Intravenous sodium ferric gluconate complex for pediatric inpatients with iron deficiency anemia or after acute blood loss

Background: Iron deficiency anemia (IDA) is a frequent finding in hospitalized pediatric patients. Sodium ferric gluconate complex (SFGC) has been in use at our institution for rapid replenishment of iron in patients unable to take or tolerate oral iron. Objective: Evaluate efficacy of SFGC, and incidence of adverse drug reactions (ADRs). Methods: Retrospective review of SFGC infusions in hospitalized patients <18 years with IDA, or after acute blood loss between January 1st 2008 and April 20th 2015. Results: Sixty-five inpatients received 1586 infusions in 738 courses of daily 1-3 mg/kg infusions followed by laboratory tests within 2-4 days. Mean number of infusions per course was 2.06±1.08, mean dose per course 4.6±3.1 mg/kg, and mean age was 8.43±6.64 years. 18.4% of the courses were administered to infants, and 24.4% to children 1-<7 years. The largest patient diagnoses group was gastrointestinal diseases (175 of 738, 23.7%), of those 64.6% (113) were inflammatory bowel disease. Comparing pre to post infusion values, there were significant increases in iron saturation, ferritin, reticulocyte count, and hemoglobin in all diagnoses and age groups. 85.8% of the courses were accompanied by erythropoietin injections. Those who received erythropoietin had higher reticulocyte count and lower ferritin levels compared to those who did not receive it (59.16±70.75 vs. 8.32±75.11, p=.005 and 81.61±179.01 vs. 134.84±117.87, p=.027 respectively). Two patients had transient hypotension but completed the infusions. Conclusion: SFGC infusions rapidly improved iron studies, and induced hematopoiesis in all age and diagnoses groups, and without significant ADRs. Safety in neonates needs further examination.