IV Iron Reduces Mortality Risk in Iron Deficiency Anemia Without Increasing Infection Severity, With Haris Sohail, MBBS

Intravenous (IV) iron administration demonstrated a positive impact on short- and long-term mortality in patients with iron deficiency anemia during acute infections, irrespective of infection type, according to data from a new retrospective cohort study.1

Presented at the 67th American Society of Hematology (ASH) Annual Meeting and Exposition by Haris Sohail, MBBS, a hematology and oncology fellow at Charleston Area Medical Center, these data challenge a longstanding controversy in IV iron administration centering around the perceived risk of worsening infection.1

Although clinical trials have suggested that IV iron can improve symptoms and quality of life in patients with iron deficiency anemia, lingering concerns from observational studies have limited its usage in clinical settings. The theoretical risk that any administration of iron, IV or otherwise, could worsen the risk or severity of infection is tied to the proliferative effect it has on bacterial growth.2

“There has been some theoretical concern that during infection, if you give IV iron, it might cause bacteria to grow, and it might cause worse outcomes,” Sohail told HCPLive in an exclusive interview. “Honestly, though, there’s no real-world studies or real-world data supporting or refuting this belief.”

Sohail and colleagues conducted a retrospective cohort study using data from the TriNetX Research Network, identifying adults aged ≥18 years between 2000 and 2024 who were diagnosed with either MRSA bacteremia, pneumonia, urinary tract infection (UTI), colitis, cellulitis, or bacterial meningitis. Additionally, patients were required to have a concurrent diagnosis of iron deficiency anemia at the time of infection and had to have received antibiotic therapy within 2 days of diagnosis.1

A total of 15,022 patients with MRSA bacteremia, 27,062 with pneumonia, 23,114 with UTIs, 7938 with colitis, and 13,005 with cellulitis were enrolled in the study. Among these groups, IV iron administration was associated with substantially lower mortality; however, 143 participants with meningitis were also included and exhibited no statistically significant difference in mortality.1

Patients with MRSA bacteremia exhibited lower mortality at both 14 days (risk ratio [RR], 0.57; 95% CI, 0.42-0.52; HR, 0.46; 95% CI, 0.41-0.51; P <.0001) and 90 days (RR, 0.72; 95% CI, 0.68-0.76; HR 0.68; 95% CI, 0.64-0.73; P <.0001). Patients with pneumonia also saw reductions at 14 days (RR, 0.48; 95% CI, 0.45-0.51; HR, 0.46; 95% CI, 0.43-0.5; P <.0001) and 90 days (RR, 0.72; 95% CI, 0.69-0.74; HR, 0.67; 95% CI, 0.65-0.7; P <.0001).1

Patients with UTIs saw lowered mortality at 14 days (RR, 0.49; 95% CI, 0.44-0.54; HR, 0.47; 95% CI, 0.43-0.52; P <.0001) and at 90 days (RR, 0.73; 95% CI, 0.69-0.77; HR, 0.7; 95% CI, 0.66-0.73; P <.0001). Those with colitis also had lowered mortality at 14 days (RR, 0.61; 95% CI, 0.52-0.72; HR, 0.6; 95% CI, 0.51-0.71; P <.0001) and 90 days (RR, 0.8; 95% CI, 0.74-0.87; HR, 0.77; 95% CI, 0.71-0.84; P <.0001). Patients with cellulitis saw lowered mortality at 14 days (RR, 0.56; 95% CI, 0.47-0.66; HR, 0.55; 95% CI, 0.46-0.65; P <.0001) and 90 days (RR, 0.73; 95% CI, 0.68-0.79; HR, 0.71; 95% CI, 0.65-0.77; P <.0001).1

Additionally, Sohail and colleagues noted that all subgroups, except for meningitis, saw substantial improvements in hemoglobin levels, which were measured 60-90 days after treatment. Patients given IV iron showed greater increases in hemoglobin than those who did not; MRSA bacteremia (1.6 vs 1 g/dL), pneumonia (1.5 vs 0.97 g/dL) UTI (1.5 vs 1 g/dL), colitis (1.6 vs 1.0 g/dL), and cellulitis (1.6 vs 1.1 g/dL) Again, meningitis patients showed no significant difference (1.4 vs 1 g/dL; P = 0.44).1

Ultimately, Sohail and colleagues determined the efficacy of IV iron in improving mortality in patients with a variety of infection subtypes. The team also noted that these data highlight the potential role of IV iron as a safe adjunctive therapy in hospitalized patients.1

“Treating iron deficiency is not just treating the patient, it’s actually making a healthier community,” Sohail said. “The goal would be a healthier community, which will be more productive.”

Editor’s Note: Sohail reports no relevant disclosures.

References

1. Sohail H, Wilson L, Collins J, Kamran A. Deciphering the dilemma: Intravenous (IV) iron use in iron deficiency anemia during acute infections. Abstract presented at the 67th American Society of Hematology Annual Meeting. Orlando, FL. December 6-9, 2025.

2. Foley PW, Kalra PR, Cleland JGF, et al. Effect of correcting iron deficiency on the risk of serious infection in heart failure: Insights from the IRONMAN trial. Eur J Heart Fail. 2025;27(1):166-173. doi:10.1002/ejhf.3504