Finding into death of Khodr El Mustapha

77y · Male·Complications of reaction to an iron infusion in a man with ischaemic heart disease

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.