2026 Eastern States Conference

Title: Evaluation of Hospitalized Medicine Patient Population Receiving Intravenous Iron Sucrose 

Authors: Olivia Giordano, PharmD; Joseph Berndsen, PharmD

Learning Objective:  Audience members will be able to identify who is indicated for IV iron and who should be getting oral iron. 

Background/Objective: AGA and KDIGO guidelines outline indications for IV vs oral iron. This study evaluates IV iron sucrose use at MHMH, assessing adherence to guideline-based indications and identifying potentially inappropriate IV use.

Methods: This retrospective chart review aims to evaluate the dosing and administration of IV iron sucrose for the treatment of adult patients with iron deficiency anemia (IDA) at Mary Hitchcock Memorial Hospital (MHMH) who were admitted to hospital medicine teams between August 1, 2024 to August 1, 2025. This review will identify how often IV iron is used in patients who could instead receive oral iron. Prescribing trends for IV iron sucrose (ex: dose, frequency) at MHMH will be compared to current guideline recommendations. The patient population evaluated must be >19 years old and have a previous diagnosis of IDA or meet the following lab criteria: Hgb <12 g/dL (women), <13 g/dL (men); ferritin <45ng/mL (stable renal function), <100 ng/mL (CKD); Tsat <20%. Multiple admissions within 30 days were considered one treatment course. Patients that received IV iron sucrose for any indication other than iron deficiency anemia and patients that are pregnant will not be included in this review.

Results: A total of 196 patients were included in the review, of whom 80 (41%) met guideline-based criteria for IV iron therapy per AGA and KDIGO recommendations. Among eligible patients, 31 (38.8%) had stable renal function and 49 (61.2%) had CKD. Among patients meeting AGA criteria, the most common indication was lack of improvement with oral iron (43%), followed by inflammatory bowel disease (29%). Among patients meeting KDIGO criteria, 61% were receiving hemodialysis for stage 5 CKD. Cumulative IV iron sucrose doses greater than 1000 mg occurred in 1.5% of patients with stable renal function and 7% with CKD. Across 460 administrations, 300 mg was the most commonly prescribed dose (72%).

Conclusion/Potential Impact: In this single-center retrospective review, only 41% of patients receiving IV iron sucrose met guideline-based criteria for therapy per AGA and KDIGO recommendations. Variability in dosing practices was also observed, including administration of doses exceeding commonly recommended thresholds. These findings highlight an opportunity to improve inpatient IV iron prescribing through guideline-driven tools and targeted education to promote safer, more evidence-based, and cost-effective care.

Self-Assessment Question: True or false - In hospitalized patients with iron deficiency anemia who can tolerate oral medications, IV iron should be routinely preferred over oral iron due to faster hemoglobin response.