Stages of Iron Deficiency
Stage 1: Iron Depletion
In this initial stage of iron deficiency, storage iron is significantly reduced
or sometimes absent; however, there is no overt effect on erythropoiesis, blood
hemoglobin levels are usually normal, and iron deficiency generally can escape detection
by hemoglobin or hematocrit screening. This first stage
of iron deficiency is often characterized by low serum ferritin levels.
Stage 2: Iron Deficient Erythropoiesis
In this stage of iron deficiency, there is a shortage of iron available to the erythroid
precursors in the bone marrow for hemoglobin synthesis.
The second stage may be characterized by abnormalities in particular iron parameters,
including low TSAT levels and elevations in free erythrocyte protoporphyrin.5 Hemoglobin levels may be reduced but the resulting mild
anemia may not be detectable using normal cutoff values for hemoglobin.
Iron deficient erythropoiesis may be difficult to detect using traditional laboratory
parameters. In iron deficient erythropoiesis, storage iron may be normal or even
increased due to impaired release of iron into the circulation.
Stage 3: Iron Deficiency Anemia-Iron
Iron deficiency anemia-iron stores are insufficient to maintain red blood cell synthesis,
leading to anemia. Iron deficiency anemia is characterized
by a significant reduction in hemoglobin levels and a decrease in mean corpuscular
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INFeD is indicated in the treatment of patients with documented iron deficiency in whom oral administration is unsatisfactory or impossible.
Important Safety Information
Anaphylactic-type reactions, including fatalities, have followed the parenteral administration of iron dextran injection. A test dose should be administered prior to the first therapeutic dose, followed by the full therapeutic dose if no signs or symptoms of anaphylactic-type reactions are seen. Resuscitation equipment and personnel trained in the detection and treatment of anaphylactic-type reactions must be readily available during all INFeD administrations. Patients should be observed for signs or symptoms of anaphylactic-type reactions during all INFeD administrations. Fatal reactions have followed the test dose and have also occurred in situations where the test dose was tolerated. Use INFeD only in patients in whom clinical and laboratory investigations have established an iron deficient state not amenable to oral iron therapy. Patients with a history of drug allergy or multiple drug allergies may be at increased risk of anaphylactic-type reactions. INFeD should be used with caution in individuals with histories of significant allergies and/or asthma, and is contraindicated in patients with hypersensitivity to the product and patients with all anemias not associated with iron deficiency. INFeD should be used with extreme care in patients with serious impairment of liver function, and should not be used during the acute phase of infectious kidney disease. Unwarranted therapy with parenteral iron will cause excess storage of iron with the consequent possibility of exogenous hemosiderosis, which is particularly apt to occur in patients with hemoglobinopathies and other refractory anemias.