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Frequently Asked Questions..

Please see below answers to questions we get asked the most about intravenous iron infusions.

A: Iron is an essential nutrient that provides oxygen and energy to the body.

  • Iron is an important part of haemoglobin (Hb), the red pigment which gives blood its colour. Haemoglobin is the substance that carries oxygen around your body.
  • Iron is also a key component of enzymes that manufacture energy in the muscles.

Lack of iron has many symptoms including fatigue, tiredness, and exhaustion. People also report reduced physical health including feeling breathless or ‘air hunger’ climbing stairs, dizziness, chest pain or palpitations. In women hair quality can reduce with increased shedding and breaking. Other symptoms include headaches, restless legs, itching, or Pica – a desire to eat ice/paper/soil.

Mental health can also be impacted with a ‘brain fog’ , inability to think clearly, reduced thought processing or poor memory. Also, insomnia despite sleeping all the time. This can be manifest as symptoms of anxiety or depression. Libido and sex drive can also be reduced.

An iron infusion is an efficient way of restoring iron stores in the body when oral iron is not tolerated or does not work (NICE NG24, QS138).

We need iron so our body can make new haemoglobin and red blood cells to carry the oxygen your body requires. Therefore, it is very important to have enough iron in our blood. In addition, iron is also essential for muscle function, energy, brain function, immune system, and enzyme functions in the body.

A: Iron Deficiency is measured by a profile of tests including : Ferritin and Transferrin saturationYour blood results have shown that the amount of iron you have in your blood is low.

  • Ferritin is a protein that stores iron in the cell, particularly the liver. Measurement of Ferritin reflects the body’s iron stores. A low Ferritin means a low store of iron.
  • Transferrin carries iron from the body’s stores to the bone marrow where iron is used to make new red blood cells. In iron deficiency the transferrin becomes empty so you develop low ‘T stats’.

A: You need iron so your body can make new haemoglobin and red blood cells to carry the oxygen your body requires. Iron is the ‘building block’ of red blood cells. Lack of iron leads to reduced production of haemoglobin and also reduced production of red blood cells. When production falls the amount of red cells in the blood circulation falls leading to anaemia. This is defined as a concentration of haemoglobin [Hb] in the blood:

Definition of anaemia:             [Hb] < 120g/L women or  [Hb] < 130g/L men

In iron deficiency even before anaemia develops, the red blood cells produced are also poor quality, being smaller than normal (microcytic seen by a low MCV on your blood test) and with reduced haemoglobin (low MCH on you blood test). Therefore, it is very important to have enough iron in your blood

A: Iron is predominantly held in the red blood cells and muscles of the body. At any one time you have about 4000mg of iron in your body, most of this (2500mg) is used to make the ‘red stuff’ in your blood called haemoglobin.  As red blood cells get old they are broken down by the spleen and the iron is recycled. The body is very good at recycling iron. A small amount of iron is lost every day (from the skin and sweat), about 2-3mg a day, and this is replenished from the diet to ‘maintain iron stores, so you normally have plenty of iron in reserves.

Iron (latin = ferrum) is moved around the body by ‘transport the iron’ = transferrin

Iron is stored in the ‘biscuit tin’ = iron-in the-tin = Ferritin.

You hold about 1000mg of iron in reserves in Ferritin. The rest of the iron (500mg) is used by cells, particularly muscle and nerves. In the cells iron is an essential component of the enzymes involved in  aerobic metabolism where energy is made from food and oxygen.


A: On average, if you are iron deficient you are probably functioning on 30–50% of your iron stores. this means your iron stores (Ferritin) are depleted so you will be deficient by about 1000mg or more depending on your weight. In these cases the iron is ‘stolen’ form the cells in the body, commonly muscles and nerves to supply the bone marrow and keep red cell production going. This explains the range of symptoms, both mental and physical, that iron deficiency can cause.

To put this in perspective: A normal menstrual cycle results in the loss of 80mg of iron, so a woman must recycles much of her body’s iron stores every year. Indeed 10–12% of women are iron deficient and anaemic at any one point in time and a third of all women will develop iron deficiency anaemia in their lifetime.

A: Changes in nutrition (increasing red meat, pulses and soya in your diet) and supplementation with iron tablets is effective for many people; particularly those with mild iron deficiency and few symptoms.

With iron tablets, although the recommended dosage is  45-65mg of ‘elemental’ iron. As the iron is made in tablets as iron sulphate / gluconate / fumarate the total dose is normally 200-300mg. It is recommended to take one iron tablet a day on an empty stomach. Unfortunately, iron tablets can make people feel sick, develop abdominal pain and constipation. Overall, about a third of people stop taking the tablets due to side effects. If side effects occur stop for 5 days, then try one tablet on alternate days.

It can take many weeks to stabilise iron deficiency with tablets and a month or more to see any improvement. Iron is very poorly absorbed and only about 3-4mg of iron is absorbed into the body from the gut, which works out about 180-240mg per month. Consequently, most patients need 4-6 weeks to see their anaemia improve and need to be on iron supplements for 3-9 months, to fully replenish normal iron stores.

If on repeat blood test at three months the ferritin has not improved towards 30, then an iron infusion should be considered

A: In the last decade years’ new preparations of iron were developed. These enable an individual to receive a ‘total dose’ infusion safely in 15 to 30 minutes. This means we can safely and effectively give you a larger dose of iron needed to replenish normal iron stores. An iron infusion is a considerably faster and more effective method to correct anaemia than iron tablets.

Typically, your doctor will prescribe 500mg to 1500mg of iron to be given. So, this is a ‘total dose’ infusion which will improve your body’s iron stores rapidly. Also, as the iron is delivered directly to the blood so supplying the muscles and bone marrow, where it is needed.

People can feel better in a matter of days and as the treatment is a total dose, you may not need any further treatment or tablets.

A: Overall this is a safe procedure. We encourage people not to be nervous as this should be no more concern than an injection of antibiotics.

At the start, the clinic nurse will place a drip in your arm. It’s important that this is sitting well within a vein so they will check this with a flush of cold water that you may feel going up the arm. Particular attention is spent to ensure the line runs without problems, this may include a second flush or a saline drip before the iron infusion. In some cases, we may re-site the cannula to another location. In unfortunate cases the line sometimes tissues or leaks, this can leave a brown stain or tattoo. Every attempt is made to reduces this risk as the stain can be permanent.

With the infusion there are some common side effects that about 3-4 people in a 100. The most common is a metallic taste in your mouth, this normally disappears within 15 minutes of you having the injection.

Flushing reactions (Fishbane) can occur, you might feel a flushed or lightheaded, queasy or dizzy. If you have these symptoms, please tell the person giving the injection. These are normally self-limiting the nurse may stop the infusion for several minutes and restart it more slowly over 30 minutes.

Other side effects that are rarer following treatment of iron include lowering of blood pressure, tingling, or numbness of the limbs, abdominal discomfort, muscular aches and pains, fever, rashes, skin flushing.

Rarely, swelling of the hands and feet and very rarely, anaphylactic like reactions (e.g. paleness, swollen lips, itchiness, weakness, sweating, dizziness, feeling of tightness in the chest, chest pain, fast pulse, difficulty in breathing). These may be an allergic reaction to the iron and you will be given antihistamine medication (hay fever tablet) or sometimes a steroid injection.

If you look on the internet the older preparations of iron were made with iron dextran. This older preparation was associated with complications. We do not use these types of iron. The new preparations are far safer and so now in routine use in the NHS and worldwide with millions of administrations. In clinical trials (of over 8000 patients) that compared people who receive intravenous iron with placebo (an infusion of saline) there was no difference in the number of events reported between the iron and placebo groups.

Overall, about 3% of people who receive intravenous iron do fell some side effects the vast majority of which are mild and self-limiting. The major risk is calculated at less than 10 people in a million.  In a recent detailed review (JAMA 2016) it was suggested that the risk of the new types of IV iron was like those receiving penicillin and overall, about one third the risk of receiving a blood transfusion.

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