First Quarter 2008 - Issues in Hematology - ION Solutions

established, and the test dose has not proved to alter thetherapeutic plan. In Europe, the test dose and black boxwarning with low-molecular-weight iron dextran have beenabandoned. With this dosage, serious adverse events areextremely rare, and any adverse event that has occurredwith iron dextran has not been related to the dose orinfusion rate. 4Regarding iron salts, when the total dose administered isless than 200 mg ferric gluconate or 300 mg iron sucrose,acute, infusion-related reactions are uncommon. No testdoses are required with these salts.IV IRON AND THE EFFICACY OF ESA THERAPYThe Centers for Medicare and Medicaid Services (CMS)has recommended that the use of erythropoiesis–stimulating agents (ESAs) begin at a hemoglobin level of