Blood Phosphate Testing After Iron Infusion with Injectafer “Should Be Mandatory”: Study

Amid continuing concerns about the side effects of iron infusions with Injectafer, which have been linked to severe injuries associated with dangerous drops in blood phosphate levels, researchers indicate that serum phosphorus testing should be considered mandatory for certain patients undergoing the treatment.

Injectafer (ferric carboxymaltose) was introduced in 2013, as an iron infusion for adults with anemia, who are not able to be treated with an oral iron supplement and have non-dialysis dependent chronic kidney disease. However, problems after an Injectafer infusions have included reports of severe hypophosphatemia (HPP), which is a medical condition associated with drops in blood phosphate levels, increasing the risk of severe health complications like cardiac arrest, respiratory failure and death.

There are now a growing number of Injectafer lawsuits being pursued by individuals who experienced complications after an iron infusion, alleging that the drug makers failed to adequately warn about the risk and importance of blood phosphate testing after treatments.

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Side effects of the iron deficiency drug Injectafer may result in severely low phosphorous levels.


In a study published earlier this year in the medical journal Europe PMC, Italian researchers found a high prevalence of HPP among children given Injectafer to treat iron deficiency anemia (IDA) caused by pediatric inflammatory bowel disease (pIBD), concluding that serum phosphate monitoring may have helped avoid these problems.

The researchers looked at data on 128 patients treated with Injectafer over a five-year period. The subjects had a median age of 13 at the time of their first infusion. Most, 64.8%, received only one Injectafer treatment, while 35.2% received multiple injections. According to the findings, 25 of the children suffered low post-infusion serum phosphate levels, and two children developed severe HPP. However, the study did find Injectafer was effective in treating the children’s low iron levels.

“(Injectafer) administration is effective for IDA management in pIBD, including children <6 years,” the researchers concluded. “Due to the high prevalence of post-infusion hypophosphatemia, serum phosphate monitoring should be mandatory.”

Plaintiffs pursuing lawsuits over the iron infusions allege the drug makers knew or should have known about the risks associated with their treatment, and placed the desire for profits before patient safety by minimizing the Injectafer FDA label warnings, previously suggesting that serum phosphate drops were “asymptomatic” or “transient”.

While updated warnings were provided in February 2020, recommending doctors monitor serum phosphate levels among patients at risk of problems or requiring repeat courses of the iron infusion, a growing number of experts now suggest doctors should be encouraged to test blood phosphate levels for all patients.

Severe hypophosphatemia (HPP) caused by Injectafer has also been linked to reports of bone fractures, heart rhythm problems, kidney problems and a host of other ailments caused by persistent and drops in blood phosphorous levels.


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