Should you avoid IV iron in an iron deficient pt who was recently transfused? Many fear iron overload, as 1U RBC transfusion contains ~200mg iron (primarily within RBCs). Is this a problem? 1/X #medsky #ansky #emimcc #hemesky #irondeficiency - ThreadSky

bloodhealth.bsky.social • 105 days ago

Should you avoid IV iron in an iron deficient pt who was recently transfused?

Many fear iron overload, as 1U RBC transfusion contains ~200mg iron (primarily within RBCs). Is this a problem?

1/X #medsky #ansky #emimcc #hemesky #irondeficiency

Comments

wildmeded.com•104 days ago

Thanks for this information. I had not heard of this concern before and, regardless, was in the practice of also giving IV iron

transfusion.health•104 days ago

A few minutes with the Ganzoni formula should convince most people that RBC transfusion is a really inefficient way to replace iron in bleeding patients. With rare exceptions (mostly heme and septic populations), it should be a heuristic to check and replace iron whenever you transfuse red cells

peteryang.hemonc.org•105 days ago

No. What?!? If the patient was anemic due to iron deficiency and did not require transfusion for another reason (e.g. MDS, sickle cell), I can't recall anyone raising that concern about a shared patient. There's such a wide space between iron deficiency and overload.

bloodhealth.bsky.social•105 days ago

Believe it or not, clinicians sometimes worry about this!

bloodhealth.bsky.social•105 days ago

Most RBCs survive long after transfusion (normal RBC lifespan 120 days, average RBC age at donation ~50 days) but 10-25% may breakdown within 48 hours, releasing at most 50 mg of iron. Any small increases in serum iron are transient.

2/x

bloodhealth.bsky.social•105 days ago

Importantly, the iron contained in those RBCs is often replacing iron that has been lost through blood loss, etc. Remember, each 500 ml blood loss equates to ~250 mg loss of iron that the body will never get back.

3/x

bloodhealth.bsky.social•105 days ago

The vast majority of iron availability for new RBC production comes from the breakdown of old RBCs. With blood loss, not only do you lose iron but you also lose your primary source of iron!

4/x

bloodhealth.bsky.social•105 days ago

So, patients are not receiving the equivalent of 200 mg of IV iron with transfusion. Not even close. Your recently transfused iron deficient patient likely still has a major iron deficit and will benefit with iron therapy. Do not be afraid to treat them!

5/5

#anemia
@shematologist.bsky.social

shematologist.medsky.social•105 days ago

Such an important point!

daniellakrn.bsky.social•105 days ago

What are the ideal ferritin levels for male/female adults?

daniellakrn.bsky.social•105 days ago

There’s a reason they need blood!

raindroprph.bsky.social•103 days ago

Also throw in recent shortages

jaqjaqeats.bsky.social•105 days ago

I think it depends on why they are being transfused and how many units. It doesn’t take much to check pre and post transfusion cbc+diff/iron/ferritin/TIBC, etc. at many acute care places (where I imagine most transfusions occur) if there are serious concerns. Patient centered care, yada yada yada. 😉

Comments

Posting Rules

Reply