Complications of reaction to an iron infusion in a man with ischaemic heart disease
AI-generated summary
A 77-year-old man with iron deficiency anaemia and underlying ischaemic heart disease died from anaphylaxis following iron polymaltose infusion. Critical clinical lessons: (1) IV iron should only be administered after oral iron has been tried or is contraindicated; investigations for the cause of anaemia should be completed before commencing IV iron; (2) anaphylaxis requires immediate transfer to a monitored resuscitation area with continuous ECG monitoring, particularly in patients with cardiac disease; (3) specific informed consent for iron infusion should be obtained before administration; (4) adrenaline administration in anaphylaxis mandates continuous cardiac monitoring given risk of myocardial ischaemia. The patient remained in the ED short-stay unit without ECG monitoring after adrenaline administration, limiting detection of cardiac complications. Earlier investigation and oral iron therapy may have prevented the need for IV iron altogether.
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Specialties
emergency medicinehaematologycardiology
Error types
diagnosticproceduralcommunicationsystem
Drugs involved
iron polymaltosehydrocortisonepromethazineadrenalinesalbutamol
Clinical conditions
iron deficiency anaemiaanaphylaxisischaemic heart diseasecoronary artery atherosclerosisbone marrow hypoplasiahypertensiondiabetes mellitus type 2
Procedures
iron infusionblood transfusionresuscitation
Contributing factors
Insufficient investigation of cause of iron deficiency anaemia prior to IV iron therapy
Oral iron not attempted or documented as contraindicated before IV iron administration
Lack of specific informed consent obtained for iron infusion
Failure to transfer patient to resuscitation cubicle upon recognition of anaphylaxis
Absence of continuous ECG monitoring following adrenaline administration in patient with known ischaemic heart disease
Inadequate monitoring in short-stay unit following onset of anaphylactic symptoms
Underlying severe double-vessel coronary artery atherosclerosis
Coroner's recommendations
Melbourne Health should review their clinical practice guideline to develop a comprehensive clinical practice guideline for iron infusion that includes: pre-treatment investigation of anaemia, indications for an iron infusion, consent requirements, and identification of the most appropriate locations within the hospital to deliver an iron infusion taking into account the need for close monitoring of patients
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