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Intravenous Iron UK
Intravenous Iron UK
Title of Guideline (must include the word “Guideline” (not Guidelines for the administration of intravenous
protocol, policy, procedure etc) iron sucrose (Venofer) to children attending as
outpatients.
Contact Name and Job Title (author) Roy Connell – Clinical Nurse Specialist
This guideline has been registered with the trust. However, clinical guidelines are guidelines only.
The interpretation and application of clinical guidelines will remain the responsibility of the
individual clinician. If in doubt contact a senior colleague or expert. Caution is advised when using
guidelines after the review date.
Indications
Management of anaemia should be considered in patients with anaemia of
chronic kidney disease when their haemoglobin level is less than or equal to
11 g/dL (or 10 g/dL if younger than 2 years of age).
In children with CKD who have serum ferritin levels greater than 100mcg/L,
functional iron deficiency should be defined by:
In children with chronic kidney disease treated with iron, serum ferritin levels
should not rise above 800 micrograms/L.
In order to prevent this, the dose of iron should be reviewed when serum
ferritin levels reach 500 micrograms/L.
Blood pressure, pulse and weight of the child should be measured and
recorded prior to administration.
Access
An appropriately sized cannula should be sited and flushed with Sodium
Chloride 0.9%. This method is required if the child is receiving the first dose of
IV iron sucrose.
A test dose must be administered to patients receiving IV iron for first time.
(see below)
Equipment
Resuscitation equipment.
Anaphylactic shock drug box
Oxygen either piped or bottled.
MHRA Alert (August 2013): Intravenous iron and serious hypersensitivity reactions: new
strengthened recommendations to manage and minimise risk.
A European-wide review of intravenous iron products for iron deficiency and anaemia has
recommended strengthened measures are taken to manage and minimise the risk of
hypersensitivity reactions.
IV iron should only be given in an environment where the patient can be adequately
monitored, and where resuscitation facilities are available. In case of a
hypersensitivity reaction, treatment should be stopped immediately and appropriate
management initiated.
There are no clear data that an initial test dose minimises risk. Therefore, an initial
test dose on first use of an IV iron product for a patient is no longer recommended.
http://www.mhra.gov.uk/Safetyinformation/DrugSafetyUpdate/CON300398
Observation
Blood pressure should be rechecked after 15 minutes in patients receiving a
test dose.
Side effects include:
Blood pressure and pulse should be measured and recorded after the infusion
has finished.
The patient should be observed for 30 minutes after the infusion has finished.
Any bleeding from venepuncture site should be stopped and site checked.
Follow up
Serum ferritin and Transferrin saturations to be reviewed 2 - 4 weeks after IV
Iron course.
If patient remains iron deficient then to receive subsequent iron doses after
discussion with clinician.
References
Anaemia management in people with chronic kidney disease.
NICE clinical guideline 39. September 2006.