Indications for IV iron therapy in pediatrics by etiology
| IDA etiology and affected patient populations . | Indications for IV iron . |
|---|---|
| Nutritional IDA (low-iron diet) | |
| Infants Toddlers Children with restricted diets (vegan, vegetarian) Adolescents with eating disorders | Severe IDA causing hospital admission, hemodynamic compromise, or severe symptoms affecting daily functioning Failed oral iron therapy due to either inability to tolerate (poor taste or GI side effects) or poor adherence History of medication nonadherence or poor follow-up |
| Blood loss | |
| Menstrual (adolescent females with HMB) Gastrointestinal (IBD, other GI tract disease) Other (recurrent epistaxis in patients with bleeding disorders) | Brisk, ongoing, difficult to control bleeding Severe IDA causing hospital admission, hemodynamic compromise, or severe symptoms affecting daily functioning Inability to tolerate oral iron due to GI side effects (patients with IBD) Ongoing IDA secondary to medication nonadherence (adolescents) Recurrent IDA in a patient who previously required IV iron |
| Malabsorption | |
| History of GI surgery/tract alteration (intestinal failure or short gut syndrome) | Absence of duodenum for oral iron absorption |
| GI tract disease (celiac, Helicobacter pylori, atrophic gastritis) | Reduced soluble iron from stomach acid insufficiency |
| Chronic inflammation/disease states | |
| Chronic kidney disease Heart failure Rheumatologic/immunologic diseases | Renal replacement therapy on erythropoiesis-stimulating agents Heart failure with evidence of iron deficiency (to maximize cardiac function) Relative or absolute iron deficiency due to hepcidin activity in the setting of chronic inflammation and inability to correct iron deficiency with oral supplementation alone |
| IDA etiology and affected patient populations . | Indications for IV iron . |
|---|---|
| Nutritional IDA (low-iron diet) | |
| Infants Toddlers Children with restricted diets (vegan, vegetarian) Adolescents with eating disorders | Severe IDA causing hospital admission, hemodynamic compromise, or severe symptoms affecting daily functioning Failed oral iron therapy due to either inability to tolerate (poor taste or GI side effects) or poor adherence History of medication nonadherence or poor follow-up |
| Blood loss | |
| Menstrual (adolescent females with HMB) Gastrointestinal (IBD, other GI tract disease) Other (recurrent epistaxis in patients with bleeding disorders) | Brisk, ongoing, difficult to control bleeding Severe IDA causing hospital admission, hemodynamic compromise, or severe symptoms affecting daily functioning Inability to tolerate oral iron due to GI side effects (patients with IBD) Ongoing IDA secondary to medication nonadherence (adolescents) Recurrent IDA in a patient who previously required IV iron |
| Malabsorption | |
| History of GI surgery/tract alteration (intestinal failure or short gut syndrome) | Absence of duodenum for oral iron absorption |
| GI tract disease (celiac, Helicobacter pylori, atrophic gastritis) | Reduced soluble iron from stomach acid insufficiency |
| Chronic inflammation/disease states | |
| Chronic kidney disease Heart failure Rheumatologic/immunologic diseases | Renal replacement therapy on erythropoiesis-stimulating agents Heart failure with evidence of iron deficiency (to maximize cardiac function) Relative or absolute iron deficiency due to hepcidin activity in the setting of chronic inflammation and inability to correct iron deficiency with oral supplementation alone |