Hussnain Javaid: IV Iron During Active Bacterial Infection Reassessing the Risks and Benefits
Hussnain Javaid, Consultant Haematologist at NHS UK, Founder of ClinHaem, shared a post on LinkedIn about a recent article by Haris Sohail et all, published in Blood, adding:
“IV Iron During Active Bacterial Infection: To Give or Not to Give?
When I started my Haematology training, the answer was usually ‘No’ or at least, ‘Proceed with caution.’
The concern was simple: iron is essential for bacterial growth, so could IV iron potentially ‘feed the bacteria’ and worsen infection?
But is it time to reconsider?
A recent large retrospective study published in Blood (2026) examined over 85,000 hospitalised patients with acute bacterial infections (including bacteraemia, pneumonia, UTIs and cellulitis) receiving antibiotics, with coexisting iron deficiency anaemia.
Interestingly, patients receiving IV iron had more days alive compared with matched controls.
The takeaway?
While observational data cannot establish causation, these findings are reassuring and challenge the assumption that IV iron during active bacterial infection necessarily worsens outcomes.
A reminder of other important cautions and contraindications with IV iron:
- Hypersensitivity reactions, including rare anaphylaxis
- First trimester of pregnancy (limited safety data)
- Hypophosphataemia, particularly with ferric carboxymaltose
- Extravasation and potentially permanent skin staining
- Anaemia unrelated to iron deficiency
- Iron overload or disorders of iron utilisation
- Decompensated liver disease
Always consider the specific formulation and individual patient risk factors.”
Title: A retrospective, real-world study of IV iron use to treat iron deficiency anemia during acute infection
Authors: Haris Sohail, Jennifer E. Collins, Kok Hoe Chan, Mohammad Ahsan Alamgir, Amir Kamran
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