Organisational strategies for the safe management of intravenous iron therapy: a revolutionary tool for implementing Patient Blood Management

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Dear Sir,
It is now common knowledge that iron deficiency anaemia (IDA) is a global health problem, affecting many millions of people worldwide. Although oral iron should be the first therapeutic option in many instances, in specific conditions, intravenous (IV) iron can be the product of choice to favour a prompt haematopoietic recovery. Last generation IV iron compounds seem to provide a high safety profile. However, with the aim of minimising the risk of delayed recognition and treatment of serious hypersensitivity reactions, in 2013, the European Medicines Agency (EMA)1, as part of the document entitled “New recommendations to manage the risk of allergic reactions with intravenous iron-containing medicines”, stated that “Intravenous iron medicines should only be administered when staff trained in evaluating and managing anaphylactic and anaphylactoid reactions are immediately available as well as resuscitation facilities”. In Italy, this has limited IV iron administration exclusively to in-hospital use, despite the fact that severe allergic reactions (mainly induced by the carbohydrate moiety surrounding the iron core) are exceptionally rare. [ … ]