e20563 Background: Anemia occurs frequently during cancer chemotherapy and contributes to the development of fatigue. Erythropoiesis-stimulating agents (ESAs) are successfully utilized in this setting but recent studies have raised concerns regarding their potentially harmful effects. Iron deficiency, real or functional is a common problem among cancer patients. In addition to bleeding and poor oral intake new studies have hypothesized that cancers as well as chemotherapy can lead to overproduction of the hormone hepcidin that shifts usable iron to the storage pool. We hypothesized that chemotherapy induced anemia (CIN) could be reversed simply by increasing the supply of usable iron by intravenous iron infusion and adopted this practice empirically at our UNC affiliated community practice. Methods: We conducted a retrospective chart review of 50 patients with documented CIN. Each received treatment with intravenous iron preparations to provide between 1,000–4,000 mg of elemental iron over a period of 1–4 weeks based on serum iron and % saturation. The goal was to identify the frequency of transfusion, ESA use, adverse events and overall cost effectiveness of this approach. Results: Intravenous iron therapy (IIT) led to an average 3g/dL increase of hemoglobin in 80% of all patients with a hemoglobin level at or below 10g/dL during chemotherapy. Transfusion could be avoided in 95% cases. Total usage of ESAs to maintain the target hemoglobin level above 10g/dL during chemotherapy was reduced by 50% of the standard recommended dose. Total cost of infusing 1,000 mg of IIT was roughly 60% of a single 40,000 unit dose of erythropoietin. We recorded a 4% incidence of grade I-II and 2% incidence of grade III-IV adverse events but no fatalities. Adverse events were significantly more frequent among young females and Hispanics. Conclusions: A prospective study should be designed to confirm the encouraging result of this review. IIT may become a standard component of anemia management during chemotherapy. It appears to be safe and cost effective, can be given alone or in combination with ESAs and we found it suitable for routine use in community cancer clinics. No significant financial relationships to disclose.