Parenteral iron—Does it increase infection risk?

BACKGROUND AND OBJECTIVES: Iron deficiency (ID) and iron deficiency anaemia (IDA) are prevalent conditions impacting various patient populations, both surgical and non-surgical conditions. The advent of patient blood management (PBM) has promoted intravenous (IV) iron therapy as an alternative to oral iron and blood transfusions. However, concerns remain regarding IV iron's potential association with infection risk. This narrative review critically examines the relationship between parenteral iron therapy and infection risk across various clinical settings. It evaluates various IV iron formulations, their benefits, safety profiles and potential adverse effects, particularly infection-related complications. MATERIALS AND METHODS: A structured literature search was conducted across PubMed, EMBASE, Medline and CINAHL (2014-2024) using pre-defined keywords. Observational studies and clinical trials relevant to IV iron formulations and infection risk were analysed. RESULTS: IV iron therapy effectively improves haemoglobin levels and reduces transfusion dependence. Studies in cardiovascular, renal, antenatal and surgical populations suggest that it is difficult to conclude that IV iron therapy significantly increases the risk of infection. Older formulations, high-dose IV iron therapy and various underlying conditions may elevate infection susceptibility due to increased levels of non-transferrin-bound iron. Emerging formulations, such as ferric carboxymaltose and ferric derisomaltose, appear to have a more favourable safety profile. CONCLUSION: While IV iron remains a cornerstone in ID management, patient-specific risk factors must be considered. Further research is needed to clarify infection risk variations among different IV iron formulations and patient populations. Optimizing IV iron therapy through individualized approaches may enhance its clinical benefits while minimizing potential adverse effects.