Background Because of the risk of anaphylaxis, the national drug agency published guidelines for the prescription and administration of parenteral iron complexes. Two drugs have been available since 2013: iron sucrose generics and more recently ferric carboxymaltose (Ferinject).
Purpose To analyse prescriptions for intravenous iron treatment and biological follow up in 5 surgical units (urology, orthopaedics, digestive surgery, stomatology, kidney transplant unit).
Material and methods Over 2 months the biological monitoring of all patients hospitalised in surgery who received parenteral iron complex were analysed: haemoglobin, red blood cells count, blood iron status (serum ferritin, transferrin, iron, and transferrin saturation rate).
Results Among 70 patients, the majority of prescriptions were written in orthopaedics (83%, N = 58) of which 98% (N = 57) included iron sucrose. 14% (N = 11) were treated with ferric carboxymaltose principally prescribed by other surgery units (N = 10). The majority of patients had anaemia (N = 66) but only in 2 was it associated with microcytosis. Blood iron status was only done for 5 patients (7%) of whom 2 presented iron deficiency.
In this study, the majority of prescriptions were to reduce the need for transfusion in orthopaedic surgery, the efficacy of which has been proven.1 Notice that the full market approval of iron sucrose includes post-surgical treatment when the oral route is not possible. The majority of ferric carboxymaltose prescriptions cause probably more controversy because of no information about blood iron status although absence of iron deficiency is a contraindication.
Conclusion Prescribers have to be reminded of the necessity for blood iron status assessment especially when ferric carboxymaltose is prescribed. Good practice in oral and parenteral iron treatment will be discussed in a multidisciplinary approach (physicians, pharmacists, and biologists). This work will be completed with a pharmacoeconomic study comparing costs between iron sucrose generics and ferric carboxymaltose, which seems to be better tolerated but more expensive.
References and/or Acknowledgements
Muñoz M, García-Erce JA, Cuenca J, et al. Blood Transfus 2012;10(1):8–22
References and/or AcknowledgementsNo conflict of interest.
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