Iron Infusion

Hi. Simon here, doctor at Preston Family Medical and I wanted to talk about iron infusions after a question from a patient this week.

Iron. We need it for our red blood cells making our hemoglobin which helps carry oxygen around the body. There’s generally three reasons that there’s inadequate iron and the first is we’re not taking in enough iron. That is because our diet is restricted; vegetarian, vegan, although certainly we can have more than enough iron in those diets, we just need the variety. We’re just simply not eating enough overall or we’re quite restricted in what we eat.

Second reason, we’re not absorbing the iron we get and this can be because of gut problems; Coeliac disease, Crohn’s disease, surgery that’s occurred on the gut, medications that interfere with iron absorption, or foods actually that interfere with on solution as well. Very high amount of tea, drinking tea in your diet can actually bind on in the gut and stop you absorbing it.

The third reason is we’re losing iron. Now in women, heavy difficult periods tend to be the common cause there, pregnancy and then loss elsewhere. Are we bleeding from the bowels? Are we regularly blood donor? Have we recently had large surgeries, something which explains recent blood loss.

We need to find out why iron is low and is it part of explaining the symptoms, any fatigue that we might have. We really should try, a good try, of oral iron. There’s increasing evidence that every second day or every 48 hours for taking oral iron may actually be better than every day, because of some research going into a hormone called a hepcidin, the iron absorption hormone, and that actually too much iron, oral irons or taking the iron supplement too regularly, may actually, strangely, suppress iron absorption and that we’re better off taking it less regularly. We also tend to get less constipation if we’re taking it less frequently as well.

If we’ve demonstrated why we don’t have enough iron, we know why or why we’ve lost it, we’ve checked their low iron that’s having an effect on red blood cell count, there’s not enough red blood cells in there, what’s called anemia, and we’re really not tolerating oral iron and we’ve given it a good try, then iron infusion can be appropriate, but it’s certainly not something to jump into and that’s because of risks.

The risks are, the two main ones, are allergy, having an allergic anaphylactic reaction to the iron infusion, that one’s more common with some older preparations. The new preparation, called Feriject, is a safer iron option and it’s now safe and appropriate to give this in general practice.

iron stains after infusion complication
iron stains after infusion complication, image from

Then the second concern is staining of the skin. As you can see from this picture, that staining can be impressive and, unfortunately, it is permanent. This is really rust that’s escaped into the skin and that staining is permanent.

When performing an iron infusion, we do a few things to try and reduce the risk. When we’re placing the needle of the drip into the vein, we give a large flush of salt water to saline to make sure that it’s flowing well and none of the iron solution is escaping into the skin and during the iron infusion we’re watching very closely to make sure none of the iron escapes as well. Those are the big risks around iron staining.

During the procedure as well, we’re observing you; blood pressure, temperature, pulse and we need you to bring a book or a magazine because it’s a pretty slow process. We need to observe you for at least 30 minutes after the procedure as well, to make sure there’s no late allergy symptoms.

In the 24-48 hours after iron infusion, you can actually feel pretty rotten and that’s the bone marrow complaining about all this flood of excess iron and it’s pulling it up out of the circulation. People can describe bone pains, muscle pains, some flu like symptoms and that’s pretty common, but a normal part of the iron infusion.

The new modern iron infusion with Feriject (Ferric carboxymaltose) is a real game changer for people who are really unable to tolerate oral iron, but iron infusion is not a magic bullet for all types of fatigue and low energy. It really needs to be the right person because it does have some risks associated and, like a lot of things in medicine, that see saw of risk versus benefit, we need to think about how it best fits into the picture. Is it the best option for you?