Absolute iron deficiency: ferritin <15 µg/L (diagnostic) or <30 µg/L (supportive), and/or TSAT <20% — particularly if symptomatic or Hb is low.
Heart failure–related iron deficiency (guideline definition): ferritin <100 µg/L OR ferritin 100–299 µg/L with TSAT <20% (iron deficiency may be present even if Hb is normal).
Inflammation / functional iron deficiency (e.g. CKD, CHF, IBD): ferritin may be normal or high but TSAT low due to hepcidin-mediated iron sequestration → oral iron often ineffective; IV iron bypasses absorption.
Oral iron failure or intolerance (GI side effects, poor adherence, malabsorption, or inadequate Hb/ferritin response).
Need for rapid repletion (e.g. symptomatic anaemia, ongoing blood loss, peri-operative optimisation, PBM pathways).
Chronic kidney disease: IV iron commonly preferred in dialysis; in non-dialysis CKD the route is individualised based on severity, response to oral iron, access, and timeframe.

🫀 Heart Failure – Practical “UK-style” Trigger

📌 Consider IV iron in chronic HFrEF when iron deficiency is present (check ferritin + TSAT), regardless of whether anaemia is present.
🎯 Evidence strongest for improvement in symptoms, exercise tolerance, and quality of life; effects on hospital admissions vary between trials.

💉 Common IV Iron Options (UK practice)

Formulation	Typical approach	Infusion time	Hypersensitivity risk	Notes
Ferric carboxymaltose (FCM) Ferinject	🔹 Large single doses (per weight/label)	⏳ ~15–30 min	🟢 Very low	⭐ Widely used; higher hypophosphataemia risk than some alternatives.
Ferric derisomaltose (FDI) Monofer / Monoferric	🔹 High total dose in one visit (per weight/label)	⏳ ~30–60 min	🟢 Very low	✅ Convenient “one-and-done”; hypophosphataemia can still occur but is generally lower than with FCM.
Iron sucrose Venofer	🔸 Smaller doses → multiple visits	⏳ ~30–60 min	🟢 Low	🏥 Common in renal units; less convenient for large deficits.

🚫 Avoid high–molecular-weight iron dextran due to historically higher anaphylaxis risk (largely obsolete in UK practice).

The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms.

Intravenous Iron Replacement

🩸In UK guidance (NICE NG24 / BSH-aligned practice), red cell transfusion is generally reserved for:

🩸 IV Iron Is Preferred or Recommended

🫀 Heart Failure – Practical “UK-style” Trigger

💉 Common IV Iron Options (UK practice)

Categories