Internal Medicine

0521779407-10 CUNY1086/Karliner 0 521 77940 7 June 6, 2007 17:44

Iron Deficiency 869

■parenteral iron replacement. Intramuscular or intravenous. Iron

dextran or iron saccharates. Test dose is essential. Methylpred-

nisolone given before iron dextran replacement aborts late side

effects (myalgias, arthralgias, fever). IM iron dextran replacement

is limited to 100 mg per treatment.

■Red cell transfusion: Life-threatening anemia only

Side Effects and Complications

■oral iron – cramps, constipation, diarrhea. One tablet at bedtime

has fewer side effects. Ferrous gluconate better than ferrous sulfate;

about the same price. Warn patients of black stools.

■parenteral iron replacement

➣Iron dextran – Test dose always IV; cessation with first sign of

reaction. IM treatment – black discoloration of skin, local irrita-

tion with fibrosis, pain. IV iron dextran – myalgias, arthralgias,

fever the day after treatment.

➣Iron saccharates – FDA approved for dialysis patients. Maximum

IV dose – 125 mg elemental iron. Very few side effects. An alter-

native for patients with allergy to iron dextran.

■Red cell transfusion – Pulmonary edema due to plasma volume

expansion with rapid RBC replacement; viral infections; hemolytic

reactions

Contraindications – Absolute

■oral iron: None

■parenteral iron: History of allergic or anaphylactic reactions to spe-

cific IV iron preparations

■red cell transfusions: None

Contraindications – Relative

■oral iron: Gastrointestinal intolerance, low gastric pH, rapid correc-

tion needed

■parenteral iron: History of multiple drug allergies (atopic state); His-

tory of reactions to dextran plasma expanders; ongoing treatment

with high-dose corticosteroids that might mask allergic reaction to

test dose

■red cell transfusions

➣Religion (e.g., Jehovah’s Witness)

➣alloimmunization

➣plasma volume expansion