Iron Deficiency
Objective: Monitor for and manage iron deficiency |
Patient population: Adult patients (>18 years) with known diagnosis of IBD |
Highlight BoxParenteral iron is recommended over oral iron; however, both oral and parenteral iron are effective in correcting iron deficiency anemia. The decision of the optimal form of iron for each individual patient, remains at the discretion of the prescriber, based on the patients’ characteristics and needs. |
Introduction
This care protocol provides a general guideline for monitoring and managing iron deficiency in adults with inflammatory bowel disease. The availability of the listed options for iron replacement may vary across organizations.
IBD Provider
1. Review CBC (hemoglobin, MCV), Fe, Ferritin, Transferrin, TIBC.
2. Confirm iron deficiency (Ferritin <20 g/L or iron saturations <15%) or if active disease, Ferritin < 100 g/L, Iron saturations <15%.
3. Review hemoglobin
a. If Hb <70 g/L –> consider urgent PRBC transfusion if symptomatic or urgent iron infusion (if asymptomatic) and repeat Hb in 2 weeks
b. If Hb = 70-100g/L –> iron infusion and repeat Hb in 2 months
c. If Hb >100g/L –> oral iron supplements, if intolerant, organize iron infusion, repeat Hb, Ferritin, Fe, Iron studies, CRP in 3 months
4. See Table 1 for Iron replacement options.
5. Arrange for IV iron replacement per protocol.
6. Inform the family physician of the plan for iron replacement.
Table 1: Options for iron replacement
Iron Formulation* | Route | Common Dose | Elemental Iron Equivalence |
Ferrous Gluconate | Oral | 300mg/tablet | 35mg |
Ferrous Sulfate | Oral | 300mg/tablet | 60mg |
Ferrous Fumerate | Oral | 300mg/tablet | 100mg |
Iron Polysaccharide (Feramax) | Oral | 150mg/tablet | 150mg |
Heme Iron Polypeptide (Proferrin) | Oral | 398mg/tablet | 11mg |
Iron Sucrose (Venofer) | Intravenous | Variable based on patient requirement (100-300mg/dose) | 20mg/mL |
Sodium Ferric Gluconate (Ferrlecit) | Intravenous | 125mg | 125mg |
Iron Isomaltoside (Monoferric) | Intravenous | Variable based on patient requirement (see table below) | 100mg/mL |
Simplified dosing table for Iron isomaltoside (Maximum single dose is 1.5g or 20mg/kg, whichever is less)
Hemoglobin (g/L) | Weight <50 kg | Weight 50-69kg | Weight ≥70kg |
≥ 100 g/L | 500mg | 1g | 1.5mg |
< 100 g/L | 500mg | 1.5g | 2mg |
References
Lim, W., Afif, W., Knowles, S., Lim, G., Lin, Y., Mothersill, C., Nistor, I., Rehman, F., Song, C. and Xenodemetropoulos, T. (2019), Canadian expert consensus: management of hypersensitivity reactions to intravenous iron in adults. Vox Sang, 114: 363- 373. https://doi.org/10.1111/vox.12773
Abhyankar, A., & Moss, A. C. (2015). Iron Replacement in Patients with Inflammatory Bowel Disease: A Systematic Review and Meta-analysis. Inflammatory bowel diseases, 21(8), 1976–1981. https://doi.org/10.1097/MIB.0000000000000386
Macdougall, I. C., Comin-Colet, J., Breymann, C., Spahn, D. R., & Koutroubakis, I. E. (2020). Iron Sucrose: A Wealth of Experience in Treating Iron Deficiency. Advances in therapy, 37(5), 1960–2002. https://doi.org/10.1007/s12325-020-01323-z