What is IV iron treatment?
IV iron treatment is the administration of iron by the intravenous route in demonstrated iron deficiency. Oral iron treatment is the first-choice route; the intravenous route is considered where oral intake is inadequate, where it cannot be tolerated, or where absorption is impaired. The procedure is based on the laboratory results.
Iron deficiency is common. The World Health Organization (opens in a new tab) reports that anaemia affects 30% of women aged 15–49 and 37% of pregnant women, and that iron deficiency is the leading nutritional cause. The same source lists fatigue, dizziness and shortness of breath, particularly on exertion, among the typical symptoms of anaemia. The World Health Organization (opens in a new tab) reports that more than two-thirds of non-pregnant women of reproductive age are deficient in at least one essential micronutrient.
An important caveat: iron deficiency is a symptom, not a diagnosis. Giving iron alone, without investigating the cause of the deficiency, is not enough. In adults, the underlying cause of iron deficiency (a source of bleeding, impaired absorption, inadequate nutrition) is assessed.
When is the procedure considered?
- In demonstrated iron deficiency anaemia
- Where oral iron treatment cannot be tolerated (where nausea, constipation or abdominal pain prevents it being taken)
- Where there has been no response to oral iron
- Where absorption is impaired (coeliac disease, inflammatory bowel disease, a history of stomach or bowel surgery)
- Where iron loss continues at a rate that oral intake cannot meet
- In clinical situations that require rapid correction (with a physician’s assessment)
Suitability is decided by assessing the full blood count, iron, ferritin and, if needed, further investigations together.
In which patients is the procedure not performed?
Also note: in patients with heart failure, in patients with kidney disease and in patients who are breastfeeding, the procedure is assessed separately. Report all the medicines and supplements you use (in particular, products that contain oral iron).
- In patients in whom iron deficiency has not been demonstrated
- In patients with iron overload (haemochromatosis) or iron accumulation
- In patients with a known allergy to iron preparations, or a history of a severe reaction to them
- In patients with a type of anaemia other than iron deficiency (treatment directed at the cause is needed)
- In patients with infection or inflammation of the vein at the application site (the procedure is carried out from a different site)
Situations that require separate assessment
- Active infection or febrile illness (the procedure is postponed)
- The first three months of pregnancy (the opinion of the relevant specialty is obtained)
- Advanced liver failure
- The patient being under 18 years of age (assessment lies within the field of paediatrics; this page has been prepared for adults)
How is the procedure performed?
- Assessment. The presenting complaint, the eating routine, the menstrual pattern, digestive system complaints, previous operations, and current medication and supplements are recorded.
- Laboratory. A full blood count, iron, ferritin, iron-binding capacity and, if needed, further investigations are requested.
- Investigating the cause. The source of the deficiency is assessed; if needed, a referral is made to the relevant specialty.
- Information and consent. The procedure, the possible side effects and the risk of an allergic reaction are explained in writing and verbally; consent is obtained.
- The procedure. An intravenous line is placed and the prepared solution is given over a set period. The patient remains under observation throughout, and the conditions required for emergency intervention are kept ready.
- Observation afterwards. The patient also remains under observation for a period after the procedure has finished.
- Follow-up. After a certain period the investigations are repeated and the response is assessed.
How long does it take, and how many sessions are needed?
How long the procedure takes and how many sessions are needed depend on the level of the deficiency, the preparation used and the clinical situation. No definite number can be given in advance.
The response is assessed with follow-up investigations. Once the deficiency has been corrected, the procedure is not continued; an excessive rise in iron levels is not desirable.
What should you do before and after the procedure?
Before the procedure, report:
- A list of all the medicines and supplements you use
- Your known allergies (in particular any reactions you have had to a medicine in the past)
- Your most recent test results
- Your pregnancy status
It is best not to come on an empty stomach; a light meal beforehand is advised.
After: there may be tenderness and bruising at the application site. The skin at the application site may change colour, and this may persist for a long time. Temporary muscle and joint pain and headache may occur within a day or two. Recommendations specific to you are given in writing at the end of the procedure.
Risks and side effects
In intravenous iron administration a needle is passed through the skin into a vein, and the procedure carries a risk of an allergic reaction.
Those that may occur commonly:
- Pain, a stinging sensation and bruising at the application site
- A metallic taste in the mouth
- Headache, dizziness
- Nausea
- Temporary muscle and joint pain
- A change in blood pressure
- A change in skin colour at the application site (in some cases this may persist for a long time)
Rare but important:
- Leakage outside the vein, and a change in colour of the tissue that may persist for a long time
- Inflammation of the vein (phlebitis)
- An allergic reaction (rash, itching, swelling of the face and tongue, shortness of breath, a drop in blood pressure. The procedure is therefore performed under observation, with the conditions for emergency intervention kept ready)
- Low phosphorus (this may be seen with some preparations)
- Iron overload (with unnecessary or excessive administration)
Results vary from person to person.
When should you see a physician without delay?
If you experience these symptoms during treatment, contact your physician without delay:
- A widespread rash, itching
- Marked palpitations
- Dizziness, a feeling of faintness
- Increasing redness, swelling, hardness or discharge at the application site
- A high fever
In the event of shortness of breath, wheezing, swelling of the face, lips or tongue, tightness in the chest, difficulty swallowing or fainting, go directly to the emergency department. These symptoms may also appear hours after the procedure.
Frequently asked questions
Why is iron given intravenously rather than by mouth?
Oral iron treatment is the first-choice route. The intravenous route is considered in situations such as an inability to tolerate oral intake, a lack of response, impaired absorption, or losses continuing rapidly. Which route is suitable is decided by assessing the laboratory results and the clinical situation together.
Should the cause of my iron deficiency be investigated?
Yes. Iron deficiency is a symptom; in adults the underlying cause (a source of bleeding, impaired absorption, inadequate nutrition) needs to be assessed. Giving iron alone does not remove the cause.
How many sessions are needed for IV iron treatment?
No definite number can be given in advance. The number of sessions depends on the level of the deficiency, the preparation used and the clinical situation. The response is assessed with follow-up investigations.
Can an allergic reaction occur during the procedure?
An allergic reaction is a rare but important risk. The procedure is therefore performed under observation, and the conditions required for emergency intervention are kept ready. If you have had a reaction to any medicine in the past, please say so.
What will I feel after the procedure?
Tenderness at the application site, temporary muscle and joint pain lasting a day or two, headache and a metallic taste in the mouth may occur. These usually settle on their own. If a rash, shortness of breath or swelling of the face develops, consult a physician without delay.
Will it leave a mark on the skin?
A change in colour may be seen at the application site; where the solution leaks outside the vein, this may persist for a long time. It is therefore important not to move your arm during the procedure and to tell us straight away if you feel any discomfort.
Is IV iron treatment used in pregnancy?
Iron deficiency is common in pregnancy; however, the suitability and timing of intravenous administration are assessed with the opinion of the relevant specialty. Particular care is needed in the first three months of pregnancy. If you are pregnant or think you may be, please say so at the start of the consultation.
Sources
- World Health Organization, Anaemia fact sheet, 10 February 2025. https://www.who.int/news-room/fact-sheets/detail/anaemia (opens in a new tab)
- World Health Organization, Healthy diet fact sheet, 26 January 2026. https://www.who.int/news-room/fact-sheets/detail/healthy-diet (opens in a new tab)
