INTRAVENOUS IRON
If the patient is absolutely unable to tolerate any oral iron preparation and they are anaemic (low Hb) they can be referred for consideration of intravenous iron (see below).
If under a parent specialty for bleeding symptoms, or with a clear organ system cause for iron deficiency, referral should be directed to the appropriate specialty, and not to haematology. Iron deficiency is common and no longer seen as primarily a condition requiring a haematology specialist. Intravenous iron is now on the East Lothian Formulary.
IV iron infusions are associated with:
- osteomalacia and rickets in some people as per the MHRA warning in the BNF
- anaphylaxis and other systemic symptoms can occur with IV iron administration even when tolerated previously
- permanent skin discolouration can occur if IV iron extravasates.
These risks should be discussed with patients prior to referral.
Many patients with historical oral iron intolerance may have received IV iron in the past. Such patients should be offered the lower dose oral iron replacement detailed above before re-referral and should be similarly counselled regarding risks of IV iron, especially as the bone side effects are more commonly seen with people receiving repeat infusions.
Who to refer:
- Iron deficiency anaemia where the patient is completely intolerant of all oral iron preparations and requires intravenous iron treatment – please refer to the involved specialist (and not haematology), who can arrange an infusion in the Medical Day Case Unit.
Who not to refer:
- Those who have not trialled the lower dose iron regimes outlined above
- Anyone who is not anaemic
How to refer:
Patients needing treatment with intravenous iron should be referred to the specialist investigating their symptoms.
