IV iron infusion

This page is for medical practices with staff trained in IV iron administration.

Red flags

Anaphylactoid reactions – ensure there are trained staff and resuscitation facilities available.

Management

Pre-procedure

  1. Investigate and treat the cause of iron deficiency according to the iron deficiency anaemia in adults pathway. Treatment with IV iron infusion does not replace the need to investigate and manage the underlying cause.
  2. Check CBC and ferritin. A ferritin < 20 micrograms/L is diagnostic of iron deficiency. If ferritin > 20 micrograms/L, IV iron is funded only after specialist recommendation.
  3. Review clinical criteria for IV iron infusion.
  4. Consider the following special situations:
    • Pregnancy – seek obstetric advice for pregnant women who are iron-deficient before performing IV iron infusion.
    • End-stage renal failure – specific protocols are used for iron deficiency in patients with end-stage renal failure. Seek nephrology advice.
    • Children – this pathway applies to adults. For advice about management of iron deficiency in children, seek paediatric medical advice.
  5. Check phosphate level if any of these indications are present. If phosphate is reduced, defer iron infusion until it has been corrected. Consider seeking endocrinology advice.
  6. Ensure no contraindications to IV iron are present.
  7. Advise your patient that adverse effects of IV iron are common, and include immediate and delayed reactions. Advise the patient to pause oral iron for one week after IV iron infusion. This is because absorption of oral iron is impaired immediately following IV iron.

Perform procedure

Iron infusions to otherwise healthy patients can be administered in primary care.

  1. Ensure resuscitation facilities are available as IV iron carries a small risk of anaphylactoid reactions.
  2. Administer ferric carboxymaltose (Ferinject) intravenously according to patient's weight. Ferric carboxymaltose (Ferinject) can be prescribed by general practitioners, and is fully subsidised under Special Authority.
  3. Refer to One Point Lesson for information on performing Ferinject infusion.
  4. For patients enrolled in Hutt Valley practices, claim for funding for the procedure via POAC. Check funding eligibility criteria.

Post-procedure

  • Consider restarting oral iron one week following IV iron infusion to delay recurrence of iron deficiency.
  • Repeat blood count 6 weeks following IV iron, or in 2 to 4 weeks if actively bleeding, to ensure anaemia is responding.
  • Repeat ferritin in 6 weeks. Do not recheck ferritin until at least 4 weeks have elapsed.
  • Monitor blood count and ferritin every 3 to 6 months, as iron deficiency anaemia may recur if the underlying cause has not been treated.
  • Review gastrointestinal symptoms and consider further investigations in patients with persistent unexplained iron deficiency anaemia.
  • Treatment with IV iron infusion does not replace the need to investigate and manage the underlying cause of iron deficiency.

Request

  • If IV iron infusion is unable to be arranged in primary care, or if it is unsuitable for patient to have this given in primary care, request IV iron infusion at local hospital day unit.
  • If patient is pregnant, seek obstetric advice for before performing IV iron infusion.
  • If patient with end-stage renal failure, seek nephrology advice.
  • If phosphate level is reduced, consider seeking endocrinology advice.

Learn more

Intravenous ferric carboxymaltose – now available for the treatment of iron deficiency BPAC, NZ, 2017
Ferinject data sheet Medsafe, NZ 
POAC one point lesson: Ferinject – ferric carboxymaltose Compass Health, NZ, 2018

References

  1. IV iron infusion procedure 3D HealthPathways, NZ, 2020
Credits: Health Navigator Editorial Team.