Intravenous (IV) iron therapy

What is iron (oral and intravenous)?

Iron is an essential nutrient for your body. It is an important part of haemoglobin (Hb), the red pigment which gives blood its colour and which carries oxygen around your body. You may be prescribed Iron therapy in the form of tablets or as an Iron infusion. Your doctor will discuss which is the best option for you and look at the underlying cause for the iron deficiency and how to correct this.

You may have to take Iron tablets for a long time to maintain your haemoglobin stores. You should take your Iron supplements on an empty stomach (preferably one hour before food), with a drink containing vitamin c (eg orange juice).

Why do I need iron infusions?

Your blood results have shown that the amount of iron you have in your blood is low. You need iron so your body can make new haemoglobin and red blood cells to carry the oxygen your body requires.

Therefore, it is important to have enough iron in your blood. Giving Iron directly into a vein is a way to increase the body’s iron levels quickly. It is a more immediate treatment than tablets or dietary changes.

Iron infusion benefits

Your blood iron level will increase, and this may result in your haemoglobin increasing as well. You may notice that you are less tired, have more energy, better concentration, and become less breathless when exercising. Less gastrointestinal side-effects such as constipation.

Iron infusion risks and side effects

Intravenous irons are widely used and are also considered safe in pregnancy, but like all medications can have some unwanted side effects that include:

• Metallic taste in your mouth – this is common and normally disappears within 15 minutes of you having the injections.
• Lightheaded, sick, or dizzy. If you have these symptoms let the nurse know
• Nausea and injection site reactions are considered common (more than 1% to fewer than 10%) and include redness, swelling, burning, pain, bruising, discoloration, and/or irritation at the site of infusion.
• Other reactions you may notice are:
  • lowering of the blood pressure
  • tingling or numbness of the limbs
  • abdominal discomfort
  • skin flushing
  • swelling of hands and feet
• Delayed reactions may also occur with iron that is given straight into the vein, these can be severe. They are characterized by arthalgia (joint pain), myalgia (muscle pain) and sometimes fever, The onset varies from several hours up to four days after administration. Symptoms usually last two to four days and settle spontaneously (without noticing) or with the use of simple pain relief such as paracetamol.
• On rare occasions skin staining can occur from the IV iron infusion. This can be significant and permanent. If you experience any discomfort during the infusion, it is important that you tell the nurse/midwife immediately.

Should you feel unwell in the days or weeks after the infusion, you should contact your doctor or your nurse/midwife. A blood test may be needed to check the phosphate level; sometimes oral phosphate tablets are needed to replace the phosphate. This situation is uncommon.

Acute severe anaphylactic (‘allergic’) reactions are considered rare (between 1 in 1,000 and 1 in 10,000 patients).

Before you receive iron injections

Stop taking your iron tablets the day before coming to your first appointment. Tell your doctor if you:

• Had severe asthma, eczema, or another atopic allergy.
• Had systemic lupus, erythematosus, rheumatoid arthritis or any other immune or inflammatory condition.

You should not receive iron injections if you are:

• Known to have liver disease – certain Iron products may not be suitable for you. Please discuss with your hepatologist.
• Known to be sensitive (allergic) to any iron preparations intended for intramuscular (given in a muscle) or intravenous (given via a vein) administration.
• You have any acute or chronic infections.

How will the iron be administered?

All infusions are administered onsite. IV iron can be given directly into the vein via a cannula (a tube that is inserted into your vein). The iron infusion will be given through a pump which takes from 15 minutes up to 4 hours depending on the iron product prescribed.

Your doctor will confirm which iron preparation you will receive and how long this will take. If you have any pain/discomfort at the infusion site at the point of administration let your nurse/midwife know immediately.

After the infusion

A member of staff will be in the room observing you for 30 minutes after the infusion to ensure that you have not had any acute hypersensitive (allergic like) reaction to the iron injection. If you feel well after this, you will be allowed to go home.

How often will I need to have an infusion?

This varies from patient to patient and why you are prescribed the Iron infusion. In some patients usually only twice. The second final infusion is normally a week later. You will then be seen in an out-patient clinic about one month later.

A week before this next appointment you will need to have a blood sample taken. This allows the doctor to review the results before you visit to see whether you require more iron and if so, the dose required. If your blood test results are within range, the iron infusions will stop.

You may need more iron to maintain the levels expected or you will be discharged. You will continue to have the iron infusions until your blood test levels come into target range.