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As the article by Beverina et al., correctly states, iron deficiency is the main cause of anemia worldwide. One of the difficulties with treating anemia without blood products has been gaining physician acceptance. The current study included 47 patients with a hemoglobin of <7.0 g/dL who met inclusion criteria.  The patients were treated with ferric carboxymaltose (FCM) as well as for folate, B12 and hypophasphatemia as needed. All patients where then monitored for two futher assessments, a mean of 10 (± SD 3) and 35 (± SD 12) days from first infusion. The results were impressive! After an average of 10 days after the first infusion, 33 patients (70.2%) reached hemoglobin (Hb) values of  more than 8.0 g/dL. By the third assessment, 45 patients (95.7 %) had a Hb of more than 10.0 g/dL. The range of total Hb improvement was between 5.0 g/dL and 6.0 g/dL in 34  patients (72.3%). While in this small study no side effects were noted, clinicans should be mindful of risk of anaphylaxis with IV iron administration. One of the limitation of the study is that only one IV iron formulation was used. There are numerous formulations of IV iron available, some of which can replete iron stores in a single dose (total dose infusion), and all of which have similar safety and efficacy. Another limitation of this study was that its success was measured by changes in laboratory values. In addition to good laboratory values, patients experiencing IDA want a good quality of life that does not include fatigue. The transition from tranfusion to IV iron has to have a starting point as was shown with this study. In conclusion, iron is ubiquitious, however, getting the clinican to accept and use it is the challange ahead for all of us.

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Richard Gammon - OneBlood https://orcid.org/0000-0002-1175-9579

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