Acute GP service

Urgent IV Iron

 

There is an ongoing pilot within RCHT  for the administration of intravenous iron.

This is available as of now. Continuation of the service thereafter is dependent on uptake and evidence of value.

 

How to refer:

Referrals should be made to Dr Richard Noble in the Haematology Dept, RCHT, via Choose and Book or its successor NHS e-RS. Referrals will be screened for appropriateness and where IV iron is indicated the patient will be invited to attend.

If the patient is referred down the investigation of iron deficiency pathway (typically GI, sometimes gynaecology) a second referral will be required to haematology to access IV iron.

There will be no responsibility in this service for identifying the cause of iron deficiency. This responsibility remains with the primary care physician to investigate and refer as appropriate.

 

Criteria for referral:

IV iron should be considered where there is proven iron deficiency and oral iron is inappropriate or not tolerated. 

 

Absolute contraindications to IV iron include previous sensitivity to any IV iron product, active infection and the 1st trimester of pregnancy (Please refer to Dr Rajasri in obstetrics if considering IV iron in pregnancy).

 

Relative contraindications include allergies  (severe asthma, eczema or other atopic allergy) , immune and inflammatory conditions – IV iron may be used but the indication must be very strong.

 

Iron deficiency should be considered when there is anaemia and

ferritin < 30, or ferritin < 70 and the CRP is raised.

 

A patient should only be considered to have intolerance to oral iron if there is a record of symptoms to justify this such that compliance is likely to be poor, or if it exacerbates symptoms of inflammatory bowel disease. IV iron may be preferable to oral iron before investigation for iron deficiency if the patient is likely to require colonoscopy.

 

Type and dose of iron:

Where iron deficiency is established with certainty and  IV iron is referral is made for IV iron the patient will be given a whole dose infusion of Ferinject up to a maximum of 1 Gram.

A therapeutic trial of IV iron will be considered for those patients who have the anaemia of chronic disease who may also have an element of functional iron deficiency. In this instance the dose will be venofer 200mg.

 

Measuring response:

At the time of administration the patient will be given blood forms to check response at 2 weeks with copy result to the GP.