Adverse Reactions to IV Iron Infusions: Rare but Serious

Iron is a mineral found in all our bodies. For some conditions, people may need extra (supplemental) iron. However, in very rare cases, some people may have a reaction to iron infusions.1,2

What is an IV iron infusion?

Iron has many jobs in our bodies. It is an important part of hemoglobin. Hemoglobin is the material in red blood cells that carries oxygen through the body. If you do not have enough iron, your body cannot make hemoglobin. This can lead to iron deficiency anemia. Symptoms of anemia include:1

  • Feeling tired
  • Pale skin
  • Difficulty breathing
  • Feeling cold or dizzy
  • Fast heartbeat
  • Problems with the immune system

Who needs iron infusions?

For many people, anemia can be treated with an iron supplement. Some can take oral iron by mouth. But some people may need to receive iron through an intravenous (IV) line. An IV uses a needle placed into a vein to deliver iron directly to the blood. This is called iron infusion. People who may need iron infusions include:1

  • People with internal bleeding in the gut that need quick iron replacement
  • Cancer patients on certain types of medicine
  • People with gluten intolerance
  • People with inflammatory bowel disease who have a sensitivity to iron pills
  • People on dialysis that sometimes lose blood during treatment

What is an adverse allergic reaction to iron infusion?

An adverse reaction to an iron infusion happens when the body has a severe allergic reaction. An allergic reaction happens when the immune system overreacts to something harmless. Because severe reactions to IV iron infusion are so rare, there is a lot that we do not know about them. We do not know exactly why some people's immune systems react to the infusion.2,3

A severe allergic reaction is sometimes called anaphylaxis. If it is not treated, anaphylaxis can be life-threatening. Signs of anaphylaxis, or a severe reaction to IV iron, include:2,4

  • Chest and throat tightness
  • Wheezing
  • Difficulty breathing or swallowing
  • Throat swelling

How common is an adverse reaction to iron infusion?

Severe reactions to IV iron are very rare. About 1 to 4 out of every 100 people who get an IV iron infusion will have a mild reaction. A mild reaction can include red or itchy skin, hives, and a feeling of pressure in the chest or back.

We do not know exactly how rare a severe reaction to an iron infusion is. But research shows the chance of a severe reaction ranges from about 1 in 1,000 to 1 in 250,000.2-4

It is also possible that a person who has had a previous adverse reaction to other drugs may be more likely to have a reaction to IV iron. And it may be that certain types of iron infusions are more likely to cause a reaction.2,3

How to manage a reaction to an iron infusion

An IV iron infusion should be administered by a medical professional. So, if you have a reaction, there should be people available to help. Tell them right away if you notice signs of a severe reaction.

You may receive a drug – such as an antihistamine – to manage the reaction. In very serious cases, some people may need an epinephrine injection.1-3

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