If a patient is above target Hgb and does not require ESA, which approach is correct per policy?

• A. Manage with IronWorks protocol
• B. Do not use IronWorks protocol
• C. Increase iron supplementation
• D. Cancel all therapies

Answer: (B)

When a patient’s hemoglobin is already above the target and they don’t need an erythropoiesis-stimulating agent, you don’t apply the IronWorks protocol. IronWorks is a tool used to guide IV iron dosing in patients who are on ESAs to help maintain a target Hgb. If ESAs aren’t being used, there’s no indication to run that dosing protocol, and adding iron could risk iron overload. Instead, continue routine monitoring of iron parameters (like ferritin and TSAT) and hemoglobin, and only treat iron deficiency if it’s clearly present. This avoids unnecessary iron supplementation and aligns with the goal of keeping iron administration appropriate to the patient’s current therapy and targets.