Abstract Number: LPB0060
Meeting: ISTH 2021 Congress
Background: While generally very safe, little is known regarding the comparative rates of infusion reactions associated with various iron repletion strategies to aid the clinician in selecting the safest therapy.
Aims: To define the rate of infusion reactions necessitating the use of epinephrine for four frequently used intravenous (IV) iron repletion strategies (iron sucrose, iron dextran, ferumoxytol, and ferric carboxymaltose).
Methods: A multicenter retrospective analysis of IV iron administered between January 1, 2015 and December 31, 2019 at 6 ambulatory centers in Portland, Oregon. Each order was categorized as a unique infusion event independent of whether or not a patient received more than one infusion on the same date. A total of 33,005 iron infusions were administered of which 19,832 were iron sucrose (for 5,215 individual patients), 9,288 iron dextran (4,587 patients), 2,896 ferumoxytol (1,389 patients), and 989 ferric carboxymaltose (419 patients). Concomitant administration of infusion reaction medications (diphenhydramine, epinephrine, famotidine, or hydrocortisone) on the day of the IV iron infusion was recorded. A severe reaction was defined as requiring epinephrine.
Results: Among the 33,005 individual infusions, 3,639 (11.0%) were associated with administration of at least one infusion reaction medication, 2,150 (10.8%) in the iron sucrose group, 1,285 (13.8%) in the iron dextran group, 160 (5.5%) in the ferumoxytol group, and 44 (4.5%) in the ferric carboxymaltose group. A subgroup analysis of per-patient epinephrine use, which is reserved for significant reactions, suggests that severe infusion reactions were uncommon: Iron sucrose (1.55% of patients received epinephrine), iron dextran (1.04%) ferumoxytol (0.14%) and ferric carboxymaltose (0%).
|Infusion Events||Unique Patients||Peri-Infusion Medication Use
(% of Infusions)
(% of Patients)
|Iron Sucrose||19,832||5,215||2,150 (10.8%)||81 (1.55%)|
|Iron Dextran||9,288||4,587||1,285 (13.8%)||48 (1.04%)|
|Ferumoxytol||2,896||1,389||160 (5.5%)||2 (0.14%)|
|Ferric Carboxymaltose||989||419||44 (4.5%)||0 (0.00%)|
|Total||33,005||11,610||3,639 (11.0%)||131 (0.40%)|
Conclusions: In this large multicenter analysis, severe infusion reactions were rare. Iron sucrose had the highest risk of infusion reaction requiring epinephrine, while iron dextran, ferumoxytol and ferric carboxymaltose had decreasingly lower risk, respectively.
To cite this abstract in AMA style:Arastu A, Cohen J, Oakes M, Olson S, Elstrott B, Aslan J, DeLoughery T, Shatzel J. The Incidence of Severe Infusion Reactions Associated with Common Iron Repletion Strategies [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/the-incidence-of-severe-infusion-reactions-associated-with-common-iron-repletion-strategies/. Accessed November 28, 2023.
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