How would you approach iron supplementation in a beta thalassemia trait patient with restless leg syndrome?
For a patient who cannot tolerate PO iron, does the presence of the beta-thal trait and resultant theoretical risk of iron overload preclude IV iron administration even if ferritin <75? Is there additional laboratory testing to assess iron loading potential that you would use beyond TSat%?
2 Answers
Mednet MemberInvited Expert
Hematology · Georgetown University School of Medicine
Answered on
Thalassemia does not alter my decision. I don't use PO iron for RLS as it is enormously more toxic. A ferritin of 75 is a light-year away from iron overload, and a total dose infusion of IV iron can be administered with impunity. This patient should be treated with a gram of LMW iron dextran over one hour, 1,020 mg of Feraheme (not ferumoxytol generic) over 30 minutes, or 1,000 mg of FDI over 30 minutes. I would avoid iron sucrose so multiple unnecessary visits are obviated and FCM because of its high incidence of hypophosphatemia.
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Mednet MemberInvited Expert
Hematology · Rochester General Hospital
Answered on
It is fine to replenish iron if the patient is deficient, regardless of underlying thalassemia trait.
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