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Iron Infusions: Helpful or Harmful?

Patients are often recommended iron infusions because they cannot tolerate oral iron due to side effects, extremely low iron levels or in an emergency from acute blood loss.

In my own clinic, I used to utilize iron infusions to help patients with anemia or low ferritin get over the top with their low iron. Iron infusions have worked wonders and likely saved many lives.

Iron infusions were historically needed because standard oral iron amino acid chelates, and salts had such low efficacy and so many side effects.,

Given the high potential for allergic reaction and non-allergic negative reaction to iron, along with the high cost to the clinic and patient I discontinued iron infusions about three years ago.  But I didn’t just stop iron infusions and let my iron-deficient patients flounder in the mess that is standard iron supplementation.

I found a golden ticket to raising iron levels ultra-efficiently with essentially no side effects that came in the form of an oral whole protein iron delivery system. You can read all about it here.

How Much Does An Iron Infusion Cost?

Iron infusions are big business. For those who have received an iron infusion you are already well aware of the steep price tag.  Iron infusions currently vary from $825 to $3,087 per infusion.

Is this not wild? Iron is a necessity for life and yet to get it via intravenous infusion is over the top costly. 

Patients start with iron poor blood and end up financially poor as well.  An iron infusion is rarely a one-time therapy.  Most patients going the iron infusion route will require at a minimum, three iron infusions.

Do Iron Infusions Have Side Effects?

Iron itself is notoriously problematic given the many side effects of standard iron supplements.  The same goes for iron infusions.  Outside of an actual allergy, iron dextran is the least problematic and iron sucrose is the most problematic, of the different types of iron available for infusion.

It is crucial that your vitamin D levels are optimal before receiving intravenous iron, as well as calcium, and phosphate levels.  If not, you are at heightened risk of hypophosphataemia which can manifest as severe anxiety, muscle cramps, palpitations, fatigue, dizziness and nausea to name a few symptoms.

Phosphorus is an essential mineral for energy production of every tissue in your body, so it is vital to keep it balanced and sufficient going into an iron infusion.

One study showed that 51% of people with iron infusion-induced hypophosphataemia experienced symptoms for up to 6 months. Unfortunately, one of the main symptoms of iron-deficient patients is fatigue and yet the bolus iron infusion itself is inducing fatigue by reducing phosphate levels.

Talk to your doctor about supplementing with vitamin D, calcium and phosphorus even if your levels are within the normal range to minimize potential hypophosphataemia episodes related to the iron infusion.

Iron Infusions and Weight Gain

Insulin resistance and weight gain are also related to iron infusions. This is thought to be related to the excess iron in the blood causing oxidative stress when iron is given via iron infusion. Weight gain is often a symptom of iron deficiency and can be very disconcerting to patients who are hoping to turn their body composition around by increasing their iron and unknowingly potentiating insulin resistance through iron infusions.

Annual Iron Infusions and Atherosclerosis

Annual iron infusions are associated with carotid artery intima thickness. This is a consistent marker for atherosclerosis. The greater the thickness, the greater the arterial damage and oxidative stress present within the blood vessels.

When the endothelium (inner lining of blood vessels) is damaged by pro-oxidant molecules like free iron from an infusion, it triggers a cascade of inflammatory events, which if not stopped will cause remodeling and hardening of the arteries.

Vitamin C and Vitamin E Decrease With Iron Infusions

The Journal of Nephrology showed that treatment with intravenous iron but not saline was associated with decreased plasma ascorbate (vitamin C) and α-tocopherol (vitamin E) levels and increased oxidized glutathione/reduced glutathione ratio. They concluded their work by stating, intravenous iron sucrose provokes oxidative damage to peripheral blood lymphocyte DNA in hemodialysis patients.

It should also be mentioned that another study demonstrated that taking high-dose vitamin E with iron infusions could reduce some of the lipid peroxidation induced by the intravenous iron bolus.

Should I Get An Iron Infusion?

The cost of an iron infusion, along with the inflammation and weight gain that usually follow, are enough to detour people away from getting an infusion and seeking an alternative solution. Of course, there are cases of acute blood and iron loss, such as trauma and long-standing menorrhagia where iron infusions may offset any potential negative effects.

However, other than in these circumstances I have not found it necessary to use iron infusions even in the cases of intensive anemia since discovering the whole protein chelated iron system. To get the most out of an iron supplement, I recommend following these dosing guidelines.

References:

Kuo KL, Hung SC, Wei YH, Tarng DC.(2008). Intravenous iron exacerbates oxidative DNA damage in peripheral blood lymphocytes in chronic hemodialysis patients. J Am Soc Nephrology, 19(9):1817-1826. doi:10.1681/ASN.2007101084

Acute Injury with Intravenous Iron and Concerns Regarding Long-Term Safety Kalkidan Bishu and Rajiv Agarwa. Clin J Am Soc Nephrol, 1: S19 –S23, 2006. doi: 10.2215/CJN.01420406

Yokus Osman, Gedik Habip.(2016). Is iron treatment related to weight gain in female patients with iron deficiency anemia? Egyptian Journal of Haematology,Volume 41 (2):42-44.

Have you received an iron infusion before? I’d love to hear about your experience in the comments below.

17 thoughts on “Iron Infusions: Helpful or Harmful?

  1. Pingback: Ferritin: The Blood Test Women Should Get at Every Doctor's Visit - Maryann Jacobsen

  2. Staci G

    I received an iron infusion about five days ago, unaware of the dangerous side effects. Now I am covered in hives and welts that come and ago and are all over my body. Now I am taking steroids to counteract this as the anti-histamines were not effective. I am terrified that I have just given myself long term hives but I am unaware of how to move forward. My side effect is not considered severe and so the journals do not have an indication of why it is happening and at what rate. I am going to buy some vitamin E because of your suggestion. I hope this helps. Thank you

    Reply
  3. Iron deficient

    Horrible experience after iron infusion. I took it for the first time a month ago, my gp didn’t inform me about sides effects other than death from allergic reaction, skin pigmentation and two day lasting headache and feeling unwell. It has been a month and I feel like a wreck. The nausea, headache and most terrible muscle pain last till today a month later. The muscle are literally in spasms and I haven’t had a proper sleep since. My skin at age of 36 is covered in acne which won’t go away. I regret listening to this gp he offered it as a magical cure saying he administrates five of them a day. I’m counting data to feel better:(

    Reply
  4. Jeanette

    I am grateful for iron infusions. Im iron deficient without anemia and no oral treatment plan has helped. I just finished my second round of Venofer in two months and other than a slight headache for the first week during the first round, and some mild edema, I’ve had zero side effects. I don’t want people to be scared to try it for themselves. I highly recommend it! I have never felt so great. Ive had low ferretin for nearly 20 years and I lost so much of my life to fatigue, etc.

    Reply
  5. Brent

    I’ve experienced anemia on and off for about 15 years. I had my first iron infusion yesterday. So far, so good. I have not experienced any problems. I can’t even find the site where they put the IV. I’ve been able to mow the lawn and other yard work. I’ll update if anything changes. So far, it works for me.

    Reply
  6. Julia Baldwin

    I’ve been getting iron infusions over the last 4 years. My first doctor I feel infused it to quickly. It was a higher dose to last me longer but was infused in under an hour. It made me feel sick for about 24 hours but I was good for at least 4 months. The next time they infused it slower and it was over a 5 hour time frame. This time I had less side effects and a lot more energy. This time my infusion lasted about 8 months. So we did another round of this and lasted another 8 months. After that my iron saturation kept staying at exactly 15 for months and I constantly felt sick because insurance won’t cover unless it hits just under 15. Apparently I was taking 1 supplement that kept my number at 15 and didn’t realize it. I stopped it and drew blood a week later and boom finally hit 13. I suffered for months because my number wouldn’t change. It’s like driving a car on empty always hoping you won’t run out of gas. So this round of infusions we are doing smaller doses 1x weekly for 8 weeks each infused over an 1.5 hr time frame and so far I’ve had no side effects, I’ve already have increased energy after 2 doses, my weight has slowly been going down on its own. I finally feel like when I sleep I’m actually getting rest. So to sum up everything I’ve done so many different oral methods before needing to go to infusions. I’ve done different methods of infusions and out of all of them so far I am liking the smaller doses over the 8 week time span. I would say I do not recommend the single major dose getting infused within an hour because that time I had felt the worst. From nausea, to just wanting to sleep, like my body just ran a 10k marathon. Now being stuck at 15 iron sats for months with all my other number dwindling I would say is far worse symptoms that getting the infusions. In those 8 months being stuck there I gained 30lbs, slept 75% of the day, was winded easy, got lightheaded from moving to quickly and had passed out a couple times from not sitting down quick enough when I started getting heart palpitations. Etc. All from 1 supplement that kept my number in the what I call it empty tank range. So in my experience iron infusions have helped my life tremendously but I have also learned what my body prefers and that’s the slower process of bringing it up.
    Also for anyone who has side effects. There are clinics that will infuse meds to counter any side effects before infusing the iron. You just need to find that specific clinic. I’ve had it done with and without and I would say having that side effect meds infused 1st made those first 24 hours after much much better and without side effects.

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  7. Mimi

    I had iron Iron fusion twice…I was not aware if the danger until reading this information. Initially I was at 2 level, extremely tired and feeling suicidal as everything felt like too much effort even just to wake up or walk up the stairs…so I had B12 injections 3 times , then my first iron infusion…I really didn’t feel much difference until 10 weeks…when i started feel with more energy…then, my iron levels drop fast again to 10…
    A year later, had my second iron infusion…but it feels like I have never recovered again, constantly feel tired, depressed, anxiety, everything seem to be overwhelming…. It started feeling like when my level were at 2…
    Just had a blood test, iron level at 10, but Vit D is very low…
    So after reading this Information regarding what could happen if getting Iron infusion having low vit D …I am scare… I don’t want to feel worse than what I feel right now… I do not what to do in order to fix this…doctors always in rush, never tell you everything…

    Reply
  8. Liza

    I felt so much better after my infusions. I had had very heavy periods throughout my life and had recently had 3 surgeries within 2 years. I wish the doctor had taken my iron levels more seriously since I was a teenager because I was always fatigued and just considered lazy and unmotivated. But my ferritin was 7-10 and doc said that was fine. But I think if I was given iron supplements long ago, it would have been under control and I wouldn’t have needed the infusions in the first place. What I don’t get is that my infusions were free. I live in Ontario. But I see that they’re costing a lot of money now. Did they just change this? Why were mine free? My iron levels are decreasing again from 150 to 50. My doctor yet again said not to be concerned but I know to keep up with my iron, I now need to take iron supplements. It’s nice to know now what I need to do. He basically told me it was all in my head but I have been fatigued and sleeping 18 out of 24 hours and out of breath etc etc. I really wish doctors would take this stuff more seriously. Instead, I have to trust my own instincts and find the right professionals to give me advice. Just not doctors unfortunately.

    Reply
  9. Faith A. R.

    I had mild iron – deficiency anemia prior to roux-en-y gastric bypass surgery over 20 years ago. Due to the removal of a portion of the small intestine involved in that I am unable to absorb sufficient oral iron, so periodically require iron infusions…usually once or twice yearly. Previously I have had a one -day infusion of iron dextran over a few hours after some pre-medications of oral Tylenol, & Benadryl & IV Zofran (for nausea). I had experienced nausea, shaking chills, migraine headaches & muscle spasms during the infusion & decreasing gradually afterwards & had fatigue for a couple of days.
    My Hematologist changed my infusion this time to Venofer (because I now have mild chronic kidney disease) divided into three two-hour doses one week apart. My first infusion was last week with the same pre-meds, & during the infusion I the chills & muscle spasms were remarkably decreased by about 75%. The migraine headache & light sensitivity was about the same, but I was given some pain medication prior to the infusion & another dose @ the onset of the migraine over headway through. This made a huge difference in the headache being decreased by 50%. A new symptom with this infusion was itching, which was relieved by taking another oral Benadryl upon arriving home. Most noticeable for me this week has been the fatigue for two days, & ongoing joint & muscle aches & intermittent nausea…all challenging & limiting my stamina but not debilitating. My next infusion is in two days & the infusion nurse will check w/my Hematologist about possibly adjusting the pre-medications or the rate of the infusion to try to manage the side-effects.
    While I don’t like the side-effects I definitely benefit from the infusions in the long run & in my overall quality of life so I am hopeful that my health care team & I can maximize the benefits & minimize the difficulties. It was also difficult to get insurance approval for awhile, which is very frustrating since I’m unable to absorb any oral iron.

    Reply
  10. Natalie

    This is extremely eye-opening to read… my doctor never mentioned the risk of phosphate levels dropping, and my levels have never been tested. My personal story (female, age 31, avid marathon runner who runs 70+ miles a week) is that I feel like receiving an iron infusion was the worst thing that ever happened to me. I received an infusion for iron deficiency anemia on 10/1/2021, and I have not felt like myself since. At the time of my infusion, my hemoglobin was 11.1, ferritin 30, TS 20%, iron 56, TIBC 279, RBC 3.8, hematocrit 35. I had been struggling for years with low ferritin and low hemoglobin, so my doctor felt an infusion was a wise next step to try because I had been feeling extremely run-down when running and my endurance capacity was tanking. After receiving the infusion, I felt terrible for months, and, to this day, I still feel like something is “off” in my body. My hemoglobin has barely increased (only to 11.7), my ferritin has stayed insanely high since the infusion (currently 220 and was as high as 320 in December 2021). Additional updated bloodwork as of 7/18/22: TS 23%, iron 74, TIBC 265, RBC 3.9, hematocrit 36. I am trying to understand why my ferritin as remained so high since my infusion (nearly a year later), while my hemoglobin has barely increased. Folate and B12 have been at good levels every time I have had them tested, and my ESR was normal, pointing to no inflammation. Hemoglobinopathy, lactate dehydrogenase, haptoglobin, and thyroid tests were all normal as well. My question is: what is causing my ferritin to remain so high??? I constantly feel short of breath when I run; my breathing has not felt normal for over a year, and my running performance has suffered as a result. Could a low phosphate level be causing the ferritin to remain high/be interfering with iron utilization in my body? Additionally, my alkaline phosphatase has been low (26-34) for the past year; is that something that could be interfering with the ferritin? Thank you so much in advance for any insights you have to offer (my current doctor seems to be at a loss, and I have been feeling hopeless – I’m a 2:54 marathoner and feel like I will never get back to that level of competitiveness with how I am currently feeling).

    Reply
  11. Dk

    HI, it seems that you’ve worked with a compounding pharmacy to come up with your own branded/ lavel iron supplement and using this as a way to discourage patients from an IV iron and purchase your own branded supplements.
    Could you provide before and after ferritin levels with your oral iron.
    I can see why (financially) you would recommend this….

    Reply
  12. Glenda Vesich

    I had absent iron storage in my Bone marrow.. than my Hemoglobin got low.. so it took 3 separate iv iron infusions to kick in the iron to bring it up.. That was well over a year ago.. and my Ferritin is high.. it’s 760.. but I do feel better now..

    Reply
  13. C. Ketchum

    I have several food allergies (milk, milk protein, soy, beef, saccharomyces), with a Ferratin of 2. I found oral iron supplements to cause a wide variety of allergic reactions, including mild anaphylaxis. Due to the Saccharomyces allergy, I am unable to take ANY vitamin supplements in the US. Most have items like thiamine, niacin, or even citric acid, which are derived from saccharomyces. From the research I have done, this includes any vitamin B additives. This allergy has made iron infusions the only option that I have found, and other than mild tiredness for 24-36 hours afterwards, I am tolerating them very well. I have been unable to find a doctor that know much about saccharomyces in my area, so I have essentially educated my dietician, doctors, and hospital because they do not have research-backed data. I am told that since it falls under one of the least common food allergies in the world (bottom 3%), no one will “waste” grant money on research for it. It is surreal after having no food allergies for most of my life.

    Reply
  14. Sofi The Great

    I have dons iron inf fusion treatments 4 times in the last 5 years. Each time it was 5-2 hour sessions. I am currently going for my 4 th session tomorrow. This week I have been tired. I’ve only ever noticed good things from my infusions. My iron was at 5 my hemagloben was 90 my muscles ached with very little exercise. I continued on doing my normal routine. I will have to research the phosphorous and vit e supplementing.

    Reply

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