When they launched iron sucrose complex for intravenous use, the pharmaceutical representatives kept telling us that the new molecule did not have any risk of allergic and anaphylactic reactions. They said there was no need for any test dose, as with the older iron dextran complex, and hence it was superior. Being superior and newer, they said it would be a little more expensive; but they said this only when we asked the price. There were some amongst us who fell for the new technology, only because it was new, and perhaps they did not want to appear backward in company of others in medical conferences and meetings. One of them gave it as a topic for dissertation to a postgraduate student (where the subjects would pay for the drug contrary to the guidelines of the Ethics Committee). I searched various medical databases and found a couple of references which reported anaphylactic reactions with the use of iron sucrose. The incidence was far less as compared to iron dextran complex. I did not use it because I knew the patients in our hospital really did not afford it, and also because the manufacturers did not state the method of giving a test dose of the preparation. My patients must have been lucky. One and a half year ago, one patient from a unit headed by one such enthusiast developed acute anaphylactic reaction when iron sucrose was administered to her intravenously. I think she survived, but with a lot of morbidity. Less than three weeks ago, another patient from another enthusiast’s unit developed acute anaphylactic reaction with intravenous use of iron sucrose. She developed cardiao-respiratory arrest, from which she was resuscitated with difficulty. She developed cardiao-respiratory arrest eight more times over the next two days and finally could not be revived any more.
“It is safer to give a test dose of iron sucrose prior to intravenous use” said an intensivist Professor “because pharmaceutical companies cannot protect one from litigation by a patient or her relatives (should the patient die), even if they are saying it does not cause such reactions.”
“It is safer to give a test dose from the patient’s point of view” I said. “Even if the doctor is not sued, the patient’s death would still be wrong because it would have been prevented by giving a test dose and withholding the drug if the patient developed allergic reaction.”
We have decided to give a test dose to all patients prior to administration of iron sucrose, whether the manufacturers and text books recommend it or not.
