OzEMedicine - Wiki for Australian Emergency Medicine Doctors

see also:

• iron deficiency anaemia
• intravenous iron Rx
• Melbourne Haematology Patient information sheet
• Nat. Blood Authority Australia March 2016: Iron product choice and dose calculation for adults (pdf)

• ideally, patients requiring an iron infusion should be referred to Western Health's MADU outpatient service at Sunshine Hospital and NOT the emergency department as it is NOT an emergent problem.
• when considering management of iron deficiency anaemia, be aware that in the absence of acute bleeding, a blood transfusion is usually NOT indicated if Hb > 70g/L, and in these patients, referral for iron infusion is a better choice if they cannot tolerate oral iron - GPs can access the WH blood transfusion policy at WH blood transfusion guidelines (pdf)

• iron infusions are no longer performed in the ED or SSU at Western Health
• patients must be referred to MADU for outpatient infusion

• patient must be aged 14yrs or older
• patient must not be on haemodialysis
• patient must not have had an iron infusion within past 1 week (max. is 1000mg/wk)
• no known allergic reaction to ferric carboxymaltose
• patient is not pregnant (avoid in 1st TM, can be used with caution in 2nd and 3rd TMs)
• patient must have documented iron deficiency
  • low serum ferritin < 15-30mcg/L in adults
  • high transferrin or total iron-binding capacity
  • low transferrin saturation (preferably on a fasting morning sample)
  • low serum iron
• either not tolerating oral iron or oral iron is not appropriate as deficiency is severe and risk of decompensating or need for blood transfusion if not given
• ED has capacity to manage the infusion safely

• PBS triplicate prescription for:
  • ferric carboxymaltose 500mg/10mL x 2 ampoules, no repeats
• IV infusion chart for:
  • ferric carboxymaltose 1g in 250mL 0.9% saline and rate over 15min
• send both the above to pharmacy to prepare
• patient will be billed PBS rates ($38.30 non-concessional, $6.30 for concession card holders)

• confirm patient identification
• iv cannula
• vital signs documentation
• commence infusion
• observe for anaphylaxis during infusion and for 30 minutes after it ceases
• other common adverse events:
  • nausea 3%
  • transient hypophosphataemia 2%
  • injection site reactions 1.6%
  • headache 1.4%
  • hypertension 1.3%
  • dizziness 1.2%

• determine need for further iron Rx:
  • if more iron is required, either on going oral iron is required or a subsequent iron infusion as an outpatient via MADU at least 1 week after this dose (referral for this can be made as above)
• discharge home with discharge letter:
  • instructions to GP for future referrals to MADU
  • ensure GP has arranged or will arrange Ix of iron deficiency as indicated (eg. gastroscopy/colonoscopy)
  • request GP to arrange and follow up rpt bloods in 1-2 weeks