Makindo Medical Notes

🩸 When IV Iron Is Preferred or Recommended

• 🧪 Absolute iron deficiency (general): ferritin typically <30 µg/L (or <15 µg/L strongly diagnostic) and/or TSAT <20% — especially if symptomatic or Hb is low.
• 🫀 Heart failure “iron deficiency” (guideline definition): ferritin <100 µg/L OR ferritin 100–299 µg/L with TSAT <20%.
• 🧫 Inflammation/functional deficiency (CKD/CHF/IBD): ferritin can be “normal/high” yet TSAT low → oral iron often underperforms; IV bypasses absorption/hepcidin effects.
• 🤢 Oral iron failure or intolerance (GI upset, poor adherence, malabsorption, no Hb/ferritin response).
• ⏱️ Need rapid repletion (e.g. symptomatic anaemia, ongoing blood loss, peri-operative optimisation / PBM pathways).
• 🩺 Chronic kidney disease: IV iron commonly preferred in dialysis; route in non-dialysis CKD is individualised (severity, response to oral, access, timeframe).

🫀 Heart Failure – Practical “UK-style” Trigger

• 📌 Consider IV iron in chronic HFrEF when Hb <150 g/L and iron deficiency is present (check TSAT + ferritin).
• 🎯 Expectation: best evidence is for symptoms, exercise tolerance, and QoL improvement; effects on admissions are more variable across trials.

💉 Common IV Iron Options (UK practice)

🚫 Avoid high–molecular-weight iron dextran (historically higher anaphylaxis risk; largely replaced by modern preparations in UK practice).

🧓 Safety Considerations (Older Adults / Frailty)

📈 Practical Follow-up

• 🧾 Check baseline: Hb, ferritin, TSAT (± CRP if inflammation suspected).
• 🔁 Recheck response at 4–8 weeks (Hb rise may lag behind symptom change).
• 🧭 Repeat IV iron only if iron deficiency persists/recurs and there is a clear clinical goal (symptoms, function, peri-op optimisation, CKD/ESA support).
• 🧲 Avoid “overfilling”: if ferritin/TSAT are high, stop and reassess cause of anaemia (don’t keep giving iron).

✅ Bottom Line (Geriatric-friendly)

• 🎯 Use IV iron when oral iron is unlikely to work (inflammation, malabsorption), is not tolerated, or when you need a quicker functional gain.
• 🫀 In HFrEF, iron deficiency is common and treatable; IV iron is mainly a symptom/QoL intervention with variable admissions impact.
• 🧓 Age alone isn’t a contraindication — base decisions on frailty, access, goals of care, and reversible causes (especially occult blood loss).
• 🧪 With repeated FCM/FDI courses, remember phosphate (especially if new weakness/bone pain).