How will I feel after an iron infusion? There are very little side effects with intravenous iron infusions.

Patient Education: Iron Infusions

by Mackenzie Gignac

An iron infusion is an effective treatment for iron deficiency. Iron is needed to make red blood cells or haemoglobin which carries oxygen from the lungs to the muscles, tissues and organs. Low iron levels cause tiredness and affect your ability to function. As the iron stores become depleted, the haemoglobin level drops, and this is called iron deficiency anaemia.

An iron infusion is a method used to treat iron deficiency. The purpose of an iron infusion is to improve the iron deficit by directly replenishing the body’s iron stores.

St Vincent’s haematologist expert, Dr. ShuhYing Tan, helps us learn more about how iron infusions work and what can be expected from those receiving one.

How is iron deficiency treated?

There are several ways to replace and restore iron stores in the body:

  1. Oral iron in the form of tablets or liquid
  2. Intravenous (IV) infusion.
  3. Intramuscular iron (injection into the muscle). This is painful, causes skin staining, and should be avoided.

Dr. Tan says that the use of oral iron is the most common way of replacing iron and is often suitable and effective.

Oral iron is not a suitable option for everyone. The intravenous method can be considered in certain circumstances such as:

  • Difficulty taking oral iron due to side effects
  • Unable to absorb oral iron
  • Ongoing blood loss exceeding the ability to restore iron levels with oral iron
  • When there is a need to replace iron stores quickly, for example, late in pregnancy or before a major surgery to avoid a need for blood transfusions
  • Individuals with chronic kidney disease receiving EPO hormonal treatment

What is an iron infusion?

Iron infusion is a treatment where iron is given through a vein and directly enters the bloodstream. It is also called intravenous (IV) iron. A needle or cannula is placed in the arm or the back of the hand, which is then connected to a drip with iron mixed in with a saline solution.

There are different IV iron preparations available; the most commonly used these days is Ferric Carboxymaltose (Ferinject). This is the most recent addition of IV iron, and the main advantage is the significantly shorter duration of infusion of no more than 15 minutes. It is also associated with a lower risk of having an allergic reaction.

Where is an iron infusion administered?

An iron infusion is carried out in a medical facility where trained health professionals can effectively manage side effects if any were to occur during or after the infusion.

No overnight hospitalisation stay is necessary with iron infusions. ‘Patients are generally in the hospital for no more than a couple of hours,’ says Dr. Tan. The infusion itself takes around 15 minutes, and after the treatment, there is a period of observation before the patient is discharged.

If you need multiple treatments and there was no reaction during the first infusion, subsequent treatments may be able to be given at your home by a trained nurse, if this service is available.

How many iron infusions will it take to properly restore my iron levels?

Dr. Tan states that a single treatment is often sufficient to restore the iron levels. The treatment can be repeated if needed; how often the treatment is needed varies depending on the condition that is causing the iron deficiency, and whether it persists. ‘For example, if the cause of iron deficiency is diet-related (vegetarian or vegan), it is quite possible that the individual will become iron deficient again,’ says Dr. Tan. ‘However, if the iron deficiency was due to bleeding, the individual may not develop iron deficiency again if the bleeding has stopped.’

What are the side effects of iron infusions?

Iron infusion is generally given without any major issues. About one out of ten patients can experience ‘flu-like’ symptoms, such as muscle or joint ache, headache or mild fever. This usually occurs a couple of days after the infusion and settles with Panadol or Nurofen. Other common side effects include feeling sick or nausea, or a metallic taste, which should resolve after a few days.

An uncommon but *important* side effect to note is brown staining of the skin due to leakage of iron into tissues around the needle or drip site. The staining can be permanent. You should inform the doctor or nurse immediately if you experience any discomfort, burning, redness or swelling at the needle site.

A rare side effect is an allergic reaction or anaphylaxis to the iron infusion. This is the reason why the treatment is given at a medical facility with staff and resources available to manage this.

How would I prepare for an iron infusion? Do I need to fast?

Fasting is not required for the procedure, and you can take all of your regular medications for the day. Patients will be able to drive home and continue on with your normal activities after the infusion.

However, if you have an unexpected reaction, you will need to have someone else take you home. ‘You will be observed for longer in hospital and can only be discharged when you are medically stable,’ says Dr. Tan.

How long after my iron infusion will I start to feel better?

Your iron levels will be restored directly right after the infusion, however, it can take up to two weeks before you start to notice a difference and feel better.

What are the benefits & risks of an iron infusion?

An iron infusion is an effective and rapid way to replenish the body’s iron stores and the cost is covered by the pharmaceutical benefit scheme (PBS). The risks of an iron infusion are the side effects listed above.

Can the doctors at the Melbourne Blood Specialists help those seeking treatment for iron disorders?

Yes, when you are referred to MBS for an iron infusion, our haematologists will do a comprehensive review. Our specialists will assess and manage the cause of your iron deficiency. If an iron infusion is needed, our specialists will refer you to an appropriate facility.