Getting more iron by eating iron-rich foods and taking an oral iron supplement are effective ways to treat iron deficiency, and while this is the preferred method of iron therapy, there are certain circumstances where intravenous (IV) iron may be necessary.
IV iron therapy is beneficial when iron supplements are unsatisfactory or impossible, such as dialysis associated anemia related to chronic kidney disease. The British Columbia Ministry of Health Guidelines and Protocols state that oral iron supplementation (compared to IV iron therapy) is safer, more cost-effective and convenient.
What is Intravenous Iron?
IV iron, a parenteral therapy, is iron administered via injection into a vein. Each infusion usually takes 3 or 4 hours and, depending on the type of iron, can be given in one infusion or spread out over a few weeks until the patient’s iron level is corrected. Your doctor will explain the frequency of injections required based on your situation.
Just to give you an idea about the cost of IV iron therapy, the British Columbia Ministry of Health Guidelines and Protocols estimate the approximate medical cost for adults to be $290 – $375 per month (plus facility costs).
Before starting IV iron therapy, a small dose may be administered to observe the patient in case of an allergic reaction. If all goes well, then the dose is increased over the next few hours.
Who Needs It?
Although oral iron supplementation is the preferred method of therapy, IV iron therapy may be beneficial for patients experiencing inadequate iron absorption, continued blood loss, or who cannot tolerate oral iron tablets or liquids. Also, patients who are required to take an erythropoietin-stimulating agent (ESA) may also require IV iron. Given by injection, ESAs are utilized to increase red blood cell production (which increases iron needs); IV iron may be needed to ensure that the body has a sufficient supply of iron (ESAs actually depletes iron stores, which means that if there is not enough iron in the body to begin with, ESAs will be ineffective).
Patients with the following conditions may require IV iron:
- Acute severe gastrointestinal bleeding
- Inflammatory bowel disease (Crohn’s disease, ulcerative colitis)
- Chronic kidney disease (on dialysis)
- Cancer patients (with anemia and taking an ESA)
- Severe menorrhagia (abnormally heavy or prolonged menstrual periods)
- Surgically induced malabsorption syndromes (gastric bypass)
What Are the Side Effects?
Currently, there is a Black Box warning for all IV iron therapies due to serious hypersensitivity reactions including life threatening and fatal anaphylaxis reactions that have been reported in patients receiving intravenous iron products. Because of this, Health Canada recommends that all IV iron therapies should only be administered within the hospital setting, when personnel and therapies are immediately available for the treatment of anaphylaxis and other hypersensitivity reactions.
In addition to anaphylactic reaction, patients may also experience mild to moderate degrees of the following side effects:
- Shortness of breath
- Chest pain
- Changes in pulse or blood pressure
- Gastrointestinal discomfort (ie. Nausea, cramps)
- Light-headedness or dizziness
- Swelling or bloating (ie. Face, hands, feet, arms, lower legs)
- Itchiness or rash
Having a small test dose may lower the risk of side effects, but some may still occur such as muscle and joint pain, or burning/swelling at the injection site.
Talk to your doctor to discuss whether IV iron is the best route for you.
Content and advice provided on The Iron Maiden is for information purposes only and should not serve as a substitute for a licensed health care provider, who is knowledgeable about an individual’s unique health care needs