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Iron dextran is an injectable complex comprising ferric hydroxide and a low-molecular-weight fraction of dextran. Iron dextran is an intravenous iron solution tailored to treat iron deficiency anemia. Oral iron therapy is frequently used for the treatment of iron deficiency anemia. However, certain patients either exhibit inadequate responses to oral iron or encounter difficulties in its administration. Iron dextran has been approved by the US Food and Drug Administration (FDA) for treating iron deficiency anemia in patients who are unresponsive to oral iron therapy or cannot tolerate it. Injectable iron proves particularly beneficial in cases of iron deficiency stemming from conditions such as excessive iron loss (eg, hereditary hemorrhagic telangiectasia and significant blood loss) or iron malabsorption (eg, Crohn disease, celiac disease, inflammatory bowel disease, and gastric bypass). The appropriate application of iron dextran is recommended for iron deficiency anemia associated with menometrorrhagia, pregnancy, and surgical blood loss. This activity is tailored for healthcare professionals and summarizes indications, mechanisms of action, pharmacokinetics, administration protocols, and potential adverse effects associated with iron dextran therapy, emphasizing the pivotal role of an interprofessional healthcare team in optimizing patient outcomes while utilizing iron dextran. In addition, this activity highlights algorithms for making informed decisions in the clinical management of patients undergoing iron dextran treatment by providing insights into contraindications, monitoring strategies, and potential overdose risks of iron dextran. Objectives: Identify appropriate candidates for iron dextran therapy based on their response to oral iron therapy, clinical indications, and iron deficiency anemia severity. Screen patients for conditions that may benefit from iron dextran therapy, including those with excessive iron loss or malabsorption syndromes. Assess patients for contraindications and potential adverse effects associated with iron dextran therapy, ensuring timely intervention if complications arise. Collaborate with other healthcare professionals to optimize patient outcomes through coordinated care and shared decision-making. Access free multiple choice questions on this topic.

Transferrin is a protein that transports soluble, nontoxic iron in the body.[39] Transferrin saturation (TSAT) is a biomarker that indicates iron status. TSAT <20% suggests iron deficiency, and TSAT >40% indicates iron overload.[40] Free iron accumulates in the liver when TSAT reaches 60% to 70%. Free iron is toxic as it changes rapidly between divalent and trivalent forms, leading to chemical reactions and the production of oxygen radicals. This results in cellular, molecular, and organ damage. Signs and symptoms of iron overload include nausea, vomiting, diarrhea, metabolic acidosis, hypotension, hepatic failure, and death.[41] The risk of iron overload increases when chronic administration of IV iron exceeds the amount of blood loss.[42][43] Iron chelating agents bind to iron accumulated in organs.[44] Iron bound to the chelator is excreted in the urine and feces. Iron chelators include IV or IM deferoxamine, oral deferiprone, and oral deferasirox.

Comprehensive knowledge, training, and collaboration among all interprofessional team members are essential for ensuring patient safety while administering iron dextran preparations. Clinicians must thoroughly evaluate the suitability of parenteral iron, including iron dextran. Pharmacists play a crucial role in error prevention by providing information on indications, dosage calculations, potential interactions, and relevant dosage adjustments. Clinicians must be present during the administration of parenteral iron to patients. Furthermore, nurses should diligently monitor patients following iron dextran administration to promptly identify any adverse drug reactions. Most infusion reactions are mild and resolve by interrupting the infusion. In cases where pharmacological intervention is necessary, the interprofessional healthcare team may opt for IV fluids, corticosteroids, and IM epinephrine, depending on the reaction's severity.[45][27] Antihistamines are not recommended in this context.[27] By ensuring proper training, fostering open interprofessional communication, and promoting cooperation, healthcare teams enhance their ability to provide quality patient-centered care and ultimately improve overall patient outcomes.