26th July 2019, Volume 132 Number 1499

Yu-Jen Chen, Christopher Lim, Jacob McCormick

Iron-deficiency anaemia is the most common form of anaemia worldwide. The incidence is particularly high in patients with colorectal cancer, as unexplained iron deficiency anaemia often prompts further investigation for…

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Iron-induced hypophosphatemia represents an increasingly recognised complication of iron infusion. A 34-year-old woman presented for surgical management of her colorectal cancer. Post-operative blood tests revealed severe hypophosphatemia, resistant to oral phosphate supplementation and large volumes of intravenous phosphate replacement. Further questioning and biochemical investigation led to the recognition of iron-induced hypophosphatemia as a contributory cause, secondary to iron infusion administered as part of pre-operative optimisation. Early consideration, diagnosis and management of this complication has the potential to reduce fluid burden associated with intravenous phosphate supplementation and optimise post-operative care.

Author Information

Yu-Jen Chen, Department of General Surgery, Royal Melbourne Hospital, Vic, Australia;
Christopher Lim, Department of General Medicine, Royal Melbourne Hospital, Vic, Australia;
Jacob McCormick, Department of General Surgery, Royal Melbourne Hospital, Vic, Australia. 


Yu-Jen Chen, Department of General Surgery, Royal Melbourne Hospital, 300 Grattan Street, Parkville, Victoria, 3052, Australia.

Correspondence Email


Competing Interests



  1. Munoz M, Gomez-Ramirez S, Bhandari S. The safety of available treatment options for iron-deficiency anemia. Expert opinion on drug safety. 2018; 17(2):149–59.
  2. Wolf M, Chertow GM, Macdougall IC, Kaper R, Krop J, Strauss W. Randomized trial of intravenous iron-induced hypophosphatemia. JCI insight. 2018; 3(23).
  3. Farrow EG, Yu X, Summers LJ, Davis SI, Fleet JC, Allen MR, et al. Iron deficiency drives an autosomal dominant hypophosphatemic rickets (ADHR) phenotype in fibroblast growth factor-23 (Fgf23) knock-in mice. Proceedings of the National Academy of Sciences of the United States of America. 2011; 108(46):E1146–55.
  4. Schouten BJ, Hunt PJ, Livesey JH, Frampton CM, Soule SG. FGF23 elevation and hypophosphatemia after intravenous iron polymaltose: a prospective study. The Journal of clinical endocrinology and metabolism. 2009; 94(7):2332–7.
  5. Anand G, Schmid C. Severe hypophosphataemia after intravenous iron administration. BMJ case reports. 2017; 2017.
  6. Carmichael JC, Keller DS, Baldini G, Bordeianou L, Weiss E, Lee L, et al. Clinical Practice Guidelines for Enhanced Recovery After Colon and Rectal Surgery From the American Society of Colon and Rectal Surgeons and Society of American Gastrointestinal and Endoscopic Surgeons. Diseases of the colon and rectum. 2017; 60(8):761–84.
  7. Brandstrup B, Tonnesen H, Beier-Holgersen R, Hjortso E, Ording H, Lindorff-Larsen K, et al. Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial. Annals of surgery. 2003; 238(5):641–8.


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