Iron dextran


Intravenous iron dextran is used in the treatment of anemia in patients with end-stage renal disease when oral iron therapy fails to maintain adequate iron reserves. The typical treatment regimen consists of 10 doses of 100 mg of iron dextran injected during hemodialysis treatment.
 
Incidence
0.1% of dextran injections (in non uremic patients).
 
0.6% of patients (non uremic).
 
4.7% in uremic patients.
 
Risk factors
History of drug allergy (OR: 2.4).
 
History of multiple drug allergy (OR: 5.5).
 
Clinical manifestations
Immediate:
 
General: hypotension, cardiac arrest.
 
Cutaneous: itching, swelling, flushing.
 
Respiratory: chest pain, dyspnea, wheezing.
 
Digestive: nausea, diarrhea, dyspepsia.
 
Delayed:
 
(4 to 48 hours after iron administration; may last for 3 to 7 days)
Lymphadenopathy, myalgia, arthralgia, fever, headache.
 
Diagnostic methods
No specific reports concerning iron dextran.
 
Mechanisms
Poorly studied.
 
The same mechanisms could be involved as were reported concerning dextrans used as plasma expanders.
 
Management
A test dose of 25 mg of iron dextran is commonly recommended, but only 40% of all anaphylactoid reactions occur with the test dose.
 
In one case, iron dextran was administered to a patient who reacted to the test dose after premedication with corticosteroids, antihistamines, ephedrine, hapten inhibition and desensitization:
 
Day 1: 50 mg/100 ml rate: 20 ml/h

Day 2: 100 mg/250 ml rate: 40 ml/h 24 hours later

           200 mg/250 ml rate: 50 ml/h 6 hours later

Day 3: 400 mg then 500 mg 24 hours later 500 mg then 250 mg

References

  1. Fishbane S, Ungureanu V.D, Maesaka J.K, Kaupke C.J, Lim V, Wish J, "The safety of intravenous iron dextran in hemodialysis patients", Am. J. Kidney. Dis., 1996; 28 (4): 529-34 
  2. Monaghan M.S, Glasco G, St John G, Bradsher R.W, Olsen K.M, "Safe administration of iron dextran to a patient who reacted to the test dose", South. Med. J., 1994; 87 (10): 1010-2 
  3. Novey HS, Pahl M, Haydik I, Vaziri N.D, "Immunologic studies of anaphylaxis to iron dextran in patients on renal dialysis", Ann. Allergy., 1994; 72 (3): 224-8 
  4. Fleming L.W, Stewart W.K, Parratt D, "Dextran antibodies, complement conversion and circulating immune complexes after intravenous iron dextran therapy in dialysed patients", Nephrol. Dial. Transplant., 1992; 7: 35-9 
  5. Hamstra R.D, Block M.H, Schocket A.L, "Intravenous iron dextran in clinical medicine", J.A.M.A, 1980; 243: 1726-31

As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.