Anaphylactic shock secondary to intravenous iron sucrose in chronic kidney disease

• Main Authors: VINEET BEHERA, VELU NAIR, RAJEEV CHAUHAN, SMRITI SINHA, VASANTHA R S KUMAR
• Format: Article
• Language: English
• Published: PAGEPress Publications 2014-08-01
• Series: Mediterranean Journal of Hematology and Infectious Diseases
• Subjects: Iron Sucrose; Anaphylactic shock; Intravenous iron; allergic reaction; chronic kidney diseas
• Online Access: https://mjhid.org/index.php/mjhid/article/view/1911

Intravenous (IV) iron is an essential component of therapy of anemia of chronic kidney disease (CKD). We present a rare case in which iron sucrose was infused to a patient of CKD and resulted in severe anaphylaxis and cardiac arrest minutes after starting the infusion. He was aggressively resuscitated with adrenaline and other measures following which he recovered.  The use of parenteral iron is associated with several adverse drug reactions (ADR) which were seen with preparations like iron dextran but became rare with the use of newer safe preparations like iron sucrose or gluconate. The ADR can be mild or can have severe life threatening features like syncope, cardiac arrhythmias, seizures, bronchospasm and rarely cardio respiratory arrest like in our case. They are more common with low iron binding states or with a underlying history of allergy. Iron sucrose is generally given as a IV infusion of 100- 200 mg over 15-30 minutes and has a very low rate of ADR even with higher doses or bolus injections. But still necessary precautions and appropriate monitoring must be done in all patients. The patients who are allergic to iron sucrose may be treated with oral or other safer preparations or by desensitisation techniques.