Iron infusion and newer intravenous iron formulations

To the Editor:
Iron deficiency (ID) and ID anemia (IDA) are common health problems worldwide. The World Health Organization (2011) estimated that 34% of the global population (>2 billion) is affected by anemia and that the most common type was ID (50% of total anemia), which primarily affects women of reproductive age.[1] Although intravenous (IV) iron has been used to treat ID and IDA for more than six decades, its use in primary care settings has been infrequent compared with its use in tertiary centers due to the historical concern of anaphylaxis, among others. The newer (non-dextran) IV formulations, which allow complete or near-complete replacement in a single sitting of 15 to 30 min, have an improved safety profile, and better tolerability, efficacy, and effectiveness compared with oral iron therapy. They are suited for administration in the primary care or community practices in a proper setting. Although oral iron remains the first-line therapy for iron replacement in most guidelines, its common side effects of gastric upset and constipation, and the need to take it regularly for months to replenish iron stores, often result in non-adherence. Intramuscular iron injection is no longer favorable because of pain, skin discoloration and requirement of multiple injections.