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Ahmad A Alharbi,1,2 Abdullah A Alharbi,2,3 Dhafer Salem Bashen,2 Tarek Owaidah4 1Pathology Department, College of Medicine, Majmaah University, Al Majmaah 11952, Riyadh, Kingdom of Saudi Arabia; 2Laboratory Department, Dr. Sulaiman Al-Habib Hospital in Al Takhassusi, Riyadh, Kingdom of Saudi Arabia; 3Pathology Department, College of Medicine, Imam Muhammad Ibn Saud Islamic University, Riyadh, Kingdom of Saudi Arabia; 4Hematology and Transfusion Medicine Department, Alfaisal University, Riyadh, Kingdom of Saudi ArabiaCorrespondence: Tarek Owaidah, Consultant Hematology and Transfusion Medicine, Alfaisal University, P.O.Box 5092, Riyadh, 11533, Kingdom of Saudi Arabia, Tel +966 50 531 2925, Email towaidah@gmail.comBackground: Iron supplementation is administered orally or intravenously to treat iron-deficiency anemia (IDA). Ferric Carboxymaltose (FCM) “Ferinject®” is an intravenous (IV) iron preparation that has emerged as a safe therapeutic option for treating IDA in the past decade.Aim: This study aimed to evaluate safety and efficacy of carboxymaltose in a cohort of patients with IDA not responding to oral therapy.Methods: This 12-month retrospective study included 106 patients with IDA, with-or without bariatric surgery, who received (single or multiple doses) of Carboxymaltose 500mg/10mL. Data points included patients’ demographics, baseline data for Hb, platelet, ferritin, and MCV pre–and at 1, 2, and 3 months following different doses of IV-Carboxymaltose. Changes in Hb, MCV, platelets, and ferritin levels were recorded in response to Carboxymaltose to assess the optimal dose, risk of hyperferritinemia, and hypophosphatemia.Results: At three months (95 days) follow-up, the median change pre-and post-therapy in hemoglobin was from 9.5 to 11.9g/dL (p < 0.01), MCV 73.6– 80.5fL (p < 0.01), and ferritin 5.3– 93.8ng/mL. A significant difference was observed between platelet count of patients who underwent bariatric surgery and those who did not. An optimal ferritin response (> 30ng/mL) was observed in 87.8% of patients who received first dose, and none of the full three doses showed no response. 37% of patients who received two doses developed hyperferritinemia. Serum phosphate levels were assessed in 28 cases, and hypophosphatemia was observed in 25% of these patients.Conclusion: Carboxymaltose is a reliable option for IDA. IV-FCM therapy helps achieve significant improvement in hemoglobin concentration and MCV from the first dose carrying a low reversible risk of hyperferritinemia following multiple doses. An interesting finding of this study is the discovery of a population of IDA patients requiring periodic assessment for iron reinfusion to sustain normal levels, mostly post-bariatric surgery. Changes in serum phosphate levels reported to occur consecutively with FCM treatment should be further studied.Keywords: iron deficiency, anemia, ferrous carboxymaltose, hypophosphatemia |
