BSPGHAN 2021 Virtual Annual Meeting

27- 29 April 2021

HYPOPHOSPHATEMIA AFTER TREATMENT OF IRON DEFICIENCY WITH FERRIC CARBOXYLMALTOSE (FCM) INFUSION IN PAEDIATRIC INFLAMMATORY BOWEL DISEASE IN A TERTIARY PAEDIATRIC GASTROENTEROLOGY CENTRE

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kyl
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kyl
18 days ago

Thank you for the interesting poster. Did any of these patients display signs of hypophosphataemia?

Which was a phosphate level post infusion checked in the first place? What was the interval between iron infusion and the post-infusion blood test?

Dhandayuthapani Rajkumar
Dhandayuthapani Rajkumar
18 days ago
Reply to  kyl

Hey, Thanks for the comment. None of the patients showed any severe signs of hypophosphataemia.

This was a retrospective review and bloods done prior to date of ferrinject were reviewed. The bloods done post infusion were also reviewed, with the drop in phosphate levels mostly noted within 2 weeks.

David Campbell
David Campbell
18 days ago

Thank you this looks very important and perhaps needs some fairly senior discussion with the hospital trust. I think you may be in possession of some data that needs some consideration of a change in practice (and all of us likewise who are unaware of the dangers that you are highlighting).
This looks does indeed look potentially dangerous. Phosphate levels of 0.2 are potentially arrhythmogenic. I think it would help to add units of measurement in the next stages of investigation.
Secondly, I wonder if your comment about serum phosphate levels and delta phosphate levels is in fact incorrect. There is a very clear trend of lowest T2 levels in the lowest T1 levels. Not administering Ferric carboxymaltose to any child with a phosphate less than 1.0mmol/l would be a safe starting point.
I am sure the changes in phosphate concentrations are temporary, but I would suggest that is not the point.

You may already be way ahead of me, but if there are mitigating factors not presented in this abstract, I would be grateful to hear of them.
Thank you

Dhandayuthapani Rajkumar
Dhandayuthapani Rajkumar
18 days ago
Reply to  David Campbell

Thank you for your comments. The phosphate measurements were in mmol/L. Do appreciate the observation of intial low PO4 levels mitigating the risk of further drop post ferrinject infusion, however given the small scale of this review, it was not possible to conclude that with certainty.

As suggesed, we are revieweing our local guidance for monitoring biochemical parameters pre and post ferrinject infusion at present. Thank you once again.

David Campbell
David Campbell
18 days ago

And thank you for your response. You still might have come up with something very important. Please keep us updated on your work. It may be small scale but what you have found certainly is sufficient to show there is a potentially important problem that needs to be pursued.
Well done!