Parenteral iron is usually reserved for patients who either cannot tolerate oral therapy or are not sufficiently responding to treatment at follow-up, usually 2-4 weeks after treatment initiation.
Intravenous iron can also be appropriate as initial therapy in the following cases:
When prompt iron repletion is needed (eg, late pregnancy, severe cases of anemia, before a scheduled surgery);
When the likelihood of subsequent bleeding episodes is increased (heavy menstrual bleeding, cancer, inflammatory bowel disease, short bowel syndrome); and
When malabsorption could be an issue (eg, celiac disease; gastric bypass, unmodifiable H2 or proton pump therapy).
AGA guidelines state that iron therapy should not be given to patients who are appropriate candidates for oral iron because anaphylaxis may result. Of note, however, concerns that parenteral iron is a "high-risk" therapy were more prevalent with high-molecular-weight iron dextran products, but the same risk is generally not associated with newer parenteral iron formulations.
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