Do you offer IV iron first line to women with iron deficiency anemia from heavy menstrual bleeding?
Wang et al., PMID 41504430, suggest that IV iron first line is cost-effective over PO iron. Has your practice changed, or do you still prefer PO iron, and if so, why?
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Do you offer IV iron first line for IDA from heavy menstrual bleeding?
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Hematology · Georgetown University School of Medicine
Answered on
I offer first-line IV iron because oral iron cannot keep up with the losses from heavy menstrual bleeding, and the majority can't tolerate it. I routinely give a gram of LMW iron dextran in one hour, Feraheme (not ferumoxytol generic) 1,020 mg in 30 minutes, or ferric derisomaltose 1 gram in 30 minutes. I never use iron sucrose or ferric gluconate because they require multiple visits, have no advantage in safety or efficacy, and are extremely inconvenient. I avoid ferric carboxymaltose because of the alarming incidence of hypophosphatemia and skeletal issues that result.
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