Clinical update: intravenous iron for anaemia Intravenous iron supplementation for the treatment of anaemia in pre-dialyzed chronic renal failure patients. A prospective randomized, controlled trial of intravenous versus oral iron for moderate iron deficiency anaemia of pregnancy. A comparison between intravenous iron polymaltose complex (Ferrum Hausmann®) and oral ferrous fumarate in the treatment of iron deficiency anaemia in pregnancy Efficacy of iron supplementation on fatigue and physical capacity in non-anaemic iron-deficient adults: a systematic review of randomised controlled trials Correction of Uremic Iron Deficiency Anemia in Hemodialyzed Patients: A Prospective Study Comparison of oral versus intravenous iron therapy in predialysis patients of chronic renal failure receiving recombinant human erythropoietin. The effect of intravenous and oral iron administration on perioperative anaemia and transfusion requirements in patients undergoing elective cardiac surgery: a randomized clinical trial. Marginal iron deficiency without anemia impairs aerobic adaptation among previously untrained women. A prospective, partially randomized study of pregnancy outcomes and hematologic responses to oral and intramuscular iron treatment in moderately anemic pregnant women. The effects of short-term oral iron therapy on developmental deficits in iron-deficient anemic infants. Oral and intravenous iron treatment in inflammatory bowel disease: Hematological response and quality of life improvement A parallel, comparative study of intravenous iron versus intravenous ascorbic acid for erythropoietin-hyporesponsive anaemia in haemodialysis patients with iron overload. Clinical evaluation of iron treatment efficiency among non-anemic but iron-deficient female blood donors: a randomized controlled trial Intravenous iron sucrose versus oral iron ferrous sulfate for antenatal and postpartum iron deficiency anemia: a randomized trial Rationale and design of the IRON-HF study: a randomized trial to assess the effects of iron supplementation in heart failure patients with anemia. A comparison of oral and intravenous iron supplementation in preterm infants receiving recombinant erythropoietin.
For nearly half a century , parenteral iron has been considered dangerous and for use only in extreme situations and when oral iron was not tolerated . This proscription was based largely on poorly characterised and infrequent anaphylactoid reactions to the high-molecular-weight dextran preparation ( Imferon ) that for most of this time was the only product available . Moreover , when parenteral iron was necessary , the recommended approach was small intramuscular doses ( ≤100 mg ) , even after intravenous administration of the total iron defi cit as a single dose or as repetitive boluses was shown to be as safe and eff ective as the intramuscular route . This mindset persists despite the subsequent introduction of low-molecular-weight iron dextran and two iron salt preparations , ferric gluconate and iron saccharate ( the latter is also known as iron sucrose ) , all of which are associated with fewer serious adverse events than the high-molecular-weight dextran . The introduction of recombinant erythropoietin for dialysis patients was associated with the development , in some individuals , of functional iron defi ciency that limited effi cacy . Intravenous iron , unlike oral iron , improves erythropoietic response in dialysis patients , and is now routinely used . The discovery of the iron regulatory peptide , hepcidin , has improved our underst and ing of the anaemia of chronic infl ammatory states , including cancer . Hepcidin is upregulated in these conditions , result ing in increased synthesis by the liver . Hepcidin inhibits iron transport across cell membranes , which decreases the accessibility of storage iron and gastrointestinal absorption of dietary iron , leading to an increased frequency of iron-restricted erythropoiesis , especially during therapy with recombinant erythropoietin . The most frequent laboratory fi ndings during the anaemia of chronic infl ammation are hypoferraemia and a low percent transferrin saturation , although these fi ndings are not always present . The increasing use of recombinant erythropoietin to treat anaemia in patients with chronic diseases has exp and ed the population of patients with functional iron defi ciency and increased interest in safe rational approaches to parenteral iron therapy . There is mounting evidence that anaemic patients with cancer undergoing chemotherapy and receiving  recombinant erythropoietin respond better when parenteral iron is administered . This benefi t is independent of baseline iron variables , such as ferritin , low percentage transferrin saturation , and stainable marrow haemosiderin , leaving the clinician in need of laboratory variables to reliably detect iron-restricted erythropoiesis in patients with infl ammatory illnesses and to predict improvement of erythropoietic response to parenteral iron in the setting of infl ammatory illness . Two new laboratory measures look promising : percent hypochromic red blood cells and reticulocyte haemoglobin content . These tests are reliable and accurate correlates of functional iron defi ciency . Although these investigations are not yet widely available , their use will probably exp and and guide identifi cation of functional iron defi ciency and rational intervention with parenteral iron . Currently , four parenteral iron preparations are available ( table ) . No r and omised trials have compared the safety and effi cacy of any of these agents . The largest retrospective review of dialysis experience suggests that most serious adverse events have been associated with the high-molecular-weight iron dextrans ( Imferon , which is no longer available and the current preparation , Dexferrum ) and are rare ( < 1:200 000 ) with the low-molecular-weight iron dextran or the two iron salts ( fi gure ) . Adverse event rates might be somewhat higher in patients with infl ammatory diseases in which immune-mediated drug reactions  may be observed more commonly than in dialysis patients . Some of the adverse clinical experience with parenteral iron is due to inappropriate supportive care . Myalgias , when they include chest and back discomfort , are mistakenly described as anaphylaxis , prompting Low – molecular – weight iron dextran Iron saccharate Ferric gluconate High – molecular – weight iron BACKGROUND Intravenous iron is a recognized therapy of anaemia in chronic haemodialyzed patients , especially in those receiving erythropoietin ( Epo ) , while its role in the anaemia of pre-dialyzed chronic renal failure ( CRF ) patients is much less clear . This study attempted to evaluate the effects of intravenous iron in anaemic pre-dialyzed patients . METHODS Sixty anaemic ( haemoglobin<11 g/dl ) non-diabetic patients with moderate CRF [ 32 males , 28 females ; mean age 52.2+/-12.5 years ; mean glomerular filtration rate 36.2+/-5.2 ml/min ] , without iron deficiency , iron overload or inflammation , without concomitant erythropoietin treatment and without any previous iron therapy were enrolled .  Intravenous iron was administered as iron sucrose , 200 mg elemental iron per month for 12 months , with 1 month pre- study survey and 1 month follow-up after the last iron dose . RESULTS Intravenous iron supplementation was associated with a significant increase in haemoglobin ( from 9.7+/-1.1 at the baseline to 11.3+/-2.5 g/dl after 12 months , a mean increase of 1.6 g/dl ) , a further 36 % of patients reaching the target haemoglobin of 10 g/dl . There was a significant increase in serum iron from 73.9+/-17.2 to 101.8+/-12.2 microg/dl , in serum ferritin from 98.0 ( 24.8 - 139.0 ) to 442.5 ( 86.0 - 496.0 ) microg/l and in transferrin saturation from 21.6+/-2.6 to 33.6+/-3.2 % . No worsening of renal function , no increase in blood pressure and no other side effects were noted . CONCLUSIONS Intravenous iron therapy in pre-dialysis patients with no Epo seems often to ameliorate the anaemia , avoiding the necessity of Epo or blood transfusions in one-third of pre-dialyzed non-diabetic patients . Intravenous iron supplementation appears to be an effective and safe treatment for anaemia in pre-dialysis CRF patients BACKGROUND Iron deficiency anaemia is the most common deficiency disorder in the world , affecting more than one billion people , with pregnant women at particular risk . OBJECTIVES AND DESIGN We conducted a single site , prospect i ve , nonblinded r and omized-controlled trial to compare the efficacy , safety , tolerability and compliance of st and ard oral daily iron versus intravenous iron . SUBJECTS We prospect ively screened 2654 pregnant women between March 2007 and January 2009 with a full blood count and iron studies , of which 461 ( 18 % ) had moderate IDA . Two hundred women matched for haemoglobin concentration and serum ferritin level were recruited . INTERVENTIONS Patients were r and omized to daily oral ferrous sulphate 250 mg ( elemental iron 80 mg ) with or without a single intravenous iron polymaltose infusion . RESULTS Prior to delivery , the intravenous plus oral iron arm was superior to the oral iron only arm as measured by the increase in haemoglobin level ( mean of 19.5 g/L vs. 12 g/L ; P < 0.001 ) ; the increase in mean serum ferritin level ( 222 microg/L vs. 18 ug/L ; P < 0.001 ) ; and the percentage of mothers with ferritin levels below 30 microg/L ( 4.5 % vs. 79 % ; P < 0.001 ) . A single dose of intravenous iron polymaltose was well tolerated without significant side effects . CONCLUSIONS Our data indicate that intravenous iron polymaltose is safe and leads to improved efficacy and iron stores compared to oral iron alone in pregnancy-related IDA Abstract : Anaemia is the most common medical disorder in pregnancy with iron deficiency anaemia accounting for the majority of cases . Over 90 % of the iron deficiency anaemia is due to red cell iron deficiency associated with depleted iron stores and deficient intake . The two main modalities of treating iron deficiency anaemia are oral or parenteral iron . Ferrous Hausmann ® ( iron dextrin ) is the latest iron preparation which can be used for intravenous parenteral administration as a total dose infusion . This study compares the efficacy of Ferrum Hausmann ® with oral ferrous fumarate therapy in the treatment of iron deficiency anaemia in pregnancy . Our study shows that treatment with intravenous Ferrum Hausmann ® ( iron dextrin ) result ed in a significantly better level and rate of increase of haemoglobin ( p<0.001 ) . Serum ferritin , which is the best indicator of iron stores , was significantly higher ( p<0.001 ) in the intravenous group . Other indices of iron status such as serum iron , serum transferrin and zinc protoporphyrin also showed a significant improvement in the intravenous group compared to those given oral iron . The results suggest that intravenous iron as a total dose infusion is able to replenish iron stores more efficiently , completely and at a faster rate than oral iron therapy , thus providing the fuel for stimulation of full erythopoiesis compared to oral iron . There were also no reports of any adverse reactions with intravenous iron dextrin , whereas there were a considerable proportion of women on oral iron therapy who reported side effects . In conclusion , intravenous iron therapy with Ferrous Hausmann ® ( iron dextrin ) is a suitable , effective and safe alternative to oral iron therapy in the treatment of iron deficiency anaemia in pregnancy Objective Iron supplementation in iron-deficiency anaemia is st and ard practice , but the benefits of iron supplementation in iron-deficient non-anaemic ( IDNA ) individuals remains controversial . Our objective is to identify the effects of iron therapy on fatigue and physical capacity in IDNA adults . Design Systematic review and meta- analysis of r and omised controlled trials ( RCTs ) . Setting Primary care . Participants Adults ( ≥18 years ) who were iron deficient but non-anaemic . Interventions Oral , intramuscular or intravenous iron supplementation ; all therapy doses , frequencies and duration s were included . Comparators Placebo or active therapy . Results We identified RCTs in Medline , Embase , Cochrane Central Register of Controlled Trials , Cumulative Index of Nursing and Allied Health , SportD iscus and CAB Abstract s from inception to 31 October 2016 . We search ed the WHO ’s International Clinical Trials Registry Platform for relevant ongoing trials and performed forward search es of included trials and relevant review s in Web of Science . We assessed internal validity of included trials using the Cochrane Risk of Bias tool and the external validity using the Grading of Recommendations Assessment , Development and Evaluation methodology . From 11 580 citations , we included 18 unique trials and 2 companion papers enrolling 1170 patients . Using a Mantel-Haenszel r and om-effects model , iron supplementation was associated with reduced self-reported fatigue ( st and ardised mean difference ( SMD ) −0.38 ; 95 % CI −0.52 to −0.23 ; I2 0 % ; 4 trials ; 714 participants ) but was not associated with differences in objective measures of physical capacity , including maximal oxygen consumption ( SMD 0.11 ; 95 % CI −0.15 to 0.37 ; I2 0 % ; 9 trials ; 235 participants ) and timed methods of exercise testing  . Iron supplementation significantly increased serum haemoglobin concentration ( MD 4.01 g/L ; 95 % CI 1.22 to 6.81 ; I2 48 % ; 12 trials ; 298 participants ) and serum ferritin ( MD 9.23 µmol/L ; 95 % CI 6.48 to 11.97 ; I2 58 % ; 14 trials ; 616 participants ) . Conclusion In IDNA adults , iron supplementation is associated with reduced subjective measures of fatigue but not with objective improvements in physical capacity . Given the global prevalence of both iron deficiency and fatigue , patients and practitioners could consider consumption of iron-rich foods or iron supplementation to improve symptoms of fatigue in the absence of documented anaemia . PROSPERO registration number CRD42014007085 This prospect i ve study was design ed to evaluate the eventual correction of anemia and iron status in 39 iron-deficient uremics starting hemodialysis . Nine patients ( control group ) had no iron supplementation  , 10 had oral ferrous iron , and 20 were treated with intravenous iron gluconate . Follow-up periods were 12 months for the control group and 26 months for patients treated with oral or intravenous iron . No patient was treated with erythropoietin . At zero time , all patients were anemic ( Hb < 78 g/l ) and showed signs of severe iron deficiency , diagnosed on the basis of depleted bone marrow iron stores , reduced hemoglobin iron , and transferrin saturation < 21 % . The hemoglobin levels , observed in patients of the control and the oral iron groups at the end of the follow-up periods , were not significantly different from those detected at zero time . In contradistinction , patients treated with intravenous iron showed after 26 months of follow-up a significant increase of blood hemoglobin values , reaching a mean value of 126 g/l . So far , this evidence supports both the concept that iron absorption is compromised in chronic uremics and that the parenteral way is the more effective route for iron replacement in this specific group of patients OBJECTIVES To compare oral versus intravenous iron in pre-dialysis patients of chronic renal failure ( CRF ) receiving recombinant human erythropoietin ( rHuEPO ) . METHODS The study was undertaken in 40 adult patients of chronic renal failure . The patients were r and omly divided into two groups A and B of 20 patients each . Group A patients were given oral iron and group B patients were given intravenous iron . All patients in both groups were given recombinant human erythropoietin 2000 IU twice weekly subcutaneously . The study was carried for up to three months . Patients were monitored every month for renal parameters and haematological parameters which included haemoglobin , reticulocyte count and packed cell volume . Ferrokinetic studies were done at baseline and at three months . RESULTS It was observed that haematological parameters showed significant statistical improvement in the intravenous iron group as compared to group A ( oral iron group ) . The ferrokinetic studies revealed that serum iron , serum ferritin and transferrin saturation , decreased significantly in oral iron group , whereas significant increase was seen in group B ( intravenous iron group ) . None of the patients developed any adverse effects because of erythropoietin or iron therapy . CONCLUSIONS Concomitant use of intravenous iron is better than oral iron in CRF patients treated with rHuEPO . The intravenous route of iron administration may be a preferred route along with rHuEPO therapy , more so in the Indian context where prevalence of iron deficiency anaemia is fairly high OBJECTIVES Anaemia is a frequent complication after cardiopulmonary bypass surgery .  Iron therapy has been variably employed by medical centres over the years . In our study we test the clinical effectiveness of intravenous and oral iron supplementation in correcting anaemia , and its impact on blood transfusion requirements , in patients undergoing cardiopulmonary bypass surgery . METHODS A double-blind , r and omized , placebo-controlled clinical trial with three parallel groups of patients . Group I ( n = 54 ) : intravenous iron(III)-hydroxide sucrose complex , three doses of 100 mg/24 h during pre- and postoperative hospitalization and 1 pill/24 h of oral placebo in the same period and during 1 month after discharge . Group II ( n = 53 ) : oral ferrous fumarate iron 1 pill/24 h pre- and postoperatively and during 1 month after discharge , and intravenous placebo while hospitalized . Group III ( n = 52 ) : oral and intravenous placebo pre- and postoperatively , following the same protocol . Data were collected preoperatively , at theatre , at intensive care unit admission , before hospital discharge and 1 month later . RESULTS ( 1 ) Baseline clinical and demographic characteristics and surgical procedures were similar in the three groups ; ( 2 ) no inter-group differences were found in haemoglobin and haematocrit during the postoperative period ; ( 3 ) the intravenous iron group showed higher serum ferritin levels at hospital discharge ( 1321 ± 495 ng/ml ; P < 0.001 ) and 1 month later ( 610 ± 387 ; P < 0.001 ) compared with the other groups and ( 4 ) we did not observe statistical differences in blood transfusion requirements between the three groups . CONCLUSIONS The use of intravenous or oral iron supplementation proved ineffective in correcting anaemia after cardiopulmonary bypass and did not reduce blood transfusion requirements . [ Current Controlled Trials number : NCT01078818 ( oral and intravenous iron in patients postoperative cardiovascular surgery under EC ) ] BACKGROUND Iron deficiency without anemia has been shown to reduce both muscle-tissue oxidative capacity and endurance in animals . However , the consequences of iron deficiency in humans remain unclear . OBJECTIVE We investigated the effects of iron supplementation on adaptation to aerobic training among marginally iron-depleted women . We hypothesized that iron supplementation for 6 wk would significantly improve iron status and maximal oxygen uptake ( VO(2)max ) after 4 wk of concurrent aerobic training . DESIGN Forty-one untrained , iron-depleted , nonanemic women were r and omly assigned to receive either 50 mg FeSO(4 ) or a placebo twice daily for 6 wk in a double-blind trial . All subjects trained on cycle ergometers 5 d/wk for 4 wk , beginning on week 3 of the study . RESULTS Six weeks of iron supplementation significantly improved serum ferritin and serum transferrin receptor ( sTfR ) concentrations and transferrin saturation without affecting hemoglobin concentrations or hematocrit . Average VO(2)max and maximal respiratory exchange ratio improved in both the placebo and iron groups after training ; however , the iron group experienced significantly greater improvements in VO(2)max . Both iron-status and fitness outcomes were analyzed after stratifying by baseline sTfR concentration ( > and < or = 8.0 mg/L ) , which showed that the previously observed treatment effects were due to iron-status and fitness improvements among subjects with poor baseline iron status . CONCLUSIONS Our findings strongly suggest that iron deficiency without anemia but with elevated sTfR status impairs aerobic adaptation among previously untrained women and that this can be corrected with iron supplementation BACKGROUND Daily oral iron supplementation during pregnancy fails to reduce the prevalence of anemia . However , 2 or 3 intramuscular doses of iron given at monthly intervals were recently found to be effective . OBJECTIVE We compared the safety and efficacy in treating pregnancy anemia of 3 intramuscular doses of iron given at monthly intervals with those of daily oral iron supplementation . DESIGN In a prospect i ve , partially r and omized study , 148 pregnant women received daily oral doses of 100 mg elemental Fe and 500 micro g folic acid , and 106 pregnant women received 3 intramuscular doses of 250 mg elemental Fe as iron dextran at 1-mo intervals and oral doses of 5 mg folic acid twice weekly .  One hundred women in each group completed the study .  Changes in hemoglobin , iron indicators , pregnancy outcomes , and birth weight were compared between the 2 groups . RESULTS Hemoglobin and iron indicators improved significantly with both treatments . The increase in serum ferritin concentration after parenteral iron treatment was significantly higher than that after oral iron treatment . No significant differences between the 2 groups in pregnancy outcomes and birth weight were observed . Systemic side effects were more common in the parenteral iron group , whereas gastrointestinal side effects were more common in the oral iron group . CONCLUSIONS The intramuscular administration of 3 doses of 250 mg Fe at monthly intervals appears to have good compliance and efficacy and may be used in women who can not tolerate oral administration of iron . However , intramuscular administration of iron is appropriate only in hospital setting s well equipped to treat anaphylactic crises To assess the effects of iron therapy on developmental test scores in infants with iron deficiency anemia , 68 Guatemalan babies 6 to 24 months of age , with and without mild iron deficiency anemia , were tested with the Bayley Scales of Infant Development before and after one week of oral iron treatment . The two major findings of the study were developmental deficits in the anemic group prior to treatment , and lack of rapid improvement with short-term oral iron therapy . The mean pretreatment Mental Development Index of the anemic group was significantly lower than that of nonanemic infants . The anemic group 's pretreatment Psychomotor Development Index was also lower than that of the nonanemic control group . In a double-blind r and omized study , six to eight days of oral iron therapy did not reverse these deficits . Consequently , the deficits of the anemic group can not be unequivocably attributed to iron lack . However , no significant differences were found between anemic and nonanemic groups in birth histories , socioeconomic level , or general nutritional status which might otherwise explain the lower developmental test scores of the anemic babies Background : The aim was to evaluate the efficacy and tolerance of oral and intravenous iron treatment in anemic inflammatory bowel disease ( IBD ) patients , considering both hematological and quality ‐of‐life outcomes . Methods : We performed a prospect i ve multicenter study in IBD patients with iron deficiency anemia . Patients having hemoglobin > 10 g/dL were prescribed oral ferrous sulfate . If hemoglobin < 10 g/dL , intravenous ( sucrose ) iron was administered . Oral iron‐intolerant patients were changed to intravenous treatment .  Clinical ( Truelove/Harvey – Bradshaw ) , hematological ( response defined as hemoglobin normalization ) , and quality ‐of‐life ( shortened CCVEII‐9 question naire ) evaluations were performed at baseline and at 3 and 6 months . Results : 100 IBD patients ( 59 Crohn 's disease , 41 ulcerative colitis ) were included . Mean basal hemoglobin levels were 10.8 ± 1.3 g/dL ( range , 6.6–12.9 ) . Seventy‐eight patients received oral treatment and 22 intravenous iron .  Hemoglobin normalization was achieved in 86 % of patients : 89 % with oral , and 77 % with intravenous iron . An IBD activity increase was not demonstrated in any patient . Four patients ( 5.1 % ) showed oral iron intolerance leading to discontinuation of treatment . No adverse events were reported for intravenous iron  . Hemoglobin correlated with CCVEII‐9 ( P < 0.001 ) . The CCVEII‐9 score increased in patients who normalized hemoglobin levels in 3 months ( from 58 ± 9 to 73 ± 10 ) or 6 months ( 54 ± 9 , 68 ± 12 , and 74 ± 10 ) ( P < 0.001 ) . Conclusions : Oral iron treatment is effective and well tolerated in most IBD patients , and does not exacerbate the symptoms of the underlying IBD . Intravenous iron , on the other h and , is an effective and safe alternative treatment for iron deficiency anemia in more severely anemic or intolerant patients . Anemia correction with iron treatment is associated with a relevant improvement in the patients ' quality of life . ( Inflamm Bowel Dis 2009 BACKGROUND Functional iron deficiency may develop and cause erythropoietin resistance in haemodialysis patients with iron overload . Controversy remains as to whether intravenous iron medication can improve this hyporesponsiveness due to decreased iron availability , or whether iron therapy will aggravate haemosiderosis . Intravenous administration of ascorbic acid has been shown to effectively circumvent resistant anaemia associated with iron overload in a small preliminary study . To eluci date further the possible mechanisms of this resistance , a parallel , comparative study was conducted to compare the effects of intravenous iron and ascorbate therapies in iron-overloaded haemodialysis patients . METHODS Fifty haemodialysis patients with serum ferritin of > 500 microg/l were r and omly divided into two protocol s. They were further stratified into controls ( Control I , n = 11 ) and intravenous iron group ( IVFE , n = 15 ) in protocol I ; and into controls ( Control II , n = 12 ) and intravenous ascorbic acid group ( IVAA , n = 12 ) in protocol II . Controls had a haematocrit of > 30 % and did not receive any adjuvant therapy . IVFE and IVAA patients were hyporesponsive to erythropoietin and functionally iron deficient . Ferric saccharate ( 100 mg dose ) was administered intravenously postdialysis on five consecutive dialysis sessions in the first 2 weeks ; and ascorbic acid ( 300 mg dose ) thrice a week for 8 weeks . Red cell and iron metabolism indices were examined before and following therapy . RESULTS Mean values of haematocrit and transferrin saturation were significantly lower , and erythropoietin dose was higher in IVFE and IVAA patients compared to controls . Intravenous iron therapy neither improved erythropoiesis nor reduced erythropoietin dose during 12 weeks . Iron metabolism indices significantly increased at 2 and 6 weeks , but decreased at 12 weeks returning to the baselines . In contrast , mean haematocrit significantly increased from 25.8+/-0.5 to 30.6+/-0.6 % with a concomitant reduction of 20 % in erythropoietin dose after 8 weeks of ascorbate therapy . Serum ferritin modestly fell but with no statistical significance . The enhanced erythropoiesis paralleled a rise in transferrin saturation from 27+/-3 to 48+/-6 % and serum iron from 70+/-11 to 107+/-19 microg/dl ( P<0.05 ) . CONCLUSIONS Short term intravenous iron therapy can not resolve the issue of functional iron deficiency in haemodialysis patients with iron overload . Intravenous administration of ascorbic acid not only facilitates iron release from storage sites , but also increases iron utilization in the erythron . Our study draws attention to a potential adjuvant therapy , intravenous ascorbic acid , to treat erythropoietin-hyporesponsive anaemia in iron-overloaded patients Background Iron deficiency without anemia is related to adverse symptoms that can be relieved by supplementation . Since a blood donation can induce such an iron deficiency , we investigated the clinical impact of iron treatment after a blood donation . Methods One week after donation , we r and omly assigned 154 female donors with iron deficiency without anemia , aged below 50 years , to a four-week oral treatment of ferrous sulfate versus a placebo . The main outcome was the change in the level of fatigue before and after the intervention . Aerobic capacity , mood disorder , quality of life , compliance and adverse events were also evaluated . Hemoglobin and ferritin were used as biological markers . Results The effect of the treatment from baseline to four weeks of iron treatment was an increase in hemoglobin and ferritin levels to 5.2 g/L ( P < 0.01 ) and 14.8 ng/mL ( P < 0.01 ) , respectively . No significant clinical effect was observed for fatigue ( -0.15 points , 95 % confidence interval -0.9 points to 0.6 points , P = 0.697 ) or for other outcomes . Compliance and interruption for side effects was similar in both groups . Additionally , blood donation did not induce overt symptoms of fatigue in spite of the significant biological changes it produces . Conclusions These data are valuable as they enable us to conclude that donors with iron deficiency without anemia after a blood donation would not clinical ly benefit from iron supplementation . Trial Registration Clinical Trials.gov : Abstract Objective : To compare oral iron to intravenous iron administration to women in late pregnancy and /or after labor to correct iron deficiency . Methods : 271 anemic women ( 148 pregnant women and 123 women post lower segment caesarean section ) with hemoglobin ( Hb ) levels below 110 g/L were enrolled over a two-year period and r and omized to receive either two tablets FGF ( ferrous sulfate with folic acid ) or 400 mg of intravenous iron sucrose plus folic acid 600 µg . Treatment effectiveness was assessed by measuring Hb and ferritin postpartum on day 1 , day 14 and day 42 . Transfusions of red blood cells and adverse drug reactions were recorded . Results : Data of 214 women were available for analysis . Both forms of iron replacement therapy led to increased hemoglobin and ferritin levels over the testing period . Ferritin was significantly higher in the i.v . iron treatment group compared to the oral iron treatment group ( p = 0.004 ) two weeks after delivery , while Hb values did not differ between the groups . No serious adverse drug reactions were observed . Red blood cell transfusion rate was low ( 1.9 % ) , with equal rates observed in both treatment groups . Conclusion : Intravenous and oral irons were both effective in correcting peripartum anemia , although intravenous iron restored stores faster than oral iron BACKGROUND Anemia is a common finding in heart failure ( HF ) patients and has been associated with increased morbidity and mortality . It is generally denominated as anemia of chronic disease ( ACD ) , but the association with true ferropenic anemia is common . Many studies have investigated the effects of treating anemia in HF patients with either erythropoietin alone or combination of erythropoietin and intravenous iron . However , the effect of iron supplementation alone in HF patients with ACD , ferropenic anemia , or both is unknown . METHODS AND RESULTS IRON-HF study is a multicenter , investigator initiated , r and omized , double-blind , placebo controlled trial that will enroll anemic HF patients with relatively preserved renal function , low transferrin saturation , low iron levels , and low to moderately elevated ferritin levels . Interventions are iron sucrose intravenously 200 mg once per week for 5 weeks , ferrous sulfate 200 mg by mouth 3 times per day for 8 weeks , or placebo . The primary objective is to assess the impact of iron supplementation  ( intravenously or by mouth ) compared with placebo in HF patients with anemia from deficient iron availability . The primary end point is variation of peak oxygen consumption assessed by ergospirometry over 3-month follow-up . Secondary end points include functional class , brain natriuretic peptide levels , quality of life scores , left ventricular ejection fraction , adverse events , HF hospitalization , and death . CONCLUSIONS The results of IRON-HF should help to clarify the potential clinical impact of mild to moderate anemia correction in HF patients OBJECTIVE To determine whether intravenously administered iron supplements would improve the hematologic response to recombinant erythropoietin  in stable preterm infants . METHODS Forty-two preterm infants ( <33 weeks ' gestation , birth weight < 1500 gm , hematocrit < 38 % ) were treated with recombinant human erythropoietin ( Eprex ) , 600 U/kg per week , and r and omly assigned to receive either an oral preparation of ferrous lactate ( elemental iron , 12 mg/kg per day ) or an intravenous preparation of iron sucrose ( 6 mg/kg per week ) . RESULTS Hematocrits , reticulocyte counts , and transfusions were similar in the oral group ( OG ) and the intravenous group ( IVG ) . However , markedly higher serum ferritin concentrations were noted in the IVG ( p < 0.001 ) , and by completion of the study the arithmetic mean values were 265 + /- 127 microg/L versus 137 + /- 65 microg/L in the IVG and the OG , respectively . The numbers of hypochromic erythrocytes increased in both groups during the study but were significantly higher in the OG ( p = 0.04 ) . Mean daily weight gain in the IVG ( 27 + /- 6.4 gm/day ) was greater than in the OG ( 22.9 + /- 4.78 gm/day ; p = 0.04 ) . CONCLUSIONS High doses of both orally administered iron and intravenously administered iron sucrose appear to supply sufficient iron for erythropoiesis in stable infants . Storage iron may become depleted after oral supplementation . The intravenous preparation appears to be safe and maintains serum ferritin concentrations , and it may be indicated for patients with low ferritin levels and for those not established on enteral feedings
Quality -of-life scores ( Piper Fatigue Scale MD 0.73 , 95 % CI 0.29 to 1.18 ; I2 = 0 % ; studies = 3 ) and peak oxygen consumption ( MD 2.77 mL/kg/min , 95 % CI -0.89 to 6.43 ; I2 = 36 % ; 2 studies , 32 participants ) were associated with very low- quality evidence , and we remain uncertain about the role of intravenous iron for these metrics .
Current evidence is insufficient to show benefit of intravenous iron preparations for the treatment of non-anaemic iron deficiency across a variety of patient population s , beyond stating that it may result in a small , clinical ly insignificant increase in haemoglobin concentration .
BACKGROUND Iron deficiency is one of the most common nutritional deficiencies , and has a number of physiological manifestations .
Early , or non-anaemic iron deficiency can result in fatigue and diminished exercise capacity .
Oral iron preparations have a high incidence of intolerable side effects , and are ineffective in certain forms of iron deficiency .
Consequently , intravenous iron preparations are increasingly used in the treatment of non-anaemic iron deficiency .
The newer , more stable iron preparations in particular purport to have a lower incidence of side effects , and are now used across a range of different patient population s. OBJECTIVES To assess the effects of intravenous iron therapy in the treatment of adults with non-anaemic iron deficiency .