Anemia is a blood disorder caused by low levels of iron-rich red blood cells. The iron deficiency that accompanies anemia can range from mild to severe, and persons with severe iron-deficiency anemia may benefit from iron infusion therapy to help increase their iron levels and improve their overall health.

Regional Cancer Care Associates (RCCA) specializes in the treatment of cancer and blood disorders, including anemia. RCCA has more than 20 locations near you in New Jersey, Connecticut, Massachusetts, and the Washington, D.C., area, including facilities that provide infusion services for non-oncologic conditions such as severe iron-deficiency anemia (IDA).

Key Takeaways

• Iron infusions help treat iron deficiency anemia by delivering liquid iron directly into a person’s bloodstream.
• Iron infusions are used as an alternative to iron supplements when the patient can’t tolerate the pills, whether due to malabsorption, gastrointestinal issues, or another reason.
• Types of iron infusions include iron sucrose, ferric carboxymaltose, low molecular weight iron dextran, and ferumoxytol.
• Side effects of iron infusions include infusion site reactions, headaches, dizziness, joint pain, muscle aches, and more.
• RCCA provides iron infusions at our infusion centers across New Jersey and Connecticut.

What Is Anemia?

Anemia is the most common blood disorder, and is characterized by a low red blood cell count. Red blood cells carry hemoglobin, an iron-rich protein that helps to carry oxygen to the body’s tissues. When the body does not have enough healthy red blood cells, the tissues do not get enough oxygen. “Anemia” encompasses many types that can range from mild to severe, be caused by other health conditions, or indicate a more serious health problem. The most common type is iron-deficiency anemia, which is characterized by low levels of the iron the body needs to stay healthy. In iron-deficiency anemia, the body does not have enough iron to function properly, resulting in decreased oxygen delivery throughout the body and often causing symptoms.

Iron-Deficiency Anemia Signs and Symptoms

The symptoms of anemia – along with its diagnosis and treatment – depend on the type of anemia and its severity. People with mild iron-deficiency anemia may not sense a problem while those with moderate to severe anemia can experience many symptoms, including:

• Tiredness or fatigue
• Weakness
• Headaches
• Pale or yellow skin
• Cold hands and feet
• Hair loss
• Irregular or fast heartbeat
• Chest pain
• Shortness of breath
• Dizziness or lightheadedness
• Pounding or whooshing sound in the ears
• Sore or smooth tongue
• Brittle nails

Many of these symptoms can be innocuous and transient, or they could signal anemia or another health problem. Anyone who persistently feels any of the above symptoms  should see a doctor, who will determine if testing is needed.

Iron-Deficiency Anemia Risk Factors

Iron-deficiency anemia is most often diagnosed in women and children, although people of all ages and genders can develop it. The iron deficiency that accompanies this type of anemia can result from many different factors – including some that can be managed and some that cannot. Some of these factors include:

• Sex assigned at birth: Women are more likely to develop iron-deficiency anemia than men because menstruation, pregnancy, and childbirth can decrease iron levels.
• Health conditions: Chronic health conditions that interfere with iron absorption can increase a patient’s risk of developing iron-deficiency anemia.
• Diet: People who are not eating properly may have lower-than-recommended levels of necessary vitamins and minerals such as iron, vitamin B12, and folic acid. This can increase anemia risk.
• Pregnancy: Pregnant women face an increased risk of developing anemia if they do not get enough folic acid and iron during their pregnancy.
• Blood loss: Persons with conditions that cause blood loss, such as heavy periods, stomach ulcers, or chronic nose bleeds, also face an increased risk of iron-deficiency anemia.

Research also has shown that infants and children who are premature, not breastfed, or who drink more than 16 to 24 ounces of cow’s milk a day are at higher risk for iron-deficiency anemia because these factors decrease iron absorption. Persons with any of these risk factors for iron-deficiency anemia can mitigate their risk by making healthy lifestyle changes, including eating a diet rich in iron and increasing their vitamin and mineral intake with supplements.

Diagnosing Iron-Deficiency Anemia

If a patient presents to a primary care provider with symptoms of iron-deficiency anemia, the provider will perform diagnostic tests to determine whether anemia is present and, if so, what is causing it. Some of these diagnostic tests include:

• A physical examination to check for symptoms such as heart murmur, pale skin, and brittle nails
• Blood tests, including tests to measure complete blood count (CBC), iron and vitamin levels, and reticulocytes (red blood cells that are not yet fully developed)
• Other tests to determine the cause, including bone marrow testing, endoscopy, colonoscopy, and urine testing

Once the anemia is diagnosed and the cause is confirmed, the patient’s medical team will have better insight into how best to treat the condition.

Treating Iron-Deficiency Anemia

After iron-deficiency anemia is diagnosed, the provider will recommend a treatment option based on symptoms, severity, and cause. All anemia treatments are designed to increase iron levels until the deficiency is fixed and the body has sufficient iron stores. These treatments include:

Dietary Changes

For mild iron-deficiency anemia, the first suggested treatment is usually dietary changes to increase iron intake. This requires the patient to eat more foods rich in iron, including:

• Meat and poultry
• Fish
• Leafy greens like spinach and kale
• Legumes including lima beans, soybeans, and pinto beans
• Squash and pumpkin seeds
• Eggs
• Tofu
• Dried fruit
• Iron-fortified grains, cereals, pasta, and rice

Often, dietary changes alone will not sufficiently increase iron levels, so another treatment, such as iron supplements, may be added.

Iron Supplements

Iron supplements are suitable for patients with iron-deficiency anemia who do not get enough iron through their diets. Doctors will prescribe special supplements of elemental iron, usually doses of 150 to 200 milligrams daily, that are stronger than over-the-counter multivitamins.

These supplements can help replenish iron levels over time, but they often take 3 to 6 months to work fully. Patients may also experience potentially bothersome side effects, such as constipation or black stools. If side effects happen, a primary care provider can discuss ways to minimize or prevent them.

Iron Infusion Therapy

Patients with more severe iron-deficiency anemia can benefit from iron infusion therapy. This modality entails administering doses of iron to patients intravenously (via a needle placed in a vein in the arm or hand), rather than in a capsule or injection into the skin or muscle. Iron infusion therapy is administered under the supervision of a blood disorder specialist, known as a hematologist.

Iron infusion therapy is especially suitable for patients who cannot tolerate iron supplements, do not absorb iron correctly in the gastrointestinal tract, or have chronic blood loss. The length and frequency of iron infusions will depend on the patient’s specific circumstances.

Blood Transfusions

Red blood cell transfusions are recommended if the severe iron-deficiency anemia is causing distressing symptoms, or during a severe bleeding episode. This method quickly increases the patient’s red blood cell count and corresponding iron levels. Transfusions, however, do not completely correct iron deficiency and are only a temporary solution.

Iron Infusion Therapy

An iron infusion is a medical procedure in which liquid iron is delivered directly into the patient’s bloodstream through a vein. It is most often used to treat severe iron deficiency or iron deficiency anemia, especially when iron pills aren’t effective or tolerable. Compared to iron supplements or pills, iron infusions work much faster, and they bypass the digestive tract, which means they don’t cause the same gastrointestinal side effects that supplements can.

There are various types of IV iron used in infusions, which differ by dosage, administration speed, and treatment frequency. They include:

• Iron sucrose: This type offers a gentle formula that is administered in smaller doses over several weeks. It is often used for patients with chronic kidney disease, especially those on dialysis.
• Ferric carboxymaltose: This is a high-dose type that administers large amounts of iron (up to 750–1,000 mg) in a single session. Therefore, it generally only requires two doses spaced a week apart.
• Low molecular weight iron dextran: This is one of the oldest types. It replenishes iron completely in a single session, but patients must first have a test dose to monitor for hypersensitivity.
• Ferumoxytol: Designed for patients with chronic kidney disease, this type provides quick administration of large doses in about 15 minutes.

Who Needs an Iron Infusion?

Most people with iron-deficient anemia will be prescribed iron supplements, which are taken by mouth daily. However, some patients will require iron infusions. Infusions are typically recommended when patients have a serum ferritin level of <30 μg/L alongside other symptoms. People who can benefit from iron infusions include:

People with Certain Conditions

There are certain conditions that can cause iron-deficiency anemia severe enough to need IV iron. They include:

• Heavy menstrual bleeding or uterine fibroids
• Gastrointestinal blood loss (ulcers, colon polyps, colon cancer)
• Malabsorption conditions (Crohn’s disease, celiac disease, post-gastric bypass)
• Chronic kidney disease
• Cancer-related anemia
• Pregnancy-related iron deficiency

Oral iron supplements may not be enough to effectively and quickly treat these severe deficiencies.

People Who Can’t Tolerate Iron Pills

When treating IDA, iron pills aren’t always suitable. Reasons that people may not be able to tolerate iron supplements include:

• GI intolerance of oral iron: Since the pills can cause gastrointestinal upset, some patients, especially those with GI conditions, may not be able to tolerate the side effects. Iron infusions bypass the digestive tract, so they don’t cause the same side effects.
• Malabsorption: People with malabsorption problems may not be able to effectively absorb the iron from the pills in the digestive tract, which prevents the oral iron from working.
• Severe depletion requiring faster restoration: If a patient has severe iron depletion that needs to be restored quickly, pills aren’t always suitable. They take longer to work, so iron infusions are a faster and more ideal option.

What Happens During an Iron Infusion?

When lab tests confirm you need IV iron, you’ll be prescribed iron infusions. These are completed in outpatient infusion centers or clinics. Before you go, eat a full meal and drink plenty of water to make finding a vein easier. You should also stop taking oral iron supplements at least 24 hours beforehand and wear loose-fitting clothing. When you arrive, the process typically includes:

• IV placement: The healthcare professional will sanitize the area and insert an IV into a vein in your arm or hand, which will deliver the iron.
• Infusion: The provider will remove the needle and leave a soft catheter connected to an IV bag of iron and saline, which slowly infuses into your vein. The process will take anywhere from 15 minutes to an hour or more, depending on the patient’s unique situation.
• Monitoring: The provider will remove the IV and monitor your vitals for 15 to 30 minutes after the infusion to look for adverse reactions.

The length and number of infusions you’ll need will depend on the severity of your iron depletion and the type of iron infusion you’re receiving. To pass the time during infusion, many people bring books or tablets.

Iron Infusion Side Effects

There are common mild side effects that people may experience during or after iron infusions, but they’re usually temporary. They include:

• Flushing or warmth
• Itching
• Headache
• Dizziness
• Temporary drop in phosphate levels (with some formulations)
• Joint pain
• Muscle aches
• A metallic taste in the mouth
• Redness or rash on the skin

Less common side effects include nausea, vomiting, and low blood pressure during infusions. A rare but serious side effect is hypersensitivity reaction, which can result in symptoms such as fever, chills, rashes, itching, and trouble breathing. If you experience these symptoms, seek medical attention immediately.

Iron Infusion at RCCA’s Infusion Therapy Centers Near You in New Jersey and Connecticut

If you’re dealing with low iron levels and related symptoms, iron infusions may be right for you. Regional Cancer Care Associates (RCCA) offers iron infusions for patients across New Jersey and Connecticut. RCCA physicians offer patients innovative therapies, including immunotherapies and targeted therapy, cutting-edge diagnostics as well as access to approximately 300 clinical trials in community-based centers close to home.

Contact us today to learn more about an iron infusion referral at one of our infusion therapy locations near you in New Jersey and Connecticut.

Frequently Asked Questions About Iron Infusions

How long does an iron infusion take?

The length of the infusion will depend on the patient’s iron levels and the type of infusion they’re receiving. However, it typically takes anywhere from 15 minutes to an hour or more.

How long does it take for an iron infusion to work?

Symptoms of low iron often start improving within one to two weeks, although the full effects of the infusion generally take four to eight weeks to work.

Does an iron infusion hurt?

No, an iron infusion doesn’t hurt. You will only feel a slight prick when the needle is inserted.

What are the side effects of an iron infusion?

Potential side effects of an iron infusion include:

• Injection site reactions, such as temporary burning or redness
• Mild headaches
• Muscle cramps or joint pain
• Nausea
• Dizziness
• A metallic taste in the mouth

How many iron infusions will I need?

It depends. The number of infusions is determined by various factors, including the severity of the deficiency, the specific IV formulation, and the patient’s body weight.

Can iron infusions be done in an outpatient setting?

Yes, iron infusions are often done in outpatient infusion centers or clinics.

Is an iron infusion covered by insurance?

Iron infusions are often covered by insurance, as long as they are considered medically necessary.

Why would a doctor prescribe an iron infusion instead of iron pills?

A doctor may prescribe iron infusions instead of iron pills if the patient can’t tolerate the pills due to gastrointestinal upset or malabsorption issues, or if they have a severe deficiency that needs to be quickly restored.

How do iron infusions compare to iron pills?

See the table below for a detailed comparison of iron infusions vs. iron pills: