You know you have iron deficiency, read all the source material online, and now scheduled your IV iron session.  Here are the nitty gritty details of what to expect to ensure you have the best experience and optimal results with your next IV iron.  

  1. We recommend a lab check within 2 weeks prior to your IV iron session.  This includes your iron, ferritin, total iron binding capacity, iron saturation, complete blood count and an inflammatory marker, C-reactive Protein or CRP.  With these labs in hand, you can best gauge your need and response to various IV iron formulations.  Everyone responds differently to IV iron but in general the higher the dose you receive, the higher your ferritin levels will be and therefore, a longer lasting result.  For example, do not expect to go from ferritin of 10 to 300 with a small infusion of ferrous gluconate 125 mg.  This will only be achieved with higher formulation like Injectafer 750 mg or Venofer 300 mg. 
  2. Prior to your infusion, prepare yourself by reviewing the consent form. 
  3. Come well hydrated and you should be free of any infections such as a sore throat, skin infection, urinary tract infection and so forth.  Bacteria also thrive on iron; hence we would not want to “feed” the active organisms.  Studies have shown no adverse effect of intravenous iron on the status of an existing infection, nonetheless, we prefer not to treat patients with active infection.
  4. The physician will check your blood pressure and heart rate, as well as perform a brief physical exam.  Next, a small catheter will be inserted into a vein in your arm.  Once IV access is secured, a small volume of normal saline will be mixed with the iron chosen by your provider and administered via a drip fashion into your vein.  The new iron formulations are bound to sugar or lipid molecules which help guard from free floating iron within the bloodstream.  The bound particles are then taken up by macrophages and stored in the cell in another specialized protein, called ferritin.  From here it will be dispersed into the circulation when needed.
  5. Be informed. One reason for reactions associated with IV iron to occur is when iron molecules float unbound in the bloodstream triggering an allergy cascade.   Body rash, chest pressure, ankle and hand swelling, drop in blood pressure and abdominal pain may be a sign that iron is unbound in the blood.  Rare cases of anaphylaxis have been reported.  We do not consider this response a true allergy, as repeat doses may not cause the same reaction.  A dose of acetaminophen (Tylenol) and diphenhydramine (Benadryl) will alleviate symptoms majority of the time.  For those who have experienced a reaction in the past, we will pre-medicate with above for added caution while also administering the infusion as a slower drip.
  6. After your infusion, you will receive a small bolus of normal saline and monitored additionally during this time to ensure you have no immediate reactions.  Your blood pressure and heart rate will be assessed.  You are free to resume your usual activities.  Some clients experience an immediate sense of energy, as if a veil has been lifted.  Conversely, some experience sleepiness after an infusion, a condition easily managed with a quick restorative nap.
  7. A follow up lab check two to four weeks after the infusion will allow us to best assess your steady state level.  If you check your iron panel less than the 2-week mark, you will have an artificially high reading.  The level of hemoglobin change also varies from person to person.  We can expect to see rising hemoglobin level about 10 days post infusion.  If levels remain less than optimal at the 1-month mark, a repeat IV iron will be given.  The larger doses will sustain your stores at optimal range for a longer period.