Treatment with ferric carboxymaltose in stable patients with severe iron deficiency anemia in the emergency department

  • Irene MottaEmail author
  • Giulia Mantovan
  • Dario Consonni
  • Anna Maria Brambilla
  • Maria Materia
  • Marianna Porzio
  • Margherita Migone De Amicis
  • Nicola Montano
  • Maria Domenica Cappellini


The AABB Choosing Wisely Campaign recommends “don’t transfuse for iron deficiency without hemodynamic instability”. However, the management of iron deficiency anemia (IDA) in the emergency department (ED) is heterogeneous and patients are often over-transfused. Intravenous iron is effective in correcting anemia and new formulations, including ferric carboxymaltose (FCM), allow the administration of high doses with low immunogenicity. The aim of this retrospective study was to analyze the management of hemodynamically stable patients aged 18–55 years with severe IDA (hemoglobin < 8 g/dL), who presented to the ED from January 2014 to July 2018. Patients who received FCM (FCM1) and those who did not receive FCM (FCM0) were compared. Efficacy and safety of FCM at follow-up were evaluated. Seventy-one subjects fulfilled the inclusion criteria (FCM0 n = 48; FCM1 n = 23). The mean Hb at admission was 6.6 g/dL. 40% in the FCM0 and 13% in FCM1 were transfused (p = 0.02). 21% of FCM0 patients were admitted to the ward, while all FCM1 were discharged (p = 0.02). Within 2 weeks, the Hb increase was 2.8 ± 1 g/dL in the FCM1 group. Sixteen FCM1 patients were evaluated at 52 ± 28 days (median 42, range 27–122): the average Hb increase was 5.3 ± 1.4 g/dL. In summary, we showed that FCM administration in the ED in hemodynamically stable patients was associated with fewer transfusions and hospital admissions compared to the FCM0 group; moreover, it succeeded in safely, effectively and rapidly increasing Hb levels after discharge from the ED. Further studies are needed to develop recommendations for IDA in the ED and to identify transfusion thresholds for non-hospitalized patients.


Severe anemia Iron deficiency Ferric carboxymaltose Transfusion Choosing wisely 


Author contributions

Irene Motta, Giulia Mantovan, Dario Consonni, Nicola Montano and Maria Domenica Cappellini contributed to the study conception and design. Material preparation, data collection and analysis were performed by Giulia Mantovan, Irene Motta and Dario Consonni. Irene Motta, Anna Maria Brambilla, Maria Materia, Marianna Porzio and Margherita Migone De Amicis took care of patients. The first draft of the manuscript was written by Irene Motta and Giulia Mantovan and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Compliance with ethical standards

Conflict of interest

IM received honoraria from Sanofi-Genzyme; NM received honoraria for lecturing from Novo Nordisk; MDC member of Vifor, Sanofi-Genzyme, Celgene, Novartis and Bluebird advisory Board.

Statement of human and animal rights

This study was approved by the Institutional Ethics Committee of our institution.

Informed consent

For this type of study informed consent is not required.


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Copyright information

© Società Italiana di Medicina Interna (SIMI) 2019

Authors and Affiliations

  • Irene Motta
    • 1
    • 2
    Email author
  • Giulia Mantovan
    • 3
  • Dario Consonni
    • 4
  • Anna Maria Brambilla
    • 5
  • Maria Materia
    • 6
  • Marianna Porzio
    • 6
  • Margherita Migone De Amicis
    • 2
  • Nicola Montano
    • 1
  • Maria Domenica Cappellini
    • 1
    • 2
  1. 1.Department of Clinical Sciences and Community HealthUniversità Degli Studi Di MilanoMilanItaly
  2. 2.Department of Internal Medicine, UOC Medicina GeneraleFondazione IRCCS Ca’ Granda, Ospedale Maggiore PoliclinicoMilanItaly
  3. 3.Medical SchoolUniversità Degli Studi Di MilanoMilanItaly
  4. 4.Epidemiology UnitFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
  5. 5.Department of Internal Medicine, Emergency MedicineL. Sacco Hospital, ASST-FBF-SaccoMilanItaly
  6. 6.Emergency DepartmentFondazione IRCCS Ca’ Granda, Ospedale Maggiore PoliclinicoMilanItaly

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