Nephrology

544b IV Iron Infusion low-dose course for children on haemodialysis

  • IV Iron Infusion low-dose course for children on haemodialysis

    • For children undergoing HD, incremental IV iron infusion can be given at a dose of Ferrum H 2mg/kg (up to a maximum of 100mg).
    • Test-dose of IV iron is given prior to first dose

    Test-dose of IV iron

              A test-dose should always be given prior to initiating IV iron therapy

     

    <10kg

    10-20kg

    >20kg

    Dose for test-dose

    0.2ml (10mg)

    0.3ml (15mg)

    0.5ml (25mg)

    The test-dose should be given during the day-time and medical staff must be present during administration and for 15 mins following test-dose. The availability of drugs for treatment of anaphylaxis (adrenaline, hydrocortisone and promethazine) should be readily available (see Adverse Reaction). Monitor vital signs 15 minutely and observe child closely for 30 minutes for adverse reactions.

    The test-dose should be given by slow IV push over 30-60 sec. The remainder of the iron dose should not be given until at least 1 hour after test-dose has been given. If no immediate allergic reactions occur, subsequent routine dosing can be given without a test-dose.

    Recommended Dosing Schedule

    Serum ferritin

    Dose-Ferrum H

    Frequency

    Regime

    <100ug/L

    2mg/kg

    Weekly for 8 weeks then review

    A

    100-300ug/L

    2mg/kg

    Fortnightly for 8 weeks then review

    B

    300-500ug/L

    2mg/kg

    Monthly for 2 months then review

    C

    >500gu/L

    Nil

    Nil

    D

    • Ferrum H is given diluted into 20 ml normal saline and infused over 1 hour during last hour of dialysis.
    • During low-dose course of Ferrum H, the Hb and iron studies should be rechecked every 8 weeks.

    References

    CARI Guidelines 2003

    DOQI Guidelines 2000

    Pediatric Nephrology (2001) 16: 779-783.