Intravenous iron therapy for treatment of anaemia

Time for cautious optimism, not wide adoption Compared with oral iron, intravenous iron represents an attractive intervention to treat both iron deficiency anaemia and anaemia of chronic disease.1 Earlier intravenous iron formulations were associated with anaphylaxis, though rare, but several intravenous iron formulations with better safety profiles are now available.2 In contrast to oral iron and its side effects that relate to gastrointestinal intolerance and reduced absorption from the small intestine, intravenous iron bypasses the gut. Consequently its absorption is not blocked by hepcidin, a peptide associated with anaemia of chronic disease.1 Intravenous iron may also improve mobilisation of iron stores, which is impaired with anaemia of chronic disease.3 In the linked systematic review and meta-analysis of randomised controlled trials, Litton and colleagues (doi:10.1136/bmj.f4822) assessed the effect of intravenous iron on changes in haemoglobin concentration, red blood cell transfusion requirements, and risk of infection.4 The review included 75 trials reporting over 10 000 patients from a variety of clinical settings (including renal failure, obstetrics, oncology, cardiology, and gastroenterology), 72 …