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Premedication protocol for iron infusions in patients with anaphylactic reaction to parenteral iron: A case series
摘要
Introduction: Iron supplementation is a mainstay of the treatment of iron deficiency that not only replenishes iron stores, but improves the life quality of the patient. Unfortunately, oral iron has myriad side effects that are intolerable for many patients, leading to iron infusion as the next step in treatment. The hypersensitivity adverse event rate for parenteral iron dextran from 1997-2002 was 29.2 reports/million, but literature for treatment of these patients is sparse. Case Series: This report is a case study involving two female patients, 37-year-old and 31-year-old. Both females presented with severe iron-deficiency anemia while intolerant to oral iron and suffered anaphylactic reactions to parenteral iron. The method of intervention involved a premedication protocol, which was initiated immediately prior to iron sucrose infusion. For Case 1, the protocol included 10 mg IV dexamethasone, one duoneb (ipratropium bromide/albuterol sulfate), normal saline at 60 cc/hour, and 0.1 mg epinephrine given subcutaneously at the start of iron infusion, with 0.3 mg of epinephrine available at the bedside as needed for allergic reaction. For Case 2, the protocol included 50 mg IV diphenhydramine, 10 mg IV dexamethasone, one duoneb, normal saline at 50 cc/hour, 0.3 mg epinephrine at the bedside in case of reaction. Conclusion: Patient iron levels were within normal limits after treatment, and no adverse events, such as anaphylactic reactions, occurred. With a precisely implemented premedication protocol initiated immediately prior to iron infusion, results of this case study indicate that such patients might be successfully and safely treated with parenteral iron.
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