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DRUG INFORMATION ROUNDS

Risk of Infection with Intravenous Iron Therapy

Internal Medicine/Nephrology Pharmacy Resident, Department of Pharmacy Services, Virginia Commonwealth University Health System, Richmond, VA

Donald F Brophy, PharmD MSc FCCP BCPS

Associate Professor of Pharmacy and Medicine, Department of Pharmacy, School of Pharmacy, Virginia Commonwealth University/Medical College of Virginia Campus, Richmond

Reprints: Dr. Brophy, Department of Pharmacy, School of Pharmacy, Virginia Commonwealth University/Medical College of Virginia Campus, PO Box 980533, Richmond, VA 23298, fax 804/828-8359, dbrophy{at}vcu.edu

OBJECTIVE: To review the potential risks of administering intravenous iron to patients with infection.

DATA SOURCES: Literature was accessed through MEDLINE (1977-June 2007) and Google Scholar, using the terms intravenous iron, iron sucrose, ferric gluconate, iron dextran, and infection. In addition, reference citations from publications identified were reviewed.

STUDY SELECTION AND DATA EXTRACTION: All English-language articles identified from the data sources were evaluated. Studies that provided data relevant to the objective were used, including in vitro and animal studies.

DATA SYNTHESIS: The role of iron in bacterial growth and the pathophysiology of cellular immunity create legitimate, yet theoretical, concerns that active infection may be exacerbated by the administration of intravenous iron. Human data relating to this issue are limited. A few small, human studies in a population with chronic kidney disease suggest a possible increased risk of developing an infection associated with intravenous iron; however, prospective human data directly linking intravenous iron to exacerbation of existing infection or infection-related mortality are lacking. In vitro data suggest that increased transferrin saturation related to iron administration may result in polymorphonuclear leukocyte dysfunction and decreased inhibition of bacterial growth. Sparse animal data have linked intravenous iron therapy with morbidity and mortality in sepsis models.

CONCLUSIONS: Despite the limited human data, careful consideration of risk versus benefit should be used when administering intravenous iron to patients with ongoing infection. Additional clinical data are needed to determine whether intravenous iron administration worsens outcomes of patients with infection.

Key Words: ferric gluconate, iron dextran, intravenous iron, iron sucrose

Published Online, July 31, 2007. www.theannals.com, DOI 10.1345/aph.1K187

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