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ASH 2025 Nonmalignant Hematologic Disorders

CE / CME

Emerging Data and Clinical Implications in Nonmalignant Hematologic Disorders: ASH 2025 Highlights

Physician Assistants/Physician Associates: 1.00 AAPA Category 1 CME credit

Pharmacists: 1.00 contact hour (0.1 CEUs)

Physicians: maximum of 1.00 AMA PRA Category 1 Credit™

Nurse Practitioners/Nurses: 1.00 Nursing contact hour

Released: February 20, 2026

Expiration: August 19, 2026

Hanny Al-Samkari
Hanny Al-Samkari, MD
Joseph J. Shatzel
Joseph J. Shatzel, MD, MCR
CME/CE Information

Activity

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IV Iron in IDA and Infection RWE: Study Design

Joseph J. Shatzel, MD, MCR:
Another important study presented at ASH 2025 was one on the use of IV iron in patients with acute infection and concurrent IDA because it shed light on certain concepts taught throughout medical school. Without much data, it has been a concern that giving iron during an infection worsens outcomes. Iron is a source of nutrition for bacteria, so it has been thought that it should be restrained. The investigators of this trial tried to answer this question.  

This was a large retrospective study conducted using the TriNetX Research Network, which encompasses more than 275 million patients worldwide.4 Patients were identified by ICD code. The IV iron cohort received at least 1 IV iron infusion up to 1 week after infection and IDA. The no-infusion cohort, the control arm, did not receive IV iron. The coprimary endpoints were survival outcomes at 14 days and 90 days. Investigators also assessed hemoglobin recovery and hospital utilization.5

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IV Iron in IDA and Infection RWE: Baseline Characteristics

Joseph J. Shatzel, MD, MCR:
Cohorts were separated by infection type. For example, in the MRSA bacteremia cohort, more than 8000 patients each were allocated to the treatment and control arms; the pneumonia cohort had approximately 19,000 in each arm; the UTI cohort had over 18,000 per arm; the colitis cohort had over 4000 per arm; and the cellulitis cohort had over 8000 per arm. This is probably one of the largest data sets to ever address a question like this.5

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IV Iron in IDA and Infection RWE: Effect of IV Iron on Survival and Hemoglobin Recovery

Joseph J. Shatzel, MD, MCR:
Perhaps the most striking outcome from this study is that IV iron appeared to influence survival. Both 14-day and 90-day survival favored the IV iron cohort. The differences were not substantial, but on such a large scale, this result is clinically meaningful. When looking at the secondary endpoints, hemoglobin increase was significantly greater in patients receiving IV iron, as one would expect.5

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IV Iron in IDA and Infection RWE: Hospital Utilization

Joseph J. Shatzel, MD, MCR:
Hospital utilization metrics included length of stay, which was similar between cohorts. There were slight differences in antibiotic use, with a modest increase in antibiotic use in the IV iron arm. Mechanical ventilation rates were similar. As expected, the transfusion requirement was lower in people who received IV iron across all subtypes examined.5

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IV Iron in IDA and Infection RWE: Summary

Joseph J. Shatzel, MD, MCR: 
The biggest takeaway for me is that there was no real signal for harm. In fact, there was a potential association with improved outcomes. These data may allow healthcare professionals (HCPs) to offer such patients iron without concerns. The survival data are hypothesis-generating, and there are some questions that can be tested prospectively. It is important to keep in mind that these data are retrospective. There were reasons physicians chose to give some patients iron and not others, so there may be inherent biases here, but in general, there are many reasons why IV iron would be a preferred treatment.

Hanny Al-Samkari, MD:
I agree. This study is hugely clinically relevant, as HCPs all over the world wonder whether IV iron can be given to sick patients, patients with infections in the ICU, etc. Overall, I am hopeful, and I agree that corroborating studies are needed to prove a real survival benefit. In my opinion, HCPs should feel comfortable giving IV iron to hospitalized patients who have acute or ongoing infections.

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