Intravenous Iron Therapy

Please read this leaflet carefully. It has been written to give you information about your treatment with intravenous iron therapy.

What is iron?

Iron is an essential mineral for your body. It is an important part of haemoglobin (the protein inside red blood cells) which carries oxygen around your body.

What is intravenous iron?

Intravenous iron is a way of quickly getting iron into your bloodstream by using a small tube which is placed into a vein in your arm, though which we can give you a liquid solution containing iron (an infusion).

Why do I need intravenous iron?

If you do not have enough iron, you may become anaemic. As a result, this can make you feel tired and short of breath. You may also have poor concentration, loss of appetite, muscle weakness and be more likely to catch colds and develop infections.

You may need an iron infusion if you are:

• Unable to take oral iron tablets

• Unable to absorb iron through your gut

• In need of a rapid increase in your iron levels before an operation to avoid a blood transfusion.

Is there any alternative to intravenous iron?

Iron supplements can alternatively be taken as tablets. These should be taken once or twice a day on an empty stomach. Food, drink and other medications should be taken at least an hour after taking them.

They can be taken with water or with orange juice as the vitamin C helps with the absorption of iron.

However, iron tablets may not treat your anaemia as well as intravenous iron and they can also cause side-effects, such as constipation and nausea. Your doctor will suggest the best treatment for you.

What will happen if you do not wish to have intravenous iron?

If you do not wish to have iron replacement, you may become or remain anaemic. You may need to have a blood transfusion to treat your anaemia. Blood transfusions are associated with some side effects and risks, such as an allergic reaction to the donor blood.

Is there any reason I shouldn’t have intravenous iron?

You should not receive intravenous iron if:

• You are known to be sensitive (allergic) to any of the ingredients used in the iron solution used for the intravenous treatment

• You have liver disease, such as severe liver cirrhosis or hepatitis, or you have recently had abnormal liver function test results

• You have any new or on-going infections

• You are less than 12 weeks pregnant

• Your anaemia is not due to a shortage of iron.

What type of intravenous iron will I be given?

Currently, we use ferric carboxymaltose (Ferinject) for the intravenous iron treatment.

What happens when I am an inpatient?

As an inpatient the need for the infusion will be discussed with you. Once consent is gained, a registered Nurse will then insert the cannula into your vein in your hand/arm.

The infusion will then be drawn up and attached to the cannula, the infusion will be attached to a pump that will deliver the correct amount of iron infusion over approximately 60 minutes.

Your blood pressure, temperature and pulse will be retaken. If you experience any side effects then you must alert a member of staff.

What happens when I attend the hospital as an outpatient?

On the day of treatment, please eat and drink as normal and take any regular medications.

You will need to attend the hospital for your treatment.

When you arrive you will be greeted by a member of the team who will take and record your temperature, blood pressure and pulse.

A registered Nurse will then insert the cannula into your vein in your hand/arm.

The infusion will then be drawn up and attached to the cannula, the infusion will be attached to a pump that will deliver the correct amount of iron infusion over approximately 60 minutes.

Your blood pressure, temperature and pulse will be retaken before you leave the unit to make sure everything is well.

If you experience any side effects then you must alert a member of staff.

When the infusion is complete the cannula will be removed, you may have some bruising where the cannula was inserted.

You will then be asked to wait 30 minutes after the infusion has completed so that staff can be sure that you have not developed and reactions to the iron solution.

You can drive following the infusion as long as you feel well enough to do so and carry on with your usual activities.

Are there any side effects?

As with all medication, intravenous iron can cause side effects, although not everybody will experience them. Side effects can include:

• Allergic reactions (less than 1 in 100 people) which can cause: shortness of breath, a rash (similar to nettle rash) or hives, other rashes, itching, skin becoming flushed (red and hot) and nausea and shivering

• temporary changes in taste (e.g. things tasting metallic)

• headache

• nausea or vomiting

• muscle and joint pain

• changes to blood pressure or pulse

• burning sensation and swelling at the infusion site

• irritation of the skin around where the infusion was given.

The above side effects are easily treated. If a side effect becomes severe during the infusion, we will stop the treatment.

Rarely, the iron infusion can cause a discolouration of the skin around the infusion site. This is due to the iron solution leaking into the skin. It can cause permanent staining of the skin. If you feel any discomfort during the infusion, please report it to staff immediately.

After the infusion

If you were taking iron tablets before the intravenous iron treatment, you can restart them 1 week after the infusion, to help prevent the iron deficiency recurring.

Sometimes side effects can occur one to two days after the infusion. These will generally settle down without the need for treatment over the next few days.

If you are worried, or the side effects are having an impact on your day-to-day activities then please contact your GP.

If you have chest pain, difficulty in breathing, dizziness or neck or mouth swelling, call an ambulance (dial 999).

How quickly does the treatment work?

Most people will start to feel their energy levels increase within a couple of weeks but this can vary person to person.

Who can I contact with questions or concerns?

Please speak to your Doctor or Nurse in charge.

Further information:

We would like to acknowledge author Oier Ateka, Silver Star Unit, Oxford University Hospitals NHS foundation Trust.

Comments, concerns, compliments or complaints

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