International Journal of Case Reports and Images - IJCRI - Case Reports, Case Series, Case in Images, Clinical Images

   
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Premedication protocol for iron infusions in patients with anaphylactic reaction to parenteral iron: A case series
Katheryn D. Hudon1, Lemuel Sibulo1, Albert M. Brady1,2
1Pacific Northwest University of Health Sciences, Yakima, WA, United States.
2Washington Hematology-Oncology, Yakima, WA, United States.

doi:10.5348/ijcri-201605-CS-10066

Address correspondence to:
Katheryn D. Hudon
3031 W Grand Blvd, Ste 450. Detroit
MI 48202

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How to cite this article
Hudon KD, Sibulo L, Brady AM. Premedication protocol for iron infusions in patients with anaphylactic reaction to parenteral iron: A case series. Int J Case Rep Images 2016;7(2):92–96.


Abstract
Introduction: Iron supplementation is a mainstay of the treatment of iron deficiency that not only replenishes iron stores, but improves the life quality of the patient. Unfortunately, oral iron has myriad side effects that are intolerable for many patients, leading to iron infusion as the next step in treatment. The hypersensitivity adverse event rate for parenteral iron dextran from 1997–2002 was 29.2 reports/million, but literature for treatment of these patients is sparse.
Case Report: This report is a case study involving two female patients, 37-year-old and 31-year-old. Both females presented with severe iron-deficiency anemia while intolerant to oral iron and suffered anaphylactic reactions to parenteral iron. The method of intervention involved a premedication protocol, which was initiated immediately prior to iron sucrose infusion. For Case 1, the protocol included 10 mg IV dexamethasone, one duoneb (ipratropium bromide/albuterol sulfate), normal saline at 60 cc/hour, and 0.1 mg epinephrine given subcutaneously at the start of iron infusion, with 0.3 mg of epinephrine available at the bedside as needed for allergic reaction. For Case 2, the protocol included 50 mg IV diphenhydramine, 10 mg IV dexamethasone, one duoneb, normal saline at 50 cc/hour, 0.3 mg epinephrine at the bedside in case of reaction.
Conclusion: Patient iron levels were within normal limits after treatment, and no adverse events, such as anaphylactic reactions, occurred. With a precisely implemented premedication protocol initiated immediately prior to iron infusion, results of this case study indicate that such patients might be successfully and safely treated with parenteral iron.

Keywords: Anaphylaxis, Iron infusion, Iron-deficiency anemia, Premedication


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Author Contributions:
Katheryn D. Hudon – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Lemuel Sibulo – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Albert M. Brady – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2016 Katheryn D. Hudon et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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