Using IV iron preparations for management of iron deficiency can cause anaphylactic reaction characterized by Hypotension (low BP). However, anemia is often associated with low BP initially, and as the hemoglobin increases the BP rises to normal.

Dear Dr. Muhammad Yousuf at first I am so grateful for your kind contribution

bu I read in the ferric carboxymaltose prescribing information they recommends monitoring patients for signs and symptoms of hypertension following each FCM administration [FDA, 2013c]. Muhammad Yousuf

Once it leads to low blood pressure, it is hypotension

Kindly check https://www.hindawi.com/journals/anemia/2015/763576/

thanks for your nice contribution dear Chinaza Godswill Awuchi

Hypertension = high blood pressure

&

Hypotension = low blood pressure

I am not MD, thank so much Laith G. Shareef .

Dear Md. Abdur Razzak Choudhury really appreciates your kind contribution,

the objective of this question is to know which type of blood pressure changes we notice while administering iron therapy ? is it hypo- or hypertesion?

Dear Laith G. Shareef

Anemia, hypotension, and hypertension after parenteral iron: Explanation?

Anemia is a complex topic and those not having in depth knowledge of blood disorders may not be clear about many of its aspects. Here I will try to give a brief relationship of anemia and particularly iron deficiency anemia, with hypotension (low BP) or hypertension (high BP) with references.

Relationship of anemia and hypotension

All patients with anemia, whether acute (due to sudden uncontrolled bleeding), or chronic (long-standing) of any type (iron deficiency, B12 deficiency, hemolytic anemias, or anemia due to bone marrow failure) are associated with hypotension to decreased number of Red Blood Cells. Such patients often complain of headache, dizziness, and if BP is checked when patient is standing, BP usually falls down compared to when lying down or sitting position (i.e. Orthostatic hypotension due to volume loss). These symptoms are more severe with sudden and severe anemia and older patients compared with chronic, mild anemia in young patients (1-3).

1. Article A review on anaemia – types, causes, symptoms and their treatments.

2. Article Hypovolemic shock - A review

3. Article Orthostatic Hypotension as a Manifestation of Vitamin B-12 Deficiency

Why parenteral iron can cause both hypotension and hypertension?

Older parenteral preparations of iron (e.g. iron dextran) were more likely to anaphylactic reaction compared to newer ones (e.g. Ferric Carboxymaltose, and iron sucrose). One of the features of such reactions (4) is HYPOTENSION (low BP) and urgent treatment may be life-saving. Giving parenteral iron is recommended to be under close observation giving a initial small dose to watch for this reaction, with arrangements to treat this reaction urgently, because it can be fatal (5).

4. Article Use of parenteral iron products and serious anaphylactic-typ...

5. Article Fatal anaphylactic reaction to iron sucrose in pregnancy

Once a patient with confirmed iron deficiency anemia has received IV iron, the response is seen over days to weeks by a rise in hemoglobin level due to production of RBC in the bone marrow. Once hemoglobin improves, the BP rises to normal, but in previously hypertensive patients, the BP may rise above normal again.

One of the important group of patients where parenteral iron is recommended is patient who have chronic kidney disease stage V (end-stage renal disease) and those on regular dialysis. Such patients often have high BP as part of disease, but BP may be controlled due to anemia. When parenteral iron is used in such patients along with erythropoiten preparations, the blood pressure may rise (hypertension) and may lead to more cardiovascular mortality. Therefore, it is not recommended to keep hemoglobin such patients in the normal range (6-8).

6. Article Effects of Intravenously Administered Iron on Systemic Blood...

7.Article Options for intravenous iron supplementation in hemodialysis patients

8. Article Administration of Parenteral Iron and Mortality among Hemodi...

Brief summary of relationship of anemia, parenteral iron with hypotension and hypertension.

1. Low BP (hypotension) is common in anemia of any type

2. Intravenous iron, can lead to severe reaction called anaphylactic shock with low BP (hypotension) as one of the prominent feature

3. After giving parenteral iron, the low BP will increase to normal, but those who had high BP previously, BP may become abnormally high (hypertesion) needing drugs to control it.

4. In patients on dialysis, IV iron is often given with erythropoeitin injections. Such patients on dialysis have high BP as a manifestation of kidney disease, and once anemia improves, BP may become high (hypertension).

Those who want details can read my above contribution and check references for further knowledge.

Dear Dr. Muhammad Yousuf , you left such a highly valuable input for this discussion, really thank you for your efforts, we learned from you an ideal academic method for discussion and reporting.

Best regards