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Updated: Aug 16, 2026
Continuous Manual Exchange Transfusion for Patients with Sickle Cell Disease: An Efficient Method to Avoid Iron Overload
Published on: March 14, 2017
Hepatocellular damage following therapeutic intravenous iron sucrose infusion in a child
David Michael Wood1, Alison H Thomson, Matthew Lawes
1Department of General Medicine, St. George's University of London, London, UK. dwood@sghms.ac.uk
Insights
Intravenous iron sucrose toxicity can occur in children after large doses. Further research is needed to determine safe dosing and pharmacokinetics for intravenous iron preparations in all patients.
Area of Science:
- Pharmacology
- Toxicology
- Pediatrics
Background:
- The maximum tolerated dose (MTD) and pharmacokinetics of intravenous iron infusions are not well-established in pediatric populations.
- Limited data exists regarding the safe dosing and metabolic fate of intravenous iron in adults.
Observation:
- A case study involving a child who received a high dose of intravenous iron sucrose (16 mg/kg) over 3 hours.
- The child subsequently exhibited symptoms indicative of systemic iron toxicity.
Findings:
- The reported case highlights the potential for severe adverse events following high-dose intravenous iron sucrose administration.
- Toxicokinetic analysis of the event is discussed, emphasizing the lack of established safety parameters.
Implications:
- Intravenous iron preparations should be administered with caution in both pediatric and adult patients due to unknown MTD and pharmacokinetics.
- Further studies are crucial to define safe dosing regimens and understand the toxicokinetics of iron infusions to prevent adverse events.
Abstract:
The maximum tolerated single dose of intravenous iron infusion and iron pharmacokinetics are not known in children and not clear in adults. The case reported here is of a child given a large dose of intravenous iron sucrose (16 mg/kg) over 3 hours, who subsequently developed features of systemic iron toxicity. A TDM consultant discusses the case in the context of toxicokinetic analysis. Because the maximum tolerated dose and pharmacokinetics of intravenous iron preparations are not known, their use in both adults and children should still be undertaken with caution.
