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Letter to the Editor
Reply
Respuesta
David Beneitez Pastor
Unidad de Anemias, Eritropatología y Patología Congénita Serie Roja, Servicio de Hematología Clínica, Hospital Universitari Vall d’Hebron, Barcelona, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">It is difficult to address all the different uses of intravenous iron &#40;IV Fe&#41; in an editorial&#44; and&#44; in the case of intensive care patients&#44; it certainly requires a separate discussion&#44; since anaemia is very common&#44; multifactorial most of the time&#44; and requires careful management due to the patient&#39;s clinical situation&#44; with multiple factors to assess&#46; The very instability of the intensive care patient often requires rapid treatment options&#44; in particular&#44; the correction of anaemia&#46; It should not be forgotten that the effect of IV Fe treatment is not immediate&#44; unlike a transfusion of packed red blood cells&#44; and this will be important when determining the use of IV Fe or other measures in certain intensive care patients&#46; At times&#44; IV Fe administration may be a strategy at the time of intensive care unit discharge&#44; more than during the stay in the unit&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">It is true that&#44; from a theoretical perspective&#44; the use of IV Fe could be indicated due to inflammation-induced iron deficiency&#44; but we will have to take into account the anaemia recovery needs as soon as possible&#44; since it is a risk factor <span class="elsevierStyleItalic">per se</span> to worsen underlying diseases with moderate degrees of anaemia&#44; and in addition&#44; its correction can improve homeostasis with the improvement of the haematocrit&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The multifactorial nature of anaemia&#44; the unstable clinical situation of the intensive care patient&#44; the need for rapid correction of anaemia to improve different aspects may explain why&#44; despite using IV Fe in these patients&#44; the number of transfusions do not decrease &#40;as mentioned in the referenced meta-analysis&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a> although I agree with the bias in the studies&#41;&#44; but probably in a group of selected patients&#44; especially those more stable&#44; the number of transfusions could be reduced&#44; as supported by the IRONMAN study&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Another important aspect&#44; and especially in an intensive care unit is&#44; as the authors point out&#44; the role of IV Fe and the risk of a greater number of infections or worsening of existing ones&#59; in fact&#44; in the Summary of Product Characteristics the use of IV Fe with an active infection is a contraindication&#44; since microorganisms also require iron for their cellular processes&#44; especially certain bacteria&#44; which are highly sensitive to iron&#46; Despite this&#44; the studies mentioned do not demonstrate a greater number of infections&#44; so it would have to be assessed in each case according to risk&#47;benefit&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Finally&#44; I agree that it is a complex group of patients&#46; Perhaps&#44; subgroups that could benefit from treatment with IV Fe could be defined&#46; I do not think an increased risk of infection due to the concomitant use of IV Fe will be proven&#44; although further studies will be needed to better assess this point&#46;</p></span>"
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                            0 => "A&#46; Shah"
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