Pros and Cons of Iron Infusions for Treating Iron Deficiency

Whether you have iron deficiency anemia (IDA) — a blood disorder and the most common type of anemia — or a milder form of iron insufficiency known as iron deficiency without anemia (IDWA), it’s important to seek treatment through iron supplementation. IDA and IDWA can both cause symptoms such as fatigue, hair loss, and concentration issues, and iron supplementation is typically recommended when ferritin levels — the amount of stored iron in the body — are less than optimal. 

Remember: “normal” doesn’t necessarily mean “optimal”! Iron supplementation may be warranted even when iron levels fall within a lab’s “normal” range. Ferritin levels of less than 100 μg/L can indicate iron insufficiency, while levels of less than 30 μg/L can indicate iron deficiency. A ferritin level of at least 100 μg/L is a good target for treatment, especially for menstruating women and individuals experiencing symptoms of low iron.

Iron infusions for anemia & iron deficiency

The good news about addressing low iron levels is that several safe and effective treatment options are available:

The first line of therapy is always to get adequate iron from food; the foods with the highest density and most absorbable form of iron are muscle tissue, i.e. red meat and dark poultry cuts. 

Vegetarian sources with higher iron levels are black beans, beet root, leafy greens but also dates. 

Supplementation with an oral iron supplement is also a good option. There are a number of forms of iron supplements, as described in my iron deficiency and anemia blog post. 

Vitamin C can increase the absorption of iron supplements, which is why taking iron with a source of vitamin C, e.g. a piece of fruit, is helpful. 

The tannins in coffee and tea however, as well as large meals eaten at the same time with an iron supplement, will prevent the absorption of iron and should be taken at least 1h before or after.

However, what to do when you have tried dietary and supplemental iron and your iron stores will not increase? Or when you have severe iron deficiency that needs immediate attention? 

An iron infusion is an outpatient procedure that intravenously delivers iron into the body, commonly used as an alternative to first-line treatments for iron deficiency.

While first-line treatments such as iron supplements and dietary changes tend to be safer, more cost-effective, and more accessible than intravenous iron, IV iron infusions offer an effective alternative for certain patients. These patients include:

• Individuals with severe iron deficiencies.
• Patients who cannot tolerate the side effects of oral iron therapy.
• Individuals who don’t respond to first-line treatments for iron deficiency.
• Those needing immediate improvements in iron status, such as pregnant women or patients preparing for surgery. 
• Patients with malabsorption issues such as celiac disease, IBD, SIBO, or H. pylori, as these types of conditions can all impair oral iron absorption.

Several other individuals may also benefit from iron infusions over oral iron supplementation. These include gastric bypass patients, individuals with elevated hepcidin levels, and iron-deficient pregnant women who already experience a great deal of pregnancy-related nausea and vomiting.  

What are the benefits of iron infusions? 

Since oral iron supplementation is commonly associated with gastrointestinal side effects such as constipation, abdominal pain, and diarrhea, one of the greatest benefits of iron infusions is that gastrointestinal issues are much less likely to occur. However, some oral iron formulations are gentler on the stomach than others, so you may need to experiment with different formulations to find an iron supplement that works for you. 

If you experience gastrointestinal side effects with all oral iron supplements, iron infusions may be worth considering. Intravenous iron is absorbed into the bloodstream without entering the GI tract, making iron infusions a good alternative for those who cannot tolerate the gastrointestinal side effects of oral iron supplements. 

Iron infusions & malabsorption issues 

The same benefit applies to individuals with malabsorption issues, as certain conditions hinder the absorption of iron through the gastrointestinal tract. Because intravenous iron bypasses the digestive system by delivering iron directly into the bloodstream, IV iron is typically more effective than oral iron supplements when malabsorption conditions are a concern. 

IV iron quickly raises iron levels

Lastly, iron infusions can raise ferritin levels much more quickly than first-line treatments for anemia and iron deficiency. Unlike dietary changes and oral iron supplements — which take weeks or months to show effects — iron infusions can significantly raise iron levels within days, and restore iron levels within six weeks of treatment. This could make IV iron a better treatment option for those requiring immediate improvements in iron status. 

Risks associated with iron infusion treatments

Despite the benefits of IV iron, there are also risks associated with iron infusion treatments. About one percent of patients experience minor reactions to iron infusions, including skin staining (at the site of injection) and hypophosphatemia (low levels of phosphate). Serious adverse effects — including anaphylaxis and some fatalities — have also been reported. 

Several potential risks of iron infusions include the following:

Potential for allergic reactions

One of the most significant risks associated with iron infusions is the potential for allergic reactions, ranging from mild to severe anaphylactic responses. Some patients may experience itching, swelling, or difficulty breathing during or after an infusion, while others have reported joint pain, muscle pain, and leg cramping. 

Other reactions to iron infusions have also been reported. One case report even linked intravenous iron therapy to an inflammatory condition known as rhabdomyolysis, while another study found that IV iron was associated with an increased risk of infection. 

Still, the risks associated with iron infusions vary depending on the specific iron formulation used. Newer intravenous formulations such as iron sucrose seem to be safer and better tolerated than iron dextran and ferric gluconate.

Risk of iron overload

There is also a higher risk of iron overload with iron infusions, particularly in patients with conditions like hemochromatosis or chronic liver disease. Therefore, monitoring iron levels before and during treatment is crucial. 

While I don’t offer iron infusions in my naturopathic functional medicine practice, I do offer in-depth lab testing, nutrient supplements, dietary recommendations, and other intravenous therapies. 

Increased inflammation and oxidative stress

IV iron can also trigger inflammation, oxidative stress, and endothelial dysfunction in the body. As a result, iron infusions could play a role in the development or worsening of inflammatory conditions. 

Iron infusions can even exacerbate existing symptoms in some cases — including the very symptoms iron supplementation is meant to reduce! However, some research suggests that co-administering antioxidants such as N-Acetyl Cysteine (NAC) can help prevent iron-induced inflammation during IV therapy. 

Iron infusions are a short-term solution

Along with the potential health risks of iron infusions, it’s important to keep in mind that IV iron is only a temporary solution for anemia and iron deficiency. For this reason, identifying and treating the underlying root cause of low iron levels is vital. This is where naturopathic functional medicine comes in!

Iron infusions vs supplements: what’s best? 

Iron infusions can be a valuable treatment option for several individuals, including those who cannot tolerate or do not respond adequately to oral iron supplements. They offer the advantage of rapidly correcting iron deficiencies with fewer gastrointestinal side effects, but they also present certain risks such as allergic reactions, increased inflammation in the body, and the potential for iron overload. 

The decision to use iron infusions must be carefully considered by patients and their healthcare providers, as IV iron is not right for everyone. A personalized approach to treating iron deficiency is needed to safely and effectively increase ferritin levels without doing more harm than good!