Efficacy of Enteral Iron Supplementation in Critical Illness

Critical illness is characterized by the anemia of inflammation, which is partially caused by sequestration of iron from bone marrow sites of erythropoiesis into storage within the reticuloendothelial system as ferritin. Also the majority of critically ill patients are hypoferremia, the efficacy of iron supplementation remains unknown. Furthermore, several retrospective studies have found an association between iron overload and infection. However, the relative risk/benefit profile of enteral iron supplementation with respect to infection has not been studied. The purpose of this study is to evaluate the efficacy of enteral iron supplementation in critically ill patients. The hypothesis is that enteral iron supplementation will result in both an improved hematocrit and a decreased need for blood transfusion, without increasing the risk of infection.

Inclusion criteria

• Age > 18 years
• Anemia (Hemoglobin < 13.0 g/dL)
• ≤ 72 hours from hospital admission
• Current tolerance of enteral medications
• Expected ICU LOS > 5 days

Exclusion criteria

• Active bleeding
• Chronic inflammatory disease
• End-stage renal disease
• Hematologic disorders
• Macrocytic anemia
• Current use of erythropoietin
• Pregnancy
• Prohibition of RBC transfusions
• Moribund state in which death is imminent
• Enrollment in another clinical trial