Anaemia is a very common finding in critically ill patients and the idea to Supplement IV iron in these patients sounds tempting. Intravenous iron preparations are licensed for patients with iron deficiency anaemia when oral iron preparations are ineffective or contraindicated. The question is whether IV iron is also helpful in the critically ill.
Pieracci et al. have looked at this question more precisely and published their results in Critical Care Medicine. In their multicentre, randomized, single-blind, placebo-controlled study they enrolled a total of 150 critically ill trauma patients in which baseline iron markers were consistent with functional iron deficiency anaemia. They randomized patients to either receive iron sucrose 100mg IV or placebo three times a weeks for up to 2 weeks.
They found that treatment with IV iron increased ferritin concentration significantly but had no effect on transferrin saturation, iron-deficient erythropoiesis, haemoglobin concentration or packed RBC transfusion requirement.
In conclusion: IV iron supplementation in anaemic, critically ill trauma patients cannot be recommended.
Pieracci F et al. Crit Care Med, September 2014 – Volume 42 – Issue 9 – p 2048–2057