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Safety and Efficacy of Total-Dose Infusion of Low Molecular Weight Iron Dextran for Iron Deficiency Anemia in Patients with Inflammatory Bowel Disease

Digestive Diseases and Sciences volume 55, pages 2327–2331 (2010)Cite this article

Abstract

Background

Intravenous iron has been suggested as a safe and effective treatment of anemia complicating inflammatory bowel disease (IBD). Low molecular weight (LMW) iron dextran has the ability to administer the patient’s total iron requirement in a single infusion.

Aims

The aim of this study was to assess the safety and efficacy of the total dose of LMW iron dextran infusion for the treatment of iron deficiency in IBD.

Methods

Fifty IBD patients (27 female, 35 Crohn’s disease, 15 ulcerative colitis) were included in the study. Mean ± standard deviation (SD) hemoglobin and ferritin levels before the infusion were 9.88 ± 1.42 g/dl and 13.9 ± 10.9 ng/ml, respectively. A 25-mg test dose was followed by infusion of the total dose of LMW iron dextran based on the iron deficit. Several clinical and laboratory parameters were measured before and on week 4 after infusion.

Results

Four patients (8%) developed adverse reactions during the test infusion and did not receive the total-dose infusion. Only one patient developed an allergic reaction during the total-dose infusion. In the remaining 45 patients, the mean ± SD iron dose that was given was 1,075 ± 269 mg. The mean ± SD elevation of hematocrit and hemoglobin on week 4 was 4.9 ± 1.9% and 1.7 ± 0.8 g/dl, respectively. Hematopoietic response was observed in 23 of 45 patients (51.1%).

Conclusion

Total parenteral iron replacement with LMW iron dextran is an easy, safe, and effective alternative method for treating iron deficiency anemia in IBD. Harmless adverse reactions may develop in a minority of patients.

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References

  1. Gasche C, Lomer MCE, Cavill I, Weiss G. Iron, anaemia, and inflammatory bowel diseases. Gut. 2004;53:1190–1197.

    Article  CAS  PubMed  Google Scholar 

  2. Wilson A, Reyes E, Ofman J. Prevalence and outcomes of anemia in inflammatory bowel disease: a systematic review of the literature. Am J Med. 2004;116(Suppl 7A):44S–49S.

    Article  PubMed  Google Scholar 

  3. Kulnigg S, Gasche C. Systematic review: managing anaemia in Crohn’s disease. Aliment Pharmacol Ther. 2006;24:1507–1523.

    Article  CAS  PubMed  Google Scholar 

  4. Tsiolakidou G, Koutroubakis IE. Stimulating erythropoiesis in inflammatory bowel disease associated anemia. World J Gastroenterol. 2007;13:4798–4806.

    CAS  PubMed  Google Scholar 

  5. Gasche C, Berstad A, Befrits R, Beglinger C, Dignass A, Erichsen K, et al. Guidelines on the diagnosis and management of iron deficiency and anemia in inflammatory bowel diseases. Inflamm Bowel Dis. 2007;13:1545–1553.

    Article  PubMed  Google Scholar 

  6. Gasche C, Waldhoer T, Feichtenschlager T, Male C, Mayer A, Mittermaier C, et al. Prediction of response to iron sucrose in inflammatory bowel disease-associated anemia. Am J Gastroenterol. 2001;96:2382–2387.

    CAS  PubMed  Google Scholar 

  7. Bodemar G, Kechagias S, Almer S, Danielson BG. Treatment of anaemia in inflammatory bowel disease with iron sucrose. Scand J Gastroenterol. 2004;39:454–458.

    Article  CAS  PubMed  Google Scholar 

  8. Schröder O, Mickisch O, Seidler U, de Weerth A, Dignass AU, Herfarth H, et al. Intravenous iron sucrose versus oral iron supplementation for the treatment of iron deficiency anemia in patients with inflammatory bowel disease—a randomized, controlled, open-label, multicenter study. Am J Gastroenterol. 2005;100:2503–2509.

    Article  PubMed  CAS  Google Scholar 

  9. Erichsen K, Ulvik RJ, Nysaeter G, Johansen J, Ostborg J, Berstad A, et al. Oral ferrous fumarate or intravenous iron sucrose for patients with inflammatory bowel disease. Scand J Gastroenterol. 2005;40:1058–1065.

    Article  CAS  PubMed  Google Scholar 

  10. Koutroubakis IE, Karmiris K, Makreas S, Xidakis C, Niniraki M, Kouroumalis EA. Effectiveness of darbepoetin-alfa in combination with intravenous iron sucrose in patients with inflammatory bowel disease and refractory anaemia: a pilot study. Eur J Gastroenterol Hepatol. 2006;18:421–425.

    Article  CAS  PubMed  Google Scholar 

  11. Reddy CM, Kathula SK, Ali SA, Bekal R, Walsh M. Safety and efficacy of total dose infusion of iron dextran in iron deficiency anaemia. Int J Clin Pract. 2008;62:413–415.

    Article  CAS  PubMed  Google Scholar 

  12. Auerbach M, Winchester J, Wahab A, Richards K, McGinley M, Hall F, et al. A randomized trial of three iron dextran infusion methods for anemia in EPO-treated dialysis patients. Am J Kidney Dis. 1998;31:81–86.

    Article  CAS  PubMed  Google Scholar 

  13. Anuradha S, Singh NP, Agarwal SK. Total dose infusion iron dextran therapy in predialysis chronic renal failure patients. Ren Fail. 2002;24:307–313.

    Article  CAS  PubMed  Google Scholar 

  14. Sinha S, Chiu DY, Peebles G, Kolakkat S, Lamerton E, Fenwick S, et al. Comparison of intravenous iron sucrose versus low-molecular-weight iron dextran in chronic kidney disease. J Ren Care. 2009;35:67–73.

    Article  PubMed  Google Scholar 

  15. Bhandari S, Naudeer S. Improving efficiency and value in health care. Intravenous iron management for anaemia associated with chronic kidney disease: linking treatment to an outpatient clinic, optimizing service provision and patient choice. J Eval Clin Pract. 2008;14:996–1001.

    Article  PubMed  Google Scholar 

  16. Ayub R, Tariq N, Adil MM, Iqbal M, Junaid A, Jaferry T. Efficacy and safety of total dose infusion of low molecular weight iron dextran in the treatment of iron deficiency anemia during pregnancy. J Coll Physicians Surg Pak. 2008;18:424–427.

    PubMed  Google Scholar 

  17. Mamula P, Piccoli DA, Peck SN, Markowitz JE, Baldassano RN. Total dose intravenous infusion of iron dextran for iron-deficiency anemia in children with inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2002;34:286–290.

    Article  CAS  PubMed  Google Scholar 

  18. Lennard-Jones JE. Classification of inflammatory bowel disease. Scand J Gastroenterol Suppl. 1989;24:2–6.

    Article  Google Scholar 

  19. Best WR, Becktel JM, Singleton JW, Kern F Jr. Development of a Crohn’s disease activity index. National Cooperative Crohn’s Disease Study. Gastroenterology. 1976;70:439–444.

    CAS  PubMed  Google Scholar 

  20. Walmsley RS, Ayres RC, Pounder RE, Allan RN. A simple clinical colitis activity index. Gut. 1998;43:29–32.

    CAS  PubMed  Article  Google Scholar 

  21. Ganzoni AM. Intravenous iron-dextran: therapeutic and experimental possibilities. Schweiz Med Wochenschr. 1970;100:301–303.

    CAS  PubMed  Google Scholar 

  22. Kulnigg S, Stoinov S, Simanenkov V, Dudar LV, Karnafel W, Garcia LC, et al. A novel intravenous iron formulation for treatment of anemia in inflammatory bowel disease: the ferric carboxymaltose (FERINJECT) randomized controlled trial. Am J Gastroenterol. 2008;103:1182–1192.

    Article  CAS  PubMed  Google Scholar 

  23. Lyseng-Williamson KA, Keating GM. Ferric carboxymaltose: a review of its use in iron-deficiency anaemia. Drugs. 2009;69:739–756.

    Article  CAS  PubMed  Google Scholar 

  24. Singh A, Patel T, Hertel J, Bernardo M, Kausz A, Brenner L. Safety of ferumoxytol in patients with anemia and CKD. Am J Kidney Dis. 2008;52:907–915.

    Article  CAS  PubMed  Google Scholar 

  25. Chertow GM, Mason PD, Vaage-Nilsen O, Ahlmén J. On the relative safety of parenteral iron formulations. Nephrol Dial Transplant. 2004;19:1571–1575.

    Article  CAS  PubMed  Google Scholar 

  26. Auerbach M, Ballard H, Glaspy J. Clinical update: intravenous iron for anaemia. Lancet. 2007;369:1502–1504.

    Article  PubMed  Google Scholar 

  27. D’Arienzo A, Manguso F, Astarita C, D’Armiento FP, Scarpa R, Gargano D, et al. Allergy and mucosal eosinophil infiltrate in ulcerative colitis. Scand J Gastroenterol. 2000;35:624–631.

    Article  PubMed  Google Scholar 

  28. Engkilde K, Menné T, Johansen JD. Inflammatory bowel disease in relation to contact allergy: a patient-based study. Scand J Gastroenterol. 2007;42:572–576.

    Article  PubMed  Google Scholar 

  29. Blaustein DA, Schwenk MH, Chattopadhyay J, Singh H, Daoui R, Gadh R, et al. The safety and efficacy of an accelerated iron sucrose dosing regimen in patients with chronic kidney disease. Kidney Int Suppl. 2003;87:S72–S77.

    Article  CAS  PubMed  Google Scholar 

  30. Hollands JM, Foote EF, Rodriguez A, Rothschild J, Young S. Safety of high-dose iron sucrose infusion in hospitalized patients with chronic kidney disease. Am J Health Syst Pharm. 2006;63:731–734.

    Article  CAS  PubMed  Google Scholar 

  31. Wall GC, Pauly RA. Evaluation of total-dose iron sucrose infusions in patients with iron deficiency anemia. Am J Health Syst Pharm. 2008;65:150–153.

    Article  CAS  PubMed  Google Scholar 

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Affiliations

  1. Department of Gastroenterology, University Hospital Heraklion, P.O. Box 1352, 71110, Heraklion, Crete, Greece

    Ioannis E. Koutroubakis, Pantelis Oustamanolakis & Elias A. Kouroumalis

  2. 1st Department of Gastroenterology, Evangelismos Hospital Athens, Athens, Greece

    Christos Karakoidas & Gerassimos J. Mantzaris

Authors
  1. Ioannis E. Koutroubakis
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  2. Pantelis Oustamanolakis
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  3. Christos Karakoidas
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  4. Gerassimos J. Mantzaris
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  5. Elias A. Kouroumalis
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Correspondence to Ioannis E. Koutroubakis.

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Koutroubakis, I.E., Oustamanolakis, P., Karakoidas, C. et al. Safety and Efficacy of Total-Dose Infusion of Low Molecular Weight Iron Dextran for Iron Deficiency Anemia in Patients with Inflammatory Bowel Disease. Dig Dis Sci 55, 2327–2331 (2010). https://doi.org/10.1007/s10620-009-1022-y

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  • DOI: https://doi.org/10.1007/s10620-009-1022-y

Keywords

  • Anemia
  • Crohn’s disease
  • Infusions
  • Iron deficiency anemia
  • Ulcerative colitis