IV Iron for Anemia in the ED

Iron Sucrose (Venofer) Ferumoxytol (Feraheme)
Dose (Max) 300mg in 250mL NS 510mg in 17mL (add to 50ml NS)
Infusion Time 2 hrs 15-60 mins
Serious Hypersensitivity 0.6 per million <5 in 1000
Cost $120 $200

Patients with the following risk factors should receive slower infusions (e.g. Feraheme® [ferumoxytol] over 60 minutes or Venofer® [iron sucrose] 300mg over 2 hours)

  • Age > 65 yrs
  • Baseline systolic BP less than 100
  • Severe asthma or eczema
  • Severe respiratory or cardiac disease
  • Treatment with beta-blockers, ACE inhibitors or 3 or more anti-hypertensive medications
  • Nephrology patients

After IV Iron, and with ongoing oral supplementation, a patient’s hemoglobin will start to rise 3-7 days. You can expect a 1-2 point rise in the hemoglobin per day, and after 2-4 weeks the hemoglobin will have risen 20-30g/L. Ferrous sulfate 300mg contains 60mg of elemental iron and 1 tab can be taken each night on an empty stomach at least 2 hours after meals with Vitamin C 500mg. Patients should also avoid taking with calcium or magnesium supplements as these decrease absorption.


Emergency Medicine Kenya Foundation