Dilemma resolved? IV iron use for iron deficiency during acute infections

Clinicians often face the dilemma of whether to administer intravenous (IV) iron to patients with iron deficiency anaemia who are experiencing acute infections. Current guidelines provide limited direction. However, results from a large real-world analysis may help solve this long-standing dilemma.

“The belief that ‘iron feeds bacteria’ has long shaped clinical practice concerning iron therapy during acute infections,” said Dr Haris Sohail (Charleston Area Medical Center, WV, USA) [1]. “However, there is not much evidence to support this claim.” Using the TriNetX research network, the researchers identified adult patients with iron deficiency anaemia and 1 of the following infections: methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia (n=16,866), pneumonia (n=38,562), urinary tract infection (n=37,226), colitis (n=8,864), or cellulitis (n=16,808). In each infection cohort, half of the patients had received at least 1 formulation of IV iron, and half had not. Propensity score matching was performed for age, demographics, comorbidities, and laboratory values. The primary outcomes were 14-day and 90-day survival.

Across all infection types, patients who received IV iron showed higher 14-day survival compared with those who did not:

• MRSA bacteraemia 97.6% vs 95.0%;
• Pneumonia 95.7% vs 91.5%;
• Urinary tract infection 97.6% vs 95.7%;
• Colitis 97.6% vs 95.5%;
• Cellulitis 98.5% vs 97.4%.

“This impact of IV iron on survival was maintained at day 90,” added Dr Sohail.

“Administering IV iron during acute infections appears to be safe and is associated with improved survival across all major infection cohorts,” he concluded. “In addition, haemoglobin recovery was enhanced, and transfusion requirements were reduced.” Dr Sohail emphasised, however, that prospective studies are needed to validate these real-world data.

1. Sohail H, et al. Deciphering the dilemma: intravenous (IV) iron use in iron deficiency during acute infections. Abstract 5, American Society of Hematology (ASH) annual meeting 2025, 6–9 December, Orlando, Florida, USA.

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Posted on 22 December 202522 December 2025