Heart Failure

and the Iron

Deficiency
Dr Hareen
Choudhary
 Introduction
• It has been studied that iron deficiency is a
common finding in people with heart failure, and
anemia worsens heart failure.
• Absolute ID was defined as ferritin < 100 μg/L.
• Functional ID is defined as ferritin 100–299 μg/L and
transferrin saturation (TSAT) < 20%.4
Study of iron metabolism in heart failure patients
Functional iron True iron
Variable Normal
deficiency deficiency
Iron 6–27 µmol/L Decreased Decreased
Normal or
Transferrin 25–45 µmol/L Increased
decreased
Transferrin
20–45% Decreased Decreased
saturation
Ferritin 100–300 µg/L Normal Decreased
• 1/3 of patients with HF and ½ of patients of
Pulmonary HTN have iron deficiency.
• In patients presenting with heart failure due to
underlying cardiac condition may have iron
deficiency but apparent clinical absence of
anemia.
• Further investigations and iron supplementation in
such patients would provide significant
symptomatic improvement.
• Various studies such as FAIR- HF, CONFIRM- HF have
demonstrated that in patients with HF with iron
deficiency , with or without apparent anemia have
shown significant improvement.
 Dosage of iron
• Generally, the dose of parenteral iron is calculated
based on body weight, current haemoglobin level,
and amount of elemental iron per millilitre of the
iron product. 
-Volume of product required (mL) =
• [weight (kg)x (14 - Hgb) x (2.145)] / C + correction of
stores
• In practice, there is no evidence that total doses
above 1000 mg of elemental iron are clinically
useful. Often a fixed dose of approximately 1000
mg.
 Iron requirement
Requirement
Children 8-18mg/day
Adult men 10-15 mg/day
Menstruating women 15-20 mg
Pregnant and lactating woman 20-25 mg
 oral iron therapy
Preparation Therapeutic Total iron
dose(mg) / content (mg)
day
Ferrous 600 180 Cheapest
sulfate
Ferrous 900 108
gluconate
Ferrous 600 198
fumarate
Iron and 6000 1200 Liquid
ammonium formulation
citrate
Ferrous 300 105
succinate
 Parenteral iron
preparations
• Ferric carboxymaltose 
• Iron Sucrose
• Iron dextran
• Ferumoxytol 
• Ferric pyrophosphate citrate
• Ferric gluconate.
 FCM vs other
preparations
• Some recent studies have shown that ferric carboxy
maltose is superior to other studies.
Managing adverse effects
• Comparitively rare with ferric carboxy maltose.
• hypotension, somnolence, flushing, dizziness.
• In pts with h/o allergies ,premedication with 125 mg
of methylprednisolone, is given intravenously prior to
administration of any IV iron product. 
• In pts with inflammatory arthritis a short course with
methyl prednisolone of1 mg/kg per day orally for
four days can be given.
• Antihistaminics should not be administered as they
can actually worsen the symptoms.
•  The iron parameters should not be repeated for at
least four weeks.
• normalization of the haemoglobin level occurs in six
to eight weeks.
• Effective treatment of iron deficiency results in
resolution of symptoms, reticulocytosis peaks in 7-10
days.
Thank you