Iron replacement therapy: entering the new era without misconceptions, but more research is needed

Iron replacement therapy dates back to the 17th century, when Sydenham first proposed the use of an oral iron salt to treat "chlorosis", a disorder of adolescent girls and young women initially believed to be an hysterical disease, but later recognised as due to iron deficiency anaemia. The first iron preparations for intravenous (IV) administration entered the clinical scenario in the second half of the past century. They were based on a common structure, i.e. a carbohydrate shell surrounding a core containing Fe3+ hydroxide particles. The newer preparations also share this structure, the difference lying in the chemistry of the carbohydrate moieties forming the shell. High molecular weight iron dextran was used initially, but soon raised safety concerns due to an unacceptable rate of severe adverse effects, including death due to anaphylaxis. This fostered fears that strongly limited physicians' use of parenteral iron and created emotional barriers which still partially remain.