Considerations for Practice

Maternal iron deficiency during pregnancy can lead to iron deficiency in infants, with potentially lifelong consequences, a new article indicates. The review explored iron status throughout the ‘first 1000 days’ from pregnancy through to two years of age, and emphasised the importance of identifying and treating iron deficiency, in addition to underlining remaining research gaps.

The optimal timing of intravenous iron therapy, in relationship to the type of erythropoiesis stimulating agent (ESA) used and the timing of ESA administration, has not been systematically studied. Since long-acting ESAs became available, it has not been established if there is an optimal window for intravenous iron use following ESA administration.

A comprehensive literature review has described the importance of treating iron deficiency in patients with heart failure. Authors state that iron deficiency is common, with a prevalence of up to 50%, but is often overlooked in this population. They describe a favourable effect of intravenous iron in this population, and provide an overview of future clinical trials that will explore the benefits of iron deficiency correction on various heart failure parameters.

Iron therapy may be recommended during pregnancy for patients who have undergone liver or kidney transplant, new research indicates. The authors of the literature review recommend a haemoglobin level of 10–12 g/dL as a therapeutic goal in this patient group, to be achieved using erythropoietin-stimulating agents (ESAs) and iron therapy. They explain that management of anaemia may help to prevent preterm delivery.

Cohen-Solal and colleagues have recently published an expert position paper from French cardiologists on the diagnosis and treatment of iron deficiency in patients with heart failure. This adds to the increasing literature, including clinical practice guidelines, and opinions expressed by cardiologists, on the possible benefits of correcting iron deficiency in heart failure, following on from Australian and European guidelines1,2.

Iron sucrose is a frequently used intravenous iron compound for the treatment of iron deficiency and iron deficiency anemia in a broad range of therapeutic areas, including in patients with conditions such as chronic kidney disease, inflammatory bowel disease, pregnancy (second and third trimester), postpartum period, heavy menstrual bleeding and cancer.

A retrospective study has revealed that iron therapy is associated with a reduction in platelet count in patients with non-dialysis chronic kidney disease (ND-CKD) independent of erythropoiesis-stimulating agent (ESA) use. Iron therapy may therefore reduce the risk of relative thrombocytosis in this patient population.

Restless legs syndrome (RLS), also known as Willis-Ekbom disease, is characterised by largely nocturnal, rest-induced, distressing urges to move the legs1.  Insomnia, interference with relationships and cramps are common, contributing to a decreased quality of life2,3. Iron deficiency is commonly associated with RLS2,3 and there are approximately three million patients in the USA alone with both conditions4. The role of intravenous iron as a primary therapy for iron deficient patients with RLS has become an area of major clinical research5

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