Why Choose Montefiore Einstein for Iron Deficiency Anemia Care?
One of the first programs of its kind, the Montefiore Einstein e-IRON Program is an innovative, asynchronous telemedicine referral platform developed for triaging and expediting the management of patients with iron deficiency and IDA who require intravenous (IV) iron infusion. Introduced during the COVID-19 pandemic, our electronic medical records (EMR)-based e-consult platform is available to referring providers, facilitating the electronic referral of patients requiring IV iron to Hematology. The platform ensures effective supervision by our team of world-renowned hematologists while dispensing with the traditional requirement of a face-to-face Hematology clinic visit prior to iron infusion, which can often result in significant delays and undermine the usefulness of this intervention. This paradigm shift in patient care effectively expedites, simplifies and standardizes the IV treatment of iron-deficient patients across a broad range of indications. We also offer access to the latest iron formulations that allow for administering a TDI of iron in a single visit. Our world-renowned team of specialists has unparalleled expertise in the administration of IV iron and is committed to ensuring patient safety and the highest-quality care at locations in the Bronx and the broader New York metropolitan area including Westchester county and Hudson valley.
With more than 1,000 referrals submitted to the program annually, e-IRON has become widely adopted by primary care providers, obstetricians, gynecologists and other specialists at Montefiore Einstein as the preferred method for referring patients who could benefit from IV iron treatment. Since the implementation of e-IRON, we have seen an unprecedented reduction in wait times between referral and IV iron administration. Novel modifications to the e-IRON platform have also been instituted to preserve the efficacy of the process without sacrificing the holistic management expected during a traditional face-to-face Hematology encounter, including addressing the underlying etiology of the iron deficiency or IDA and ensuring appropriate follow-up.
Your e-IRON Program Team
Mark H. Chaitowitz, MD
Our multidisciplinary team of world-renowned hematologists and specialized advanced care providers specializes in the prevention and management of iron deficiency and IDA and addresses the needs of all patients who require IV iron therapy. Our e-IRON platform ensures effective supervision by our team of experts and effectively expedites, simplifies and standardizes the treatment of iron-deficient patients with IV iron across a broad range of indications.
Advanced Treatments for Iron Deficiency Anemia
As a function in the Montefiore Einstein Epic EMR system, e-IRON is made available to referring providers to facilitate an electronic referral to Hematology for consideration for IV iron. Our template-based design ensures that all required information, such as symptoms, experience with oral iron and current lab work, is included in the electronic referral. A specialized hematologist generally evaluates referrals through e-IRON within 48 hours of the electronic referral and determines if IV iron is appropriate. Iron infusions typically occur within 10 business days of the referral. The hematologist may also specify if a face-to-face Hematology appointment is required. In cases where IV iron is not deemed appropriate, guidance will be provided regarding alternative management. Our e-IRON protocol also includes routine screening for a history of heavy menstrual bleeding at the time of the iron infusion, and we have instituted an expedited referral pathway to gynecology providers when necessary.
We offer access to the latest iron formulations, such as ferric carboxymaltose (Injectafer®) and low-molecular-weight iron dextran (INFeD®), which allow for the administration of a TDI in one visit to enhance convenience. Most patients complete their treatment with a single visit and usually do not require more than two visits. The administration of IV iron is commonly performed at our dedicated infusion suite at the Montefiore Medical Park Hematologic and Non-Oncology Infusion Center under the supervision of board-certified hematologists and specialized nurse practitioners.
Research & Clinical Trials for Iron Deficiency Anemia
We are leading collaborative IV iron therapy research and have conducted several studies evaluating the feasibility, efficacy and efficiency of e-IRON. We are also actively participating in clinical trials studying the safety and efficacy of various IV iron formulations for IDA. Through our clinical trials, our patients can access emerging technologies and innovative treatments that are otherwise unavailable to the general public.
Our pediatric specialists participated in the multicenter clinical trial that led to the expanded Food and Drug Administration approval of Injectafer®, an IV ferric carboxymaltose, to include pediatric patients one year of age and older with IDA who have an inadequate response to oral iron therapy. We are also actively participating in a phase 3, randomized multicenter, multinational study to evaluate the safety, efficacy and pharmacokinetics of ferumoxytol or IV iron infusion in comparison to iron sucrose (Venofer®) for the treatment of IDA in pediatric subjects with chronic kidney disease.
A recent meta-analysis conducted by our Cardiology Division showed that IV iron–carbohydrate complex therapy in patients with iron deficiency and heart failure with reduced ejection fraction was beneficial in lowering the risk of hospitalization due to heart failure.
e-IRON Program
From our initial study of the pilot e-IRON Program, our research revealed that by dispensing with the need for a face-to-face Hematology visit, e-IRON simplifies the process of referral for IV iron across a broad range of indications and significantly reduces the time required from referral to infusion scheduling, accelerating the administration of IV iron when appropriate. Roughly 2% (2/81) of cases where IV iron was indicated, in-person, face-to-face appointments were required.
Results from 477 unique consults from more than a year of experience with the e-IRON platform verified the feasibility and efficiency of a telemedicine approach in expediting the management of patients requiring IV iron. In a study of 239 pregnant women who were referred to the e-IRON Program, our researchers found that e-IRON facilitates rapid triage and treatment of anemic pregnant patients requiring IV iron and that the earlier the infusion is administered, the greater the increment in hemoglobin level, underscoring the value of a protocol that minimizes the time interval between referral and infusion. Of 958 referrals to the e-IRON Program during 2023, IV iron was approved in roughly two-thirds of the cases, and a traditional face-to-face encounter was recommended in 3% of the cases.
From an analysis of 266 women of reproductive age with IDA who were referred for consideration for IV iron via e-IRON, our data provided evidence that the pathological role of heavy menstrual bleeding was underrecognized, resulting in high recurrence rates of IDA. As a result of this research, we modified our e-IRON protocol to include routine screening for a history of heavy menstrual bleeding at the time of the iron infusion and have instituted an expedited referral pathway to gynecology providers when necessary.
Care Navigation & Support Services for Iron Deficiency Anemia
If you or your child is newly diagnosed with iron deficiency or IDA requiring IV iron therapy, our world-renowned team at Montefiore Einstein Hematology is here to provide you with exceptional support, care and resources. Our compassionate and deeply knowledgeable doctors, nurses, specialists and support staff are dedicated to helping you at every step of your care journey.
About Iron Deficiency & Iron Deficiency Anemia
Iron deficiency is one of the most common nutritional deficiencies in the world and the most common cause of anemia. Most cases of iron deficiency and IDA can be successfully managed with oral iron supplementation. However, a substantial number of individuals will only achieve normal hemoglobin levels after protracted courses of treatment, which may often be associated with significant gastrointestinal (GI) toxicity. With the availability of new formulations that allow for TDI, eliminating the need for multiple infusion visits, IV iron has become increasingly recognized as a rapid, reliable and safe strategy in addressing IDA.
For individuals with severe iron deficiency and/or IDA, the circumstances and associated conditions we treat with IV iron infusion include the following:
- Blood loss from conditions such as heavy menstrual bleeding (menorrhagia), GI bleeding, postoperative anemia and bleeding disorders
- Inability to use oral iron
- Cancer
- Intolerance to oral iron
- IDA in pregnancy
- Malabsorption causing impaired oral iron absorption from conditions such as inflammatory bowel disease, celiac disease, H. pylori gastritis, intestinal failure, GI surgery (such as gastric bypass surgery and resection of the small intestine) and short bowel syndrome
- Nonhemodialysis-dependent chronic kidney disease
- Nutritional deficiency (a diet low in iron)
- Optimization of preoperative anemia before major elective surgery or urgent surgery
- Symptomatic heart failure with reduced ejection fraction to improve exercise capacity
- Unsatisfactory response to oral iron
