What is an intravenous (IV) iron infusion?

An iron infusion is a medical procedure where iron is given directly into your bloodstream through a vein. Your doctor may recommend this if you have low blood iron, also known as iron deficiency.

Receiving iron this way helps replenish your blood iron levels quickly. You may need this, for example, if taking iron tablets or liquid do not work, or if you aren’t able to take iron in tablet or liquid form because of a health condition, such as Crohn’s disease.

Why is iron important?

Your body needs iron to make haemoglobin (Hb) — a part of red blood cells that carries oxygen in the blood. If you don’t have enough iron, your body can’t make enough healthy, oxygen-carrying red blood cells, and you may feel tired or unable to do normal daily activities.

If your iron levels continue to drop, your haemoglobin levels can drop below normal. This is known as iron deficiency anaemia (IDA).

Iron is also important for:

• muscle strength
• energy
• good mental function

When might an IV iron infusion be recommended?

Iron can be given as a tablet or liquid that you can swallow, and this is usually recommended first to treat IDA.

However, your doctor may recommend an IV iron infusion if your iron level is low, or you have been diagnosed with iron deficiency anaemia and you:

• can’t take iron tablets or liquids
• are not responding to or absorbing iron tablets or liquids
• need to quickly replenish your iron levels because of surgery, are late in pregnancy or need to avoid a blood transfusion
• have chronic kidney disease or chronic heart failure
• cannot have a blood transfusion, such as for religious reasons

Depending on your iron levels you may need more than one infusion. Usually, iron infusions are given at least one week apart.

How do I prepare for an IV iron infusion?

Iron infusions are usually given in a day medical unit or doctor’s surgery. They can also be given in hospital if you are an inpatient for another reason.

Your doctor will usually give you a prescription for an iron injection, which you will need to collect from a pharmacy and bring with you to your appointment.

Before you have an IV iron infusion, you should tell your doctor if you:

• are pregnant (IV iron should be avoided in the first trimester)
• have asthma, eczema or other allergies
• have had a previous reaction to iron
• have a history of high iron levels, haemochromatosis or liver problems
• are taking any medicines, including supplements or over the counter medicines
• if you know or think you have an infection

You do not usually need to do anything special on the day to prepare for an iron infusion. Eat breakfast and lunch (depending on your appointment time), take your regular medicines and make sure you drink lots of water.

You will be able to drive home and return to your normal activities unless you have an unexpected reaction. Before leaving, make sure you have the number to contact if you have any questions or concerns, and any dates for follow-up tests or appointments.

You will need to have a blood test 2 to 4 weeks after an infusion to check if your iron levels have improved.

What happens during the procedure and straight after?

Before your IV iron infusion, a nurse will insert an IV line into your vein (usually in the back of your hand or arm) using a needle. They will attach the line to a drip that will deliver the iron, which will be mixed with saline (a sterile saltwater solution).

They will also check your vital signs such as:

• pulse
• blood pressure
• temperature
• breathing rate

A nurse will then start the iron infusion. How long the IV runs for depends on the amount of iron that your doctor prescribes. You can ask your doctor or nurse how long the infusion will take. Although some infusions may not take very long, you should be prepared to be in the day unit or your doctor’s surgery for 2 to 3 hours.

During the procedure, your vital signs and IV line will be checked by a nurse and for 30 minutes after it has finished. This is to make sure you do not have a reaction to the IV iron infusion.

What are the risks or side effects of an IV iron infusion?

Side effects and severe reactions are very rare. The most common side effects are:

• headaches
• dizziness
• redness of the skin, especially cheeks or neck
• feeling sick (nausea)
• muscle or joint pain
• a metallic taste in your mouth
• changes to blood pressure or pulse

Some of these side effects can start 1 to 2 days after the infusion, but normally settle down by themselves over a few days.

Fewer than 1 out of 100 people experience a severe allergic reaction.

Change in skin colour near the IV site is also a very rare side effect. This happens when the infusion leaks into the surrounding soft tissue.

Your nurse will keep a close watch during your infusion to minimise your risk of side effects. If they are concerned that you are having a reaction to the infusion, they may stop or slow your infusion.

When should I see my doctor?

If you have ongoing side effects after your infusion that don’t settle by themselves over a few days, or if you have any other concerns, you should speak to you doctor or call the infusion clinic for advice.

If you feel unusually tired, that you are unable to do your usual activities or feel that you can’t concentrate, see your doctor and ask about your iron levels. They will be able to assess you and order a blood test to help diagnose you.

Resources and support

For further information on IV iron infusions or support you can do the following:

• Speak to your doctor or pharmacist.
• Call healthdirect on 1800 022 222 at any time to speak to a registered nurse (known as NURSE-ON-CALL in Victoria) for more information and advice.
• Read The Royal Children’s Hospital iron infusions fact sheet for information on IV iron infusions in children.

You can also find out more about iron deficiency from the Australian Red Cross.