 2004, and June 30, 2009.
For decades parenteral iron has been used in patients with iron deficiency who are unresponsive to oral iron therapy and in hemodialysis-dependent patients receiving erythropoietin. Iron dextran, used extensively in the past, is associated with a high rate of serious anaphylactic reactions and thus its use in children has been very limited.
Intravenous iron sucrose was approved by the FDA in 2000 for patients with chronic renal disease receiving erythropoietin. Its safety profile being much more favorable than that of iron dextran, it has generally replaced iron dextran for use in both adults and children with chronic kidney disease. However, the use of iron sucrose for other indications in children has been widely reported. The Texas researchers sought to review their institution’s favorable experience with IV iron sucrose in children without chronic renal disease.
One hundred and fifty-seven children received at least one dose of IV iron sucrose during the study period. The patients with chronic kidney disease (n=116) were excluded as well as three patients with insufficient medical records. The remaining patients (n=38), who received iron sucrose for other indications, were analyzed. They included 13 patients who received IV iron sucrose for iron deficiency refractory to oral iron therapy, 13 for primary iron malabsorption or dependence on parenteral nutrition, seven for chronic gastrointestinal blood loss, and five for miscellaneous indications.
The 38 children received a total of 510 doses of iron sucrose. Those who were refractory to oral iron showed a mean hgb rise of 3.5g/dL with IV iron sucrose, compared with a rise of 0.03 with oral iron. Other figures were 1.8 IV vs 1.1 oral for malabsorption, 2.9 vs 1.5 for chronic blood loss, and 1.7 vs 1.1 for other conditions.
There were only six adverse reactions attributed to the infusions. Five were mild (including headache, stomach irritation, transient mild hypotension, and vasovagal reaction). One serious reaction occurred in an adolescent who received a large dose of (500 mg iron sucrose diluted in 250mL of normal saline over 35 minutes). The patient developed anxiety, face swelling, thready pulse, and hypotension. The patient promptly recovered following epinephrine, diphenyhydramine, and methylprednisolone.