• Iron Infusion Clinic

Iron Deficiency

Iron Supplements and Iron Infusion

Why treat iron deficiency?

Iron Deficiency may cause:

  • Anaemia that may eventually require a blood transfusion.
  • Restless legs syndrome or hair loss.
  • Less specific symptoms include fatigue, or poor concentration.
  • Problems during pregnancy.

Oral iron is the first-line for the majority of people as it’s safe, easily accessible, and cheap.

What are the reasons for an iron infusion?

There are the usual reasons for an iron infusion:

  • Side effects of oral iron are troublesome, or
  • The iron supplement ‘isn’t working’ based on repeating the iron levels at least 6 weeks after starting the supplement, or
  • Medical conditions like inflammatory bowel disease, chronic renal disease or chronic heart failure, or
  • Pregnancy – though we ask you to obtain any infusion through your hospital antenatal provider.

Which oral Iron supplement should I take?

A lot of people think they are taking iron supplements when the dose of iron is far too low!

The dose of Iron required to treat iron deficiency is 100mg  to 200mg of ‘elemental iron’ daily for at least 3 months. The dose stated on the front of the box will usually be dose of the iron compound  rather than the dose of the elemental iron. The compound dose is around 3 times the elemental iron dose.

Look for the dose of ‘elemental iron’ in the small-print on the box, or ask the pharmacist.  Examples of brands that include an adequate level of iron are:

  • ®Ferrograd C has 105mg elemental iron with vitamin C.
  • ®Ferro-F-tab has 100mg elemental iron.
  • ®Ferroliquid that contains 30mg/ml elemental iron.
  • ® Maltofer – there is evidence it may be better tolerated than other oral iron preparations.

Side Effects of iron supplements

Side effects of oral iron supplements are dose-related and include:

  • Metallic taste
  • Nausea
  • Constipation
  • Black bowel motions

How should iron supplements be taken?

  • Take with orange juice or a Vitamin C supplement as 500mg Ascorbic Acid.
  • Iron supplements are ideally taken on an empty stomach to increase absorption.
  • Antacids for heartburn or indigestion should be taken at least 2 hours before or 4 hours after taking iron supplements.

How can I tolerate oral iron better?

You can consider the following to help tolerate the oral iron:

  • Try Taking iron supplement with food. This doesn’t work as well as taking it on an empty stomach, but it’s better to have iron with food than not at all!
  • Try splitting a single dose into smaller doses through the day. This is easiest to do liquid versions of oral iron.
  • Alternate day dosing.
  • Take with a stool softener.

It’s time to think about an iron infusion when Iron supplements are just not working, or causing side effects.

Iron Infusion

The risks and benefits of an iron infusion

What are the benefits of an Iron Infusion?

  • Rapid return to normal Iron levels.
  • Gets around the gastro side effects of oral Iron supplements.

What are the risks of an Iron Infusion?

Anaphylaxis is a rare but potentially very serious allergic reaction and the risk will be discussed with you in the clinic. The best formulation for use in a walk-clinic is Ferric carboxymaltose ‘as it can deliver up to 1 g of iron in 15 minutes and has an excellent safety profile.

It is considered normal practice for Iron Infusions to be administered in the general practice setting when full Resuscitation facilities are available.

A rare but troublesome risk is permanent staining of the skin. Meticulous confirmation that the cannula is sited in the vein access may possibly reduce this risk.

Side effects of an iron infusion

Symptoms that may occur at the time of the infusion include headache, nausea, vomiting, muscle aches, joint aches and a metallic taste.

Side effects that may occur a day or two later are headache, joint ache, muscle ache or mild fever.

Headache occurs in around 3% of people and can last a few days.

How is The Iron Infusion given?

The Ferric Carboxymaltose infusion is given into a vein over 15 minutes. Up to 1g may be administered in one session. The amount of iron you need is determined by The Ganzoni Formula.

Ferritin is a measure of Iron levels and will peak around 7-9 days after the infusion.

I want the Practicalities of an Infusion!

  • See The doctor for an initial assessment – what is the cause of the iron deficiency?
  • The doctor gives you treatment options which may include an iron infusion.
  • Intravenous cannula is inserted at the infusion appointment.
  • The injection is administered by The doctor.
  • You need to stay in the clinic for 30 minutes after the infusion.
  • A blood test is arranged 6 weeks later to re-check your Iron levels.

Iron Infusion and Kidney Disease or Heart Failure

Iron absorption is poor in people with kidney disease or heart failure, meaning that oral iron supplementation is not usually sufficient. The ferritin is a poor measure of iron deficiency in these conditions. Iron Infusion is therefore often recommended.

Iron Infusion FAQs

Who is unsuitable for an Iron Infusion at the clinic?

Iron infusions can rarely cause life-threatening anaphylaxis. Whilst very rare, the infusion does need to be medically justified.

Most people requesting an infusion are clearly suitable for an infusion. However, the reasons why an iron infusion are not recommended include:

  • There is no significant iron deficiency on the blood tests
  • The person hasn’t tried oral iron supplements.

South East Medical recommends an infusion in a secondary care facility for a person under 18 years of age, or during pregnancy.

I already know I need an infusion - A doctor has asked me to get one!

You may make an appointment for an infusion in the first visit (rather than an initial consultation) when:

  • We have a referral letter from a specialist asking for you to have an iron infusion. The letter does not need to be named to a specific doctor.

The reason we ask for a letter from the specialist is that, on occasion, the infusion doctor may disagree with a referring GP that an infusion is indicated.

Please note that We also would like to have blood test results within the last 6 weeks.

Please note that an infusion on the first visit will require an extra-long 45 minute appointment rather than the standard 30 minute appointment.

The summary is simply don’t worry about a referral letter – but if you have one that’s great.

What is the cost for an Iron Infusion?

The first appointment is a normal specialist GP ‘long appointment’ which is the same as The AMA recommended private fee for a long GP consultation.

The infusion itself requires a second long appointment and incurs the same cost (The AMA recommended private fee for a long GP consultation) with a small charge for the equipment required.

In addition, the pharmacy cost for The Ferinject script is around $37.

What can I expect at my first appointment?

There are a number of medical conditions may cause Iron deficiency and the doctor will need to exclude these at your first appointment.

Above all, you’ll need to know why you are low in Iron. It’s often straightforward. However, further blood tests are often recommended to check for conditions like Coeliac Disease, Gastritis and Haemolysis.

You will be offered the full range of treatment options which may include an Iron Infusion.

Remember that the risk of life-threatening anaphylaxis is around 1 in 1000 and there does need to be medical justification for the infusion.

The iron infusion itself is booked at the second appointment.

Which Iron Preparation do you use?

Iron Carboxymaltose comes in 2 x 500 mg vials. The brand name is ®Ferinject.

The cost of the script from a pharmacy will be the standard cost for a PBS script which is around $37.

Do I need to bring anything to my appointment?

Please bring along any blood results.

When do I get my post-infusion blood test?

The Iron should be re-checked around 6 weeks later.

We will inform you of your Iron levels by phone or text.

What happens if I need an Infusion a year later?

No initial appointment is usually required – providing you bring blood results from the last 6 weeks.

WRITTEN BY: Dr Richard Beatty
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