| Mild: Itching, flushing, sensation of heat, slight chest tightness, hypertension, back/joint pains | - Stop iron infusion for ≥15 minutes
- Inform doctor
- Monitor pulse, blood pressure, respiratory rate, O2 saturation
- Wait and watch
- Avoid use of antihistamines, which can cause hypotension, somnolence, diaphoresis, and tachycardia, mimicking anaphylaxis
| - Administer IV glucocorticoid (eg, hydrocortisone 200 mg or methylprednisolone 40 mg IV)
- Restart iron infusion at reduced rate (eg, 50%)
| - Treat as for moderate/severe reaction
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| Moderate: As in mild reaction plus urticaria, edema, cough, chest tightness, shortness of breath, nausea, emesis, tachycardia, or hypotension or Severe: Wheezing/stridor, cyanosis, loss of consciousness, cardiac/respiratory arrest | - Stop iron infusion
- Monitor pulse, blood pressure, respiratory rate, O2 saturation
- Call doctor or summon resuscitation team if severe
- Place in recumbent position if tolerated, elevate lower extremities; place pregnant patients on left side
- Promptly give epinephrine (adrenaline) IM in the anterolateral thigh 0.3 to 0.5 mg of 1 mg/mL (1:1000)
- Initiate continuous electronic monitoring (BP, HR, RR, pulse oximetry)
- Oxygen 8 to 10 L per minute via facemask
- If hypotensive, give volume (eg, isotonic volume load, 1 to 2 liters IV)
- If severe, give IV glucocorticoid (eg, hydrocortisone 200 mg or methylprednisolone 40 mg IV)
| - Observe for one hour after infusion complete
- Document event
- Consider future treatment strategy
| - Summon resuscitation team
- Initiate ACLS protocol if needed
- Repeat epinephrine (adrenaline) IM 0.3 to 0.5 mg of 1 mg/mL (1:1000) after five minutes if first dose and volume loading are not successful; most patients with anaphylaxis respond to one, two, or at most three doses of IM epinephrine
- If hypotensive, insert two large bore IV catheters and continue fluid resuscitation
- Transfer quickly to critical care unit
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