Anemia
INESSS PMN No 888030 (September 2026) is Québec IV iron in adults. Clinic doses, infusion rates, and coverage codes live in the PMN and OIPI — open those.
Diagnose
- INESSS Institut national d'excellence en santé et services sociaux
| Decision | Guideline |
|---|---|
| Who | Adults ≥18 y with iron deficiency per PMN ferritin / TSAT.General ferritin <30 mcg/L.
Other cutoffs for inflammation, CKD, HFrEF, ESA-cancer — open the PMN table.
|
Treat
Open the INESSS PMN and OIPI for milligram schedules, dilution volumes, infusion rates, and RAMQ codes.
- INESSS Institut national d'excellence en santé et services sociaux
| Decision | Guideline |
|---|---|
| Who / when IV iron | |
| Prefer IV when | Prefer IV when oral iron is ineffective or intolerant, and in the named PMN situations. Open the full list.
|
| Contraindications | Prior anaphylaxis to one IV iron formulation is a contraindication to that formulation, not to the whole protocol.
|
| Products (September 2026) | |
| Ferric carboxymaltose | September 2026 PMN adds ferric carboxymaltose (carboxymaltose ferrique), on the RAMQ list since November 2025 per the INESSS publication, alongside other parenteral options named in the protocol — open the live table.
INESSS fer IV repertoire opens in a new tabINESSS opens in a new tab |
| Hypophosphatemia | Hypophosphatemia risk may increase with repeated carboxymaltose doses.Open the PMN. |
| Test dose | No routine test dose or premedication is recommended for the parenteral preparations in the protocol.Administer where anaphylaxis can be managed (epinephrine available). |
| Posology | Open the PMN and OIPI for posology, infusion rates, and maximum per dose. INESSS opens in a new tabINESSS OIPI fer IV opens in a new tab |
| Infusion reactions | |
| Distinguish | During infusion, distinguish anaphylaxis vs Fishbane vs isolated symptoms.Fishbane is non-allergic, variable, usually early, and without strong anaphylaxis signs.
Follow the PMN section 7 decision algorithm and the OIPI.
Do not reprint the tree. INESSS opens in a new tabINESSS OIPI fer IV opens in a new tab |
| Antihistamines | Antihistamines should not be given for Fishbane reactions (may worsen) — PMN algorithm note. |
| Next dose | After Fishbane or isolated symptoms without anaphylaxis, the next administration may proceed with protocol adjustments (for example lower dose or slower rate) as in the algorithm — open the PDF. INESSS opens in a new tabINESSS OIPI fer IV opens in a new tab |
Follow-up
- INESSS Institut national d'excellence en santé et services sociaux
| Decision | Guideline |
|---|---|
| Labs | Lab follow-up modalities are in the PMN (ferritin / TSAT / Hb timing).Open that section. |
Reviewed 28 September 2026 against the official sources below.
Sources
Blue square: Québec. The code names the body; each section's key gives its full name.