FCM therapy

1. TREATMENT OF IRON DEFICIENCY ANEMIA WITH
FERRIC CARBOXYMALTOSE
Dr. Kunal Chhattani
MBBS MD DrNB [Clinical Hematology]
Hematologist and Hemato-Oncologist,
Chhattani Hematology Clinic, Nagpur

2. ANAEMIA

3.  WHO Cut Offs:
 M<13g/dl
 F<12gm/dl
 Anemia in pregnancy:
 1st Trimester Hb< 11
 2nd trimester Hb <10.5
 3rd trimester Hb<11
 Post partum Hb <10

4. Iron
Homeostasis

5. IRON HOMEOSTASIS
 1-2mg of iron –absorbed and lost every day
 Most absorption- Duodenum
 2 forms- Ferrous and ferric
 Ferric iron Ferrous iron at brush border
 Iron Blood transferrinBone marrow2/3rd in
Hb

6.  Storage:
1. Reticulo Endothelial System
2. Liver
 Key Regulator: Hepcidin
 Hepcidin blocks Ferroportin  Reduced iron
absorption from gut and stores

9. Diagnosis

10. SCREENING FOR IDA
 Ferritin <30ng/ml
 Transferrin saturation <20%.

13. Treatment

14. ORAL IRON
 Ferrous form is better absorbed
 Most commonly available : Ferrous sulphate,
ferrous fumarate, ferrous gluconate, ferrous
ascorbate.
 Any of these is acceptable.

15. Advantages:
 Efficacious for most patients
 Low risk of serious side effects
 Low cost
Disadvantages:
 GI toxicity
 Compliance

17. SOME QUERIES

18. IV iron

19. INDICATIONS OF IV IRON
 Failure/intolerance of oral iron
 Noncompliance
 Rapid response required
 Malabsorption
 Continuous bleeding

20. D. Girelli et al 2017

21. CONTRAINDICATIONS TO IV IRON
 Pregnancy <12 weeks
 Lack of facilities of managing allergic reaction
 Anaphylaxis to any parenteral iron preparation
 Iron overload

22. APPROVALS

23. D. Girelli et al 2017

25. D. Girelli et al 2017

26. PARENTERAL IRON STRUCTURE

28. DILUTION AND DURATION
 Dilute FCM 500mg in 100ml NS and 1gm in 250ml
NS. Concentration of FCM <2mg/ml is not
permissible.
 Infuse 500mg in minimum 6minutes and 1gm in
minimum 15minutes
 Long duration of infusion and excess dilution can
lead to destabilization of iron complex and adverse
effects