ED is seeing increasing numbers of patients presenting requesting iron infusions. After an infusion the patient’s haemoglobin does not start to rise for 1-2 weeks and may take 6-10 weeks to peak, thus routine iron infusions should never be performed in the ED setting but may be considered on a case-by-case basis depending on haemoglobin, symptomatology and other patient factors. Consider having a lower threshold in the homeless population who may not consistently manage oral iron therapy, nor be able to organise their own infusion in the community. Please also make sure to go through potential risks vs benefits with anyone who is being assessed for an iron infusion in ED and consider formally documenting this discussion (particularly with regards to the skin staining which can be permanent).
Be aware that this guideline is aimed at the management of chronic iron deficiency, not situations like acute gastrointestinal bleeds.
Note that we do maintain a small stock of emergency after-hours Ferinject (in addition to our usual supply of Ferrosig) in the ED pharmacy room. Please only use this supply when the patient is for imminent discharge post infusion, as it is significantly more expensive.
Date implemented – 10/2023
Review date – nil planned
Author – Tim Cook / Haematology / ED Pharmacy