Getting Your Iron Through IV Injection

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

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45 thoughts on “Getting Your Iron Through IV Injection

  1. bee says:

    i had a ferritin of four which now up to 20 after THREE YEARS or supplements- i wan’t iron infusion but my doc doesn’t do them, where can i go in toronto?

    • Leona, RN & Blood Specialist says:

      Hi Bee,

      Wow, I am surprised of your success with the sole use of oral iron supplements given your extremely low ferritin level of 4. Anecdotally, once your ferritin level is less than 20 it is difficult (if not impossible) to normalize it with oral iron alone. Again, the definition of normal is skewed… a normal ferritin level is 20-300 (wide range) however patients may be symptomatic of iron deficiency with a ferritin level less than 50.

      Although you have achieved a ferritin level of 20 I would be interested in knowing if you are still symptomatic of iron deficiency and if your iron panel is within normal range. Many hospitals in Toronto give intravenous iron in their outpatient medical departments. Some centres do charge while others do not. You may want to try contacting centres that have Bariatric Centres of Excellence and/or Patient Blood Management programs to see if they give intravenous iron.

      Let me know if I can be of further assistance


      • Penny r Jones says:

        Hi I had 2 iron infusion one week and the next then 2weeks after the last one my ferritin was407 and before all this it was 7 but my oncologist didn’t do my levels the er did and they had a totally different results there highest was 207 and my blood doctor was 466 is the highest I’m confused on the er results and how their so different from my blood doctor and should I be concern my back is killing me and I have pleurisy that is why I went to er but why is er different from the oncologist

        • The Iron Maiden says:

          Hi Penney,

          I am so sorry that you are struggling with health issues. The further you are out from your infusion the lower your ferritin level will be. I trust you are taking some form of oral iron supplementation so that your levels do not drop below 20 again.

  2. julie says:

    Hi Leona,

    For the sake of ease, I’m going to use point form to give you some background:

    *have had low Ferritin levels for many, many years…typically under 10. Hgb hovers around low normal, occasionally dipping below normal.
    *was always told “this won’t give you symptoms…take this supplement”
    *saw a G.I. Doc last spring for some stomach symptom…he took one look at my blood values and said “why the heck hasn’t anyone done anything to help you”
    * ordered 5 weeks of IV Venofer
    * it was like ‘crack’….I haven’t felt so healthy in years!!
    *since then…over the past year my Ferritin has progressively dropped again and I currently sit at 4 with a hemoglobin of 12.1 (US)
    *I have been feeling progressively weaker and short of breath over the past few months
    *I feel lightheaded
    *heart often feels like it’s “pounding out of my chest”
    *have recently been unable to make it through my usual workouts without getting lightheaded and having to stop.

    Unfortunately, I am currently living in the US on a temporary basis so cannot see the GI doc who originally helped me
    *my new GP also told me “low Ferritin will not cause these symptoms”
    *she insists it is anxiety/depression related and wants me to take an anti-depressant
    *sending me for a stress test this week to rule out cardiac involvement.

    So…..I am SO frustrated. Is there any chance Ferramax 2 capsules per day has any hope of correcting my levels or do I desperately plead for another round of IV??

    PS. No cause of G.I. bleeding found during upper and lower scopes. Do have very heavy peri-menopausal periods.

    Open to any and all thoughts! So tired of being tired!!


    • Leona, RN & Blood Specialist says:

      Hi Julie,
      Your GP is quite right the symptoms you describe. The symptoms are more in line with the third stage of iron deficiency – anemia, and not of the early stages of iron deficiency. If your ferritin level is 12, then you are either stage one or two. These stages are characterized by chronic fatigue, irritability and difficulty concentrating. You may also notice sleep disturbance and decreased appetite. As you progress, you will notice difficulty maintaining hair and nail growth.

      Anecdotally, ferritin levels that are less than 20 are difficult (if not impossible) to reverse with oral iron alone. I would be recommending intravenous iron in your case. That being said, your options are limited to the use of oral iron supplements until you find a physician who is open to a little education or is already knowledgeable about iron deficiency.

      You can increase the bioavailability and thus absorption of your FeraMAX by opening the capsule and mixing it with a warm beverage or soft food. It is odourless and tasteless but will make whatever it is mixed with darker in colour.

  3. Erin Kenny says:

    So, after 3 weeks of IV Iron my ferritin is apparently a bit high (407), but my hemoglobin is still dropping (~80). Does my ferritin being that high mean I’m no longer anemic?

    I’m supposed to see the haematologist in a month and will be doing more blood work before that. Should I just chill out and hope it works itself out by the time I see the doc?

    • Leona, RN & Blood Specialist says:

      Hi Erin,

      Your ferritin level does little in terms of determining whether your anemic or not, it helps to decipher if you are stage one or stage two iron deficient. More specifically, if your iron deficiency in absence of anemia will respond to oral iron therapy or if intravenous iron is required. Given that you are currently receiving IV iron, I would venture a guess that your ferritin level was less than 20, a prime indicator that your iron deficiency cannot be treated with oral iron.
      Iron is only one cause of anemia; it is possible that you have more than one issue contributing to your anemia (B12 deficiency, Erythropoietin deficiency, etc.).
      Dependent on when, in relation to your iron infusion, it is quite possible that the drop in hemoglobin is related to a dilution of your circulating volume of blood by the intravenous fluid, and that the iron received is still circulating rather than being stored. Ferritin levels can be falsely elevated as well, related to inflammatory processes, infection or chronic illness. Ferritin levels are NEVER falsely low.

      A more dependable marker is your iron panel. I normally look at a CBC, Iron Panel and Ferritin Level drawn either just before the third iron infusion or (if possible) one week after the third infusion to determine if treatment was effective. If it was not effective (Ferritin Level over 100 and Iron Panel normalized), I continue with Intravenous Iron. If it is effective, I can use those as a baseline and would review serial labs to adjust the patient’s unique oral iron dose.
      Quick answer, hang tight for a week and review labs then. If you are concerned, please contact the health care professional that organized your iron infusions as S/He will be more attuned to your unique health care issues.

      Good luck, and I hope you are able to maintain your iron levels without any further infusions.

  4. Clo says:

    Hi Leona

    I just found your site. It is very informative; thank you very much. I have had a low ferritin level for a number of years (between 6 and 3). I’ve been taking FeraMax on and off, but have always found this was very hard on my digestive system. I’ve recently had surgery for a complete bowel obstruction and feel I am unable to take the oral tablets. My doctor has just prescribed iron infusion for me, I believe it is for 5 initial treatments. I had never heard of this before, so am excited to try it out. I am just wondering how long it will take for me to feel the effects of this treatment.

    Many thanks


      Hi Clo,

      Thank you for your question. Unfortunately, the answer sounds like a cliché…everyone is different.

      It all depends on how depleted you are and how fast your body can utilize the iron. Some of my clients find that their symptoms improve after one infusion while others do not feel a change until they are almost done. The important thing is that you are finally getting the appropriate treatment for your long-standing iron deficiency.

      Kudos to your health care provider!

  5. Boyd Kodak says:

    Hi Leona,
    First I would like to thank you for the great information on your site, it has helped me emensly.
    I was born with an autoimmune/connective tissue disorder. It has come and gone in flare ups over the years, resulting in Protien C Deficiency blood disorder and Primary Schelorosing Cholingitis liver disorder. For the second time in two years, I had to have IV iron due to low hemoglobin and ferritin of 3.5. I have been suffering with all the symptoms of iron deficiency, to the point of being non functionable, but it is so hard to get an iron IV. Two years ago they found I had a bleeding ulcer, but no H pyloria. I was under a period of extreme stress at that time, and have been again recently. I’ve tried feramax with orange juice, eating iron rich foods, B12 under the tongue for months, with no improvement. I ended up in emergency this week and finally got an iron infusion. They said I was anemic. The infusion feels like getting new life.
    They found some blood and 3 whole tablets in my stool. The tablets are supposed to absorb in the lower intestines. My research suggests I have developed lower intestine malabsorbtion syndrome.

    I don’t want to lose ferritin levels again, so do you think I should continue taking the feramax, and when should I start again? Any advice greatly appreciated.

    Thanks so much,


      Wow Boyd,

      You’ve been through the mill and back, haven’t you!?

      My best advice for you would be to open the FeraMAX capsule and dissolve it in a warm beverage or soft food. This will increase it’s bioavailability and thus it’s absorption. It is odourless and tasteless but will darken the colour of the liquid you place it in. Opening the capsule can be difficult if you lack dexterity in which case you may wish to try the Paediatric FeraMAX Powder format; it does smell strongly of grape/raspberry (flavouring added for children), but can be mixed with a cold or warm beverage, or even with food. Please discuss with your Pharmacist how much of the powder is equivalent to 150 mg of elemental iron.

      Normally I would recommend “maximum dose” (150 mg) of FeraMAX for 4-6 weeks post infusions followed by lab work (CBC, Iron Panel and Ferritin level) to appropriately adjust your dose. You will need to discuss with your Physician and/or Pharmacist regarding what is a “safe”, “maximum dose” for you given your personal health status.

      Good Luck, I hope you get back to a normal healthy state soon.


  6. vic says:


    Ive had very low ferritin levels for as long as ive known. At least ten years. Ive been diangnosed with celiac disease based on one positive TTG test (out of several ). I never had the symptoms of celiac disease such as bloating , gas, diahrea, etc. ONLY low ferritin. Out of search for the further answers… I gpt a endoscopy done to confirm celiac damage with 4 weeks of a gluten containing diet prior to the test. It came back negative.
    So, now i really dont know whether im celiac or not??? More so, why im not absorbing iron. Ican take 2-3 ferremax a day… and still have low ferritin

    Suggestions… please

    • The Iron Maiden says:

      Hi Vic,

      Thank you for taking the time to reach out. At this time, our best suggestion is to touch base with your doctor once again for further testing to ensure your treatment plan accurately reflects your individualized needs. We wish you the best of luck and hope you receive clarity on your condition soon.

      Thank you,
      The Iron Maiden

  7. Robert says:

    Is there a difference between the different kinds of iron formulations, in terms of side effects and general effectiveness? They want to give me iron dextran by IV, but there was no mention of how many infusions I would get or for how long. As far as I know my doctor has only ordered one session. My ferritin is 3 and my hemoglobin has been under 100 for over 2 years, needing regular blood transfusions.

    I have ulcerative colitis and two major flares have left me without any iron. The only bleeding I have no is from rectal fissures, but with no iron stores in the body, even minor regular bleeding depletes me.

    The reason they didn’t do IV iron sooner is that the last time I took oral iron, it caused a colitis flare that nearly killed me, so my doctor was afraid that even IV iron could trigger a flare. My research indicates this is unlikely, so I’m willing to give it a try.

    Some people online say that iron dextran is harsher on the body and might have more GI side effects, and that I should request iron sucrose. As far as I know, dextran is the only form available in Canada. My GP offered to do IM injections to test the iron on me, but I’m fair skinned and it’s possible the solution would permanently dye my skin, much like a tattoo. No thanks! So I have requested IV iron instead.

    How many mg of iron are in a standard infusion, or can it vary? How much iron does it take to raise ferritin by 1 point? Can’t seem to find that info online.

    Thank you!!

    • The Iron Maiden says:

      Hi Robert –

      Thank you for taking the time to reach out and for sharing your story.

      In general, oral iron supplements have a higher incidence of GI upset, and injectable iron supplements may cause more general hypersensitivity. When a rapid correction of iron is needed, intravenous irons are sometimes preferred over oral irons. In your case, since colitis flare had happened when using oral iron, IV iron may be a better option, even though the cause of flare might have not necessarily been the oral iron’s fault.

      There are multiple IV iron treatments available in Canada, each of which target a more specialized patient as determined by their medical state and/or cause of ID/IDA (some of which are not interchangeable according to their approved indications). These iron therapies comprehensively include: the treatment of patients with documented iron deficiency in whom oral iron administration is unsatisfactory or impossible, the treatment of iron deficiency anemia in adult patients with chronic kidney disease (CKD), the treatment of patients undergoing chronic hemodialysis who are receiving supplemental erythropoietin therapy, and the treatment of non-dialysis-dependent chronic kidney disease (NDD-CKD) patients with or without Erythropoietin. If applicable as a treatment for you, it’s important to note and discuss with your healthcare provider that Health Canada has issued several safety alerts (you can read more in depth here and here) over past few years due to serious allergic reactions with FERAHEME IV iron.

      Although treatments may be administered by either intramuscular (IM) injection or intravenous (IV) infusion, IM iron+ (remove +!) therapy is not the first line recommendation for treatment due to its unpredictable absorption as well as local complications (e.g. pain, staining of the skin, sarcoma formation).

      Current Canadian guidelines indicate that oral iron replacement is preferred to IV therapy (it is safer, more cost-effective, and convenient when compared to IV therapy). However, intravenous therapy may be substituted when there is inadequate iron absorption, continued blood loss, or intolerance to oral iron therapy. Further consultation with your personal medical professional is recommended as each and every person and circumstance is different. You may learn more about IV iron products by searching them (i.e. with brand name, active ingredient, Drug Identification Number, etc.) on Health Canada Online Drug Product Database reading their provided Product Monographs.

      Thank you and best of luck!

  8. Katie Layland says:

    Hi there, thanks for the post- my ferritin was down to about 8 but i had normal haemoglobin levels and my doctor still gave me an infusion- 500mg of ferric carboxymaltose. i had my iron rechecked after this from another doctor and she said it had gone up to 200- she didn’t say what part of my iron had gone up- she said it was high but didn’t seem concerned. I initially felt worse after the infusion and a bit better after my first period and feel i’m better in some ways and yet just not myself and so wondering if a one off iron infusion can lead to damage? just cos i know too much iron can cause free radicals and store in things like the brain and heart if there is too much but i didn’t know if that was more after a long period of time or lots of infusion/long term supplementation. I can check next time i go back but it wont be for a while and just feeling a bit worried if i have done damage from too much iron so would love any feedback. Thanks 🙂

    • The Iron Maiden says:

      Hi Katie,

      A ferritin of 8 did warrant an infusion of iron, it is common to have “flu-like symptoms” (muscle aches, lethargy, fatigue, low grade fever) after an iron infusion. It is something foreign in your body and your body mounts an immune response. These symptoms can be avoided by taking an “over the counter” remedy like acetaminophen or ibuprofen and hour before your next infusion.

      The 200 likely referred to your ferritin level, and we would expect it to be elevated after an infusion, that is why we give iron infusions.

      Brain damage related to “free radicals stored in the brain and heart” are only an issue with prolonged elevated levels of iron such as those with hemochromatosis or those who intentionally overdose on iron.

      Again you staring Ferritin Level was 8, normal is 20-300, patients are symptomatic of low iron at ferritin levels less than 50. Rest assured that the one dose of intravenous iron you received was of far more benefit than risk.

      Congratulations on having a physician who understands and is willing to treat iron deficiency in the absence of anemia. Stay well and continue to supplement orally.

  9. Hooman says:

    Hi everybody & thanks for sharing your different situations about iron deficiency anemia and treatment plan, My problem is very low ferritin & Hgb. I cant tolerate oral iron supplement due to severe GI upset so my family doctor recommend IV iron replacement therapy. I am a newcomer, have no job and right now this is very costly for me. Is there any solution for my problem ?

    Thanks for your help

  10. MLU says:

    Hello there,
    Thank you so much for your informative site and great advice. I have endometriosis which results in severe menstrual bleeding. As a result, I am struggling with iron deficiency. A little over a year ago I was able to get iron IV infusions. Originally, I was supposed to have 5 within a 2.5 weeks time and 200mg dosage. Sadly, after the first infusion I had serious side effects of the infusion. I have endo so I have a VERY high pain tolerance. This was as if I was severely poisoned. The cramping and pain in my whole body including chest pains was unbearable. Additionally, I had extreme nausea. They lowered my dosage to 50mg and I got 7 treatments over a month and a half. They also did a Gravol IV following each iron infusion. This made things significantly better but I still had a lot of nausea and dizziness throughout the weeks of my infusions.
    Now it is a little over a year later and my iron levels have bottomed out again. I barely function although I only work part-time and am a PhD student. I can’t think, I don’t have any energy, my memory is poor and I’m just so tired of being tired. A month ago my Dr. referred my back for more infusions but I haven’t heard anything (my hemoglobin level is normal so I’m not a high priority). I live in Alberta but have only been in Canada for around 5 years. I understand that I’m not a high priority for getting the infusions but I also straight up can’t function in my day to day life. Is there a way to just pay for them and get them right away? I don’t understand how the Canadian system works. Don’t get me wrong it is a bazillion times better than the US system. I’m just unfamiliar with how to navigate it properly.
    Second, is there anything you recommend for people who have severe reactions to the infusions. I took copious amounts of ginger anti-nausea medication during my infusions. I also wore a sea-band 24/7 and then the Gravol IV at the end of my treatments.

    • The Iron Maiden says:

      Hi MLU,

      Sounds like you have a significant health history. I am not sure what type of IV iron you originally had. “Flu-like symptoms” (low grade fever, headache, muscle aches) are common with most of them. I often recommend patients take whatever “over-the-counter” medication they take for headache or pain (ibuprofen and acetominophen etc.) prior to their infusion.

      It is possible to obtain a prescription for Intravenous Iron and find an independent infusion clinic to administer it. While I know these clinics exist across Canada I do not know specifically what is available in Alberta. So some research will be necessary on your part. Your physician will also need to call the private clinic to clarify what his responsibility is in terms of writing the infusion orders and availability during the infusion. Some independent infusion clinics have a physician on site, others like to have the prescribing physician available by phone while still others want the physician to accompany the patient. Sometimes the requirements change depending on what is being infused and the potential for allergic reaction.

      While not the best solution intra-muscular injection of iron is an alternative worthy of consideration.

      Good Luck with your studies, research and journey back to health.


  11. Bella says:


    I suffer from extreme blood loss due to menorrhagia and have been dealing with iron deficiency and sometimes anemia for years. It is brutal and it is killing me. My pulse is being effected, I get heart palpatations, and am out of breath walking up stairs. My hair is falling out, I get ringing in my ears, body aches, extreme fatigue and anxiety etc etc.

    I am in desperate need to find a Dr or clinic in Vancouver who will take my iron deficiceny seriously and help me. I have a 1yr old and I am so unwell.

    Do you have any suggestions or ideas where to go to get help? I think I badly need iron infusions. I am so desparate to find a Dr who will take iron device seriously.

    • The Iron Maiden says:

      Hi Bella,

      From your symptoms list, I agree you sound to be significantly iron deficient. An iron panel (serum iron, TIBC and % Transferrin Saturation) should easily prove this speculation. Once completed, if the results prove iron deficiency (they should) a ferritin level will tell if oral iron is a consideration for repleting your iron stores. If your ferritin level is less than 20 it is difficult if not impossible to replete your iron stores with oral iron alone. If your iron panel reveals iron deficiency and ferritin level normal it is safe to assume that your ferritin level is falsely elevated.

      In terms of treatment, you need 2 referrals. You need to see a clinical hematologist, specifically a Benign Clinical Haematologist. Benign Clinical Haematologist’s tend to treat iron deficiency more aggressively than Haematologists that work with oncology patients. You also need a referral to a gynecologist to address your dysfunctional interuterine bleeding.

      Some physicians may suggest treating the source of the problem, the dysfunctional bleeding, before addressing the iron deficiency. While more economical you are currently debilitated by your symptoms and correcting the iron deficiency should be the priority, even if it means repeating the process several times before the cause can be addressed.

      Good luck on your journey back to wellness.

  12. Neely says:

    Hi. I have chronic low ferritin due to RNY Gastric Bypass. My iron levels have always been good though.. After many years of oral iron (ALOT of it), and it not doing much of anything, i finally got a new set of doctors with more of a clue and said i should be having infusions because i do not absorb iron because the part of the intestine that absorbs most of the iron is bypassed (makes sense to me) . So the first set was a series of 3 infusions of Venofer. I had no issues felt fine, a month later my levels were in normal ranges and remained there for 8 months. Due to an insurance change, the next time i needed them, i was sent to a hematologist and he agreed, i should be in infusions, not oral iron . So this time, i had 2 infusions of Feraheme. Well, so another doctor ran blood work about 2 weeks after my 1st infusion and they ran an iron and ferritin. My iron came back really high and my ferritin was in the 800’s. They just called me back about it and i advised i had had an infusion and all she said was “that makes sense, ill tell the doc”. I am assuming this is normal them for a peak after infusion? my hematologist didnt wanna check my iron till 2 months after the infusions. The other office didnt say anything about contacting the hematologist. Im confussed

    • The Iron Maiden says:

      Hi Neely,

      You are correct in assuming that your serum iron and ferritin level would be very high after iron infusions. It is possible that when your primary physician referred you to a haematologist s/he was unaware of what treatment the haematologist planned or when the intervention was to take place. What I disagree with is the suggestion that you are IV iron dependent. Iron Salts do not work in the gastric bypass population because the section of the small intestine where they are absorbed is the section that is bypassed. Both Polysaccharide and Heme Polypeptides can be absorbed as their absorption surface is lower in the small intestine. If, after following a rigid titration schedule which involves starting with the maximum dose of either of these iron supplements and increasing/decreasing according to scheduled lab work (every 6-8 weeks), it becomes evident that you cannot maintain your ferritin and iron panel levels, then it would be fair to suggest that you need IV iron.

      I have Bariatric patients for whom I have titrated their unique dose of appropriate iron supplement after repleting their stores with IV iron who have never needed IV iron again. I have some who, despite taking the maximum dose of an appropriate oral iron, need it as frequently as every six weeks to annually. I am IV iron dependent, however, with an oral iron support I have gone from needing weekly iron to needing it every six weeks. It may be worth your while to try and use an appropriate oral iron at an appropriate dose before resigning yourself to being IV iron dependent.

      Take care


  13. Arlene says:

    Dear Liona,
    Thanks for the great information you provide. I have been dealing with low iron for about a year. My ferritin is 12 and my hemoglobinin 115. I have been taking three Profferin daily and it doesn’t seem to be helping at all. I have been on a PPI for 20 years and in conjunction with my family doctor, I have been reducing the amount I take… I was hoping that reducing the PPI would help with my iron levels…. but so far it hasn’t helped. Today I am going for an IV iron infusion. .I am so tired. Do you think there would be any value in switching to Feramax? I am so appreciative of your advice.

    • The Iron Maiden says:

      Hi Arlene,

      Let’s start with very basic information. Non-Salt iron supplements (polysaccharide and heme polypeptide iron supplements) are not affected by PPI inhibitors. The issue lies with the depletion of your ferritin level. Literature suggests that with ferritin levels less than 20 it is difficult, if not impossible, to replete your iron stores with oral iron alone. Oral iron will support your hemoglobin, staving off stage three iron deficiency (aka anemia), but it will not rectify the symptoms associated with stage one and stage two iron deficiency. To rectify these symptoms I would recommend you request a referral to a benign clinical haematologist and discuss intravenous or intramuscular iron.

      I hope you can get to definitive treatment of your iron deficiency soon.


  14. Arlene says:


    Thanks very much. I am very appreciative of your comments. I had an iron infusion 3 weeks ago and it allowed me to go on vacation with ease. I do have a hematologist in Toronto that I am working with. I have blamed my low ferritin on the PPI that I have been taking for 20 years. . Perhaps this has been wrong. I wish I knew why my iron stores have been low.

  15. Elle says:

    Leona, First I have to Thank you for your website. The information and how you explain anemia is invaluable. My question is could an Iron Iv be useful to me. I’m in the states and I’ve been a vegetarian most of my life. I’m in my 40s now. When I was in my 20s I had minor surgery and had a severe allergic reaction to an antibiotic which took a huge toll on my adrenals and thyroid. That experience left me with total insomnia, loss of menstrual cycle for many years (no reason found) and no peristalisis in the instestines. My best understanding is because of being a Non-diagnosed Anemic most of my life this is the reason by body never recovered. 5 years ago my Ferritin was 7…at this point I didn’t understand Ferritin’s purpose and my Reverse T3 thyroid hormone was quite high. My adrenals didn’t product much cortisol. During these last 5 years I’ve had several adrenal crisies. Taking Iron pills has caused me to have bad reactions…like severe Parasonmia, swollen thyroid and adrenal glands. My last bloodwork was Dec 2016: RBC: 5.12 (4.00-5.10); Hemoglobin: 14.6 (12.0-15.00); hematocrit: 43.0 (35.0-44.0); RDW: 12.9 (12.0-16.0); Iron: 141 (28-170); Ferritin: 16(11-307); Transferrin: 286 (192-382); % Iron Saturation: 20 (15-50). I still suffer from Severe insomnia, very irregular menstrual cycle, and no peristalisis in Instestines. I have some different doctors but non say I’m anemnic. From my research, raising Ferritin by way of an Iron IV could help me a lot. Thank you so much for advice and input.

    • Elle says:

      Hi Leona, I recently had more bloodwork done in June 2017 and had to share results.
      I can’t believe my Ferritin has gotten to this number without an Iron IV or major Iron supplementation. The best thing I can understand is my Serum Iron is stll too low, Iron Saturation is low and WBC is high so my body is finally storing Iron because it’s under continual stress. Can an Iron IV still help me? Thank you so much again for any advice.
      Sed Rate 3 mm/hr <=20 mm/hr
      Ferritin 68 ng/mL 11 – 307 ng/mL;
      Hemoglobin 14.4 gm/dL 12.0 – 15.0 gm/dL
      Hematocrit 42.0 % 35.0 – 44.0 %
      MCV 84.1 CU MIC 80 – 97 CU MIC
      MCH 28.8 PG 27.5 – 33.0 PG
      RDW 12.3 % 12.0 – 16.0 %
      Platelets 220 th/cmm 150 – 400 th/cmm
      WBC 9.1 th/cmm 4.4 – 10.5 th/cmm
      Iron, Serum 56 mcg/dL 28 – 170 mcg/dL
      Transferrin 232 mg/dL 192 – 382 mg/dL
      Iron Saturation 17 % 15 – 50 %
      WBC 9.1 th/cmm 4.4 – 10.5 th/cmm

      • The Iron Maiden says:

        Hi Elle,

        Looks like your journey back to health and well-being has been a difficult trek. Fortunately, the lab values you list reveal nothing other than Stage One Iron Deficiency. The triad of iron deficiency applies directly to this stage, specifically chronic fatigue, irritability and difficulty concentrating.

        These symptoms normally appear when your ferritin is less than 50. The often become the “new norm” for most suffering from iron deficiency.

        Given your status as a vegetarian, heme polypeptide iron supplements are off the table. Polysaccharide irons can be an alternative. They significantly eliminate digestive tract side effects. I would be remiss if I didn’t tell you that some of the polysaccharide capsules use porcine byproducts. Polysaccharide iron is safe to open and dissolve its contents in a warm beverage (not tea or coffee) or soft food. It will not stain your teeth, is flavourless, and odorless.

        In Canada, there is a polysaccharide iron complex, FeraMAX which is vegetarian-friendly. The capsule is vegetable based and, if necessary, dissolves if dropped into a hot liquid.

        In the absence of digestive issues, you could consider Iron Salts and/or vegetable based iron supplements. The problem with these iron supplements is they have to be converted from the type of iron they are to the type of iron our body absorbs. When taken under optimum conditions only about 8% gets converted for absorption…what isn’t digested and converted passes through our digestive tract causing the gastrointestinal symptoms associated with this source of iron supplements.

        Finally, any client of mine with a ferritin less than 20 would be referred to a benign clinical hematologist for IV iron, once iron stores are repleted I would work with them to find an oral iron supplement that fits their lifestyle at a dose unique to them that maintains their iron.

        I hope your road back to health and well-being has a few less potholes to impede your progress from this point on.

        Thank you for your patience given my delayed response.


    • The Iron Maiden says:

      Hi Elle,

      With regards to your thyroid, please keep a 4-hour interval between your iron supplements and thyroid medications as these interact negatively. Look to your other comment for my full reply 🙂


  16. Patricia O'Connor says:

    I have been dizzy since I can remember for 20years and misdiagnosed with MS because I was clumsy
    Then they thought my 12 deficiency was MS. My genetics indicate iron absorption problems with the H63D gene from Hemochromatosis.

    Where is your office?

    • The Iron Maiden says:

      Hi Patricia,

      I am very sorry to read of your ongoing, long standing health issues. Chronic health issues beat down your spirit.

      Unfortunately, due to my own personal health issues, I have taken a leave of absence from my full-time work. I am trying hard to keep up with the blog but sometimes, like the present, I do fall behind.

      Please feel the best you can. Meet your daily challenges head on…as soon as I am back to work I will let you all know…it will be at least another year…but I will be here, and making a better effort to stay up to date.


  17. Z says:

    Hi Leona,

    Great site. I’m in TO – my ferritin is 20 and i feel super run down. Will the doctor be able to get me an iron panel or do i need go somewhere else to get it? My blood test doesn’t have TIBC , Serum etc. I have mercury poisoning, so I think that’s what’s not helping.

    • The Iron Maiden says:

      Hi Z,

      Wow, the fatigue alone related to a ferritin of 20 is debilitating. Let’s talk about how you can work with your doctor to feel better sooner!

      Yes, you health care practitioner should be able to order an iron panel, it has to be written on the requisition. Unfortunately, in Ontario, some labs will not draw both an iron panel and a ferritin level if they are listed on the same requisition. Often they will elect to do just the ferritin level as it is one blood test vs three. This is fine if the ferritin level comes back low, as a ferritin level is never falsely low. However, if it comes back normal range or high, we haven’t ruled out iron deficiency. Ferritin levels can be falsely elevated by inflammatory processes, infection, liver issues, chronic illness etc.

      In my practice, I order the iron panel, and if these values indicate iron deficiency or “borderline,” I will then order the ferritin level. If the ferritin level comes back normal, I know I am dealing with a falsely elevated ferritin. A patient can’t be stage two iron deficient without being stage one.

      With a ferritin of 20, no doubt you are feeling chronically fatigued, have difficulty concentrating and are a bit “irritable”. Twenty is my cut off when deciding oral versus IV repletion. With you bang on 20 I would suggest a 6 week trial of “maximum dose oral iron” as per your health care professional’s recommendation. If after that, there is no improvement in your iron panel and ferritin level, consider requesting a referral to a benign clinical hematologist.

      Feeling better is a team effort that involves you (the expert on you) and your health care professional (the expert in medicine). Glad to see your playing ball!


  18. Eva says:


    I am scheduled to have an Iron Infusion next week, due to difficulty with oral supplements and heavy menstrual periods caused by fibroids. Reading the many comments and replies above, I’m unclear what you mean when you say “false ferritin” levels. I’m assuming this means a blanket reading, that actually hides a deficiency? My numbers have been very erratic over the past 2 yrs, but always within range (low end). As we speak they are—Hem – 125, and Ferritin – 62.
    I have a VERY physically demanding job, and suffer with chronic gastritis, so all these factors put together, is allowing me to be a candidate for the infusion, as I do feel symptoms quite easily. I have stopped the pills again, and know that the numbers with eventually fall.
    My questions are – should I wait for that to happen? And is it dangerous to have infusion when you’re already in range?

    Thank you,

    • The Iron Maiden says:

      HI Eva,

      Sorry you are struggling.

      When I refer to a “falsely elevated” ferritin level, I am talking about a ferritin that appears to be normal range when actually it is much lower. A normal ferritin is 20-300 with symptoms appearing when your ferritin is less than 50.

      68 is not all that high of a ferritin level. Fifty is only the “average” with some being symptomatic at levels less than fifty and some at levels higher than 50. So it is possible that your ferritin is truly 68 and you are symptomatic. OR It could be that 68 is a “falsely elevated” value.

      A ferritin level is never falsely low but can be falsely elevated related to infection, inflammatory processes, and/or chronic health conditions, to name a few. Falsely elevated ferritin levels can be ruled out by checking an Iron Panel (Transferrin Saturation, TIBC and serum iron) if these indicate stage two iron deficiency or borderline stage two iron deficiency, we know your ferritin level is truly less than 20 as you can’t have stage two iron deficiency without having stage one.

      If you are requiring IV iron, taking one supplement a day while receiving IV iron should not be a problem. I would also continue post infusion with a quality iron supplement that is easily absorbed and has fewer to no gastrointestinal side effects (polysaccharide iron complex or heme polypeptide).

      Taking the maximum dose of one of these irons should help decrease the frequency of your iron infusions once your ferritin is normal range.

      I hope this clarifies things for you. Good luck with your IV iron, I truly hope you are not IV iron dependent.

      Take care.


      • Eva says:

        Hi, thank you for all your insight—-I love this page, it’s very informative and rather comforting—-especially when you’re about to have an infusion done.

        Well, my first infusion was two days ago, and I haven’t really noticed anything in the way of energy level changes, but I suppose that will come in time. The only small things I noticed were the metal taste in the mouth as the infusion was being done, and I had a very restless almost nervous sleep, the first night. Nothing too earth shattering.

        I’m looking forward to feeling energetic again, like I was five years ago.

        I wondered too, how much does iron deficiency over a long period of time, affect moods? As in depression or anxiety..

        Thank you again


        • The Iron Maiden says:

          Hi Eva,

          I am glad that you are receiving intravenous iron for your significant iron deficiency. While symptom resolution is not instant you should notice a change in energy levels as your iron stores replete. In my experience, it normally takes 3 infusions before you notice a significant difference. The first infusion restores your liver stores, the second your bone marrow, and the third fuels the manufacture of hemoglobin.

          Regarding your question about iron deficiency and mental health. The earliest signs of iron deficiency are chronic fatigue (often misdiagnosed as depression), difficulty concentrating (focusing on a task, organizing one’s thoughts, etc) and irritability.

          When compounded with the lack of physical energy and always feeling like you’re behind the eight ball; it’s not a stretch of the imagination to assume that long-standing iron deficiency can be detrimental to one’s mental health.

          Feel better soon and remember to be compliant with oral iron supplementation after your iv iron so that you can maintain your iron stores and never feel this poorly again.

          Take care Leona

  19. Nina says:

    Hi, i had an iron infusion at the beginning of the month . Got my period the next day. It was very black and thick for a few days , then the colour became normal. I have now got my period again. I am on my 3rd day and very very light compared to usual (i have very heavy period), and again its very thick, black and sticky. Is this normal?

    • The Iron Maiden says:

      Hi Nina,

      Sounds like you are one of the 20% of Canadian women struggling with iron deficiency. Fortunately, you have a health care provider who is treating it appropriately!

      What you are describing as per your menses does not seem normal. To answer the unasked question, I do not believe the cause is the IV iron.

      My recommendation would be to speak with your gynecologist. If you don’t currently have a gynecologist, it may be time you ask for a referral to one. I strongly suspect the source of your iron deficiency may be dysfunctional intrauterine bleeding.

      Please let us know how you fair on your journey back to health.


  20. Sunitha says:

    Hi I am 38 female from India. I had low levels of ferritin (12.1) and suffering from tiredness, breathlessness, and giddiness. Doctor advised me for iron shots intravenous @ 500mg for two doses in two weeks interval. I have completed the two doses and checked the ferritin level after 4weeks. Surprisingly my ferritin level was 411. Still I am getting the symptoms of tiredness and mild cough symptoms. Can one explain what is the reason behind this and how to restore to normal level.

    • The Iron Maiden says:

      Hi Sunitha,

      Thanks for your question. Ferritin Levels are only useful when they are low. A month after receiving 2 rounds of iv iron should show that you have a normalized ferritin level (20-300) and a significant reduction in symptoms (if not symptom-free).

      At this point, I would suggest an iron panel (Transferrin Saturation, TIBC and serum iron) to see if your iron deficiency has been corrected. If those values continue to show iron deficiency or borderline iron deficiency I would question the validity of the ferritin level. Ferritin levels can be falsely elevated by infection, inflammatory processes, and chronic illness.

      If the iron panel suggests that your iron deficiency has been corrected we then need to consider other processes that may be causing your symptoms.

      If you look at the symptoms checklist you will see a number of symptoms that could easily represent other health issues (eg. Chronic fatigue could be hypothyroid, hair loss and brittle nails could also be a protein insufficiency). Very few disease processes are as easy to diagnose, treat, and significantly impact one’s quality of life as iron deficiency, however; if symptoms remain once the deficiency is treated other sources for symptoms must be reviewed.

      Let us know how your health and well-being develops.


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