Iron infusion: Indication, side effects, and contraindications:

Why is iron given in injection form?

Iron infusion is a medical management approach for low hemoglobin levels, in which iron, a mineral used by the body to produce hemoglobin, is administered. This is responsible for transporting oxygen from the lungs to the other cells of the body. However, the proper amount of iron is necessary in the body to make hemoglobin.

 If the levels are not enough to make a hemoglobin molecule, the patient will be suffering from low hemoglobinemia, also called anemia in medical terminology.  So, to correct the hemoglobin levels, the health care provider will administer/prescribe iron supplements, which are in the form of tablets/pills/syrup form or in injection form. Depending upon the severity levels, your healthcare provider will choose the form of iron, e.g, pill, syrup, or injection.

What are the symptoms of iron deficiency?

Iron deficiency symptoms depend upon the hemoglobin level in the blood. A person can assess their own symptoms, which may include skin color, eye color, and assess their tongue, as well as other symptoms, such as their energy level. The following are the symptoms of low iron/hemoglobin levels.

• Pale skin
• Short of breath on exertion /during climbing stairs or doing a walk or exercise, sometimes without exertion
• Tiredness
• Unable to perform work
• Feeling sleepy all the time
• Lack of concentration
• Forgetfulness /unable to memorize things, words
• Body pains in some cases
• Low blood pressure
• High pulse rate

Red or strawberry red color tongue in iron deficiency anemia, purple or bluish in severe cases, indicates very poor oxygen levels in the blood.

What diseases /conditions need iron infusion?

Must consult your healthcare provider if you feel lethargic or have low energy levels, or if your skin color is pale. Moreover, your healthcare provider will do some blood tests on the basis of your symptoms, besides low hemoglobin levels, which could be seen on a complete blood count test (CBC), your healthcare provider will check iron levels in your blood.

 Which test identifies the low iron levels?

The test is known as serum ferritin levels. The ferritin levels will indicate the actual need for iron supplements. On mild levels, only an oral supplement can work. However, from moderate to severe levels, injectables are preferred. Sometimes, the hemoglobin levels are normal, but the test shows low ferritin levels. The actual ferritin levels show iron storage in the body.

What are the side effects of iron supplements?

Iron supplements have the following side effects:

• Bloating
• Abdominal pain
• Nausea
• stomach fullness
• Greenish or dark blackish stools
• Hard stools or constipation

What precautions should you take while taking iron supplements?

It is necessary to take medicine with caution as follows.

• Take the pills with food after food, as the iron supplements irritate the stomach and cause nausea and vomiting.
• Do not take the supplements with milk or other calcium-containing foods or drugs; also, avoid antacids or antibiotics, which can interact with the iron.
• To prevent constipation, take a high fiber diet, plenty of fluid, and water.
• If there is a need to take a calcium supplement, take a gap of 12 hours between both supplements. It usually happens during pregnancy.

How long does it take to recover after an iron infusion?

Recovery depends upon the levels. Usually, the patient starts feeling better after a week of infusion. The recovery symptoms will be

• Feeling active and energetic
• Skin will get pink, especially the tongue and eyes
• No shortness of breath
• Improves memory
• Normal blood pressure

Can iron infusion be given if the patient actively bleeds?

No, you cannot give an iron supplement; the iron infusion is for active bleeding. First, the bleeding is stopped, transfusions are done, and yes, later on, iron infusion could be given to restore the iron levels in the body.

What side effects can be seen during and after the injection?

The oral forms usually do not need close observation, but yes, side effects are explained to the patient. However, the iron infusion is always given under the close observation of your healthcare provider.

Why is the iron infusion given under close observation?

Due to the high potency of causing reactions, the iron infusion is given under close observation. The expected severe side effects or reactions could be as follows.

Shortness of breath due to an anaphylactic reaction

Skin rash

Low blood pressure

High pulse rate

Dizziness or fainting

Nausea or vomiting

Swelling on the face, tongue, and lips.

The healthcare provider will be with you, observing and monitoring closely. However, one must call for help in case of the above-mentioned symptoms.

What precautions should be taken to avoid or manage anaphylactic shock?

If a person has a history of reaction in the previous infusions, the healthcare provider must inject a steroid and antihistamine shot at least 30 minutes before the infusion. Then start the infusion slowly under close monitoring and observation.

What will be the total time of infusion?

The total infusion time depends upon the type of iron preparation. Such as follows

Venofer  (iron sucrose ) 15 – 30 minutes

Ferrenject  (iron gluconate) 1- 2 hours

Injectafer (Ferric carboxymaltose) 15 minutes.

In which case, iron injection is preferred over iron pills?

Iron infusion is preferred over the pills in the following cases:

In case of severe nausea and vomiting(hyperemesis gravidum) which usually occurs in pregnancy, the healthcare provider will prefer the iron infusion over the pills.

In case of a very low level of hemoglobin or ferritin, iron infusion is preferred over the pills.

To get faster results, iron infusion is preferred

Patients who suffer from chronic kidney disease.

What are the contraindications for iron infusion?

Iron infusion is contraindicated in the following cases:

Severe liver diseases

Anemia not caused by iron

Iron overload usually happens in thalassemic children of patients with a history of massive blood transfusion.

If a patient is suffering from any active infection.

If a patient has a history of severe allergic reactions to iron preparations.

So, iron infusion needs proper monitoring and observation. Moreover, a complete patient history and general fitness are required, as liver function tests or kidney function tests should be carried out before the infusion