I cannot say I was completely caught off guard. Just weeks prior to my blood tests, I had experienced my second miscarriage within six months, resulting in considerable blood loss. I felt drained, but it was difficult to discern whether this fatigue stemmed from the physical loss or the emotional toll of the experience.
Instead of opting for iron pills, I stuck to my prenatal vitamins, which included a modest amount of iron. Though I never arranged a follow-up appointment to assess my levels, I received weekly blood tests due to my fertility treatments, convinced that if any iron deficiency arose, someone would notify me.
No one addressed it. Years later, after a successful and normal pregnancy, I found myself once again battling similar exhaustion. This time, bloodwork showed that I was anemic: my counts of red blood cells, hemoglobin, and ferritin (the protein responsible for iron storage) had all fallen below the “normal” range. Again, my doctor recommended over-the-counter (OTC) iron pills, which I decided to try. While I had heard about the risk of constipation (a common side effect of iron), I experienced severe nausea instead. Consequently, I stopped taking them and committed to consuming more steak and spinach while exploring homeopathic remedies.
By summer 2024, my state of fatigue had escalated to depletion. I found myself dozing off during work, having difficulty catching my breath on stairs, and experiencing dizziness along with chest tightness. It was time to acknowledge the symptoms and finally seek treatment to restore my iron levels.
A few friends who faced similar anemia challenges introduced me to the concept of iron infusions, which involve receiving iron supplementation via an IV infusion. Intrigued, I consulted a hematologist (a specialist in blood disorders) to assess whether I was an appropriate candidate. Fortunately, I was deemed suitable.
Here is my experience with iron infusions, how they have worked for me thus far, and the reasons why these treatments remain largely underutilized.
First, what are iron infusions?
Iron infusions are medical procedures administered under supervision, wherein doctors deliver supplemental iron through an intravenous (IV) drip at a medical facility or in the doctor’s office. This treatment is typically reserved for individuals with chronic kidney disease or severe iron deficiency anemia, a condition affecting approximately 34 percent of women1 aged 18 to 50 in the United States, as noted in a recent study featured in JAMA Network Open.
“We typically provide IV iron for two primary reasons,” states Ariela Marshall, MD, an expert at the American Society of Hematology and associate professor of medicine at the University of Minnesota. “One is when someone has tried iron tablets but cannot tolerate them due to side effects.” The other scenario is when the individual’s body struggles to absorb iron, which can occur in people with certain health issues likeanaphylaxis, which instilled a long-lasting wariness among some healthcare providers. However, advancements in the formulations of IV iron have significantly improved their safety profiles in recent years.
My journey with iron infusions
During my first appointment with Dr. Rachel Kramer, a hematologist at American Infusion Centers in New York City, I had my initial iron infusion scheduled within 30 minutes. After reviewing my lab results and medical history, Dr. Kramer suggested I begin treatment with Venofer, a lower-dose formulation of iron sucrose, right away. She expressed concern that my heavy menstrual cycles were contributing to my low ferritin levels and was uncertain about the efficacy of oral iron supplements, as most of her patients struggled with them.
Curious about whether changes in my diet and lifestyle, such as incorporating more red meat and using cast iron cookware, could boost my iron levels, I asked Dr. Kramer for her opinion. She stated, “I’ve never seen that work,” reflecting a sentiment echoed by Dr. Marshall. She illustrated the difficulty of replenishing iron levels through diet alone by comparing low iron levels to a nearly empty fuel tank: “The tank is running low, but the car is still operational, making it challenging to refill just by consuming iron-rich foods.”
Swift and straight forward treatment
Once my queries were addressed, I was escorted to a treatment room where several patients were already receiving IV therapy. I settled into a recliner, and the nurse sterilized my left elbow before inserting the needle. Prior to starting the infusion, she collected two vials of blood for lab testing. Next, she connected an IV bag containing a brown liquid—essentially a mixture of iron, water, and other stabilizers like saline.
The infusion process itself was quick, lasting approximately 35 minutes. I experienced no side effects, aside from dark urine, which my doctor assured me was normal. (It’s worth noting that some individuals may encounter side effects such as nausea, headaches, or allergic reactions from iron infusions; in such cases, physicians might recommend premedicating with Benadryl.)
Dr. Kramer prescribed three additional infusions to occur one to two weeks apart, with the understanding that we would adjust future appointments according to my blood results and how I was feeling.
Positive changes after one week
Despite Dr. Kramer’s warning that it might take some time to notice any symptom relief, I began feeling better within a week of my initial appointment. My sleep improved (I had been experiencing restless leg syndrome, a common effect of low iron), and I found myself with increased energy levels. While running, my legs felt lighter, and my breathing steadied—a welcome adjustment after having to amend my training routine to deal with fatigue.
My lab results, while still not optimal according to Dr. Kramer, were moving in a favorable direction. My ferritin, red blood cell count, and hemoglobin levels were higher than they had been in years.
This led to a pressing question: Why hadn’t doctors recommended iron infusions sooner? The answer revealed a tendency for this treatment to be under-utilized.
Reasons for the underprescription of iron infusions
Dr. Kramer explains that physicians outside of hematology often hold misconceptions about the use of iron infusions. “Some believe there’s something ‘extreme’ or ‘drastic’ about receiving IV iron,” she remarks, with many questioning why such a significant measure would be necessary if oral iron is an option. Several additional factors contribute to its infrequent prescription:
Misunderstandings about safety
Some healthcare workers may harbor misconceptions regarding the safety of iron infusions, as noted by Dr. Marshall. She points out that over thirty years ago, certain IV iron formulations (specifically iron dextran) were associated with significant allergic reactions, such as anaphylaxis, leading to lasting reservations among healthcare providers about the administration of IV iron treatments.
Anaphylaxis (commonly known as severe allergic reactions) has contributed to negative perceptions surrounding IV iron, as noted by Dr. Marshall.
However, it became clear that the culprits were the additives in the formulations rather than the infusions themselves. The formulations have since been improved, leading Dr. Marshall to assert that “true, serious reactions are now rare.”
While most individuals tolerate iron infusions well, there are still some who experience adverse reactions3. These can range from hypersensitivity to more significant allergic reactions. As a precaution, new patients are monitored closely, and medical personnel are trained to identify and address these symptoms swiftly.
Cost is a barrier
Financial considerations also pose a significant barrier. Beyond the costs associated with office visits and administrative fees, the price of iron can vary dramatically, with infusions costing anywhere from hundreds to thousands of dollars. While insurance may cover a portion of these expenses, out-of-pocket costs will differ widely based on the individual’s insurance provider.
Underdiagnosed iron deficiency
Moreover, iron deficiency can sometimes be overlooked or underestimated. The acceptable range for a “normal” ferritin level can be broad, which means if a patient’s levels fall on the lower threshold but within that range, a general practitioner might declare them fine. Additionally, some doctors fail to include an iron panel in routine blood tests.
In certain situations, doctors may also misinterpret or downplay iron deficiency in women, as its symptoms can closely resemble those associated with stress, lack of sleep, or aging.
This was the case for Tina Martinez, a food stylist from New York. Initially, she attributed her symptoms of iron deficiency to perimenopause. Previously, she was an active CrossFit athlete, but she found herself unable to complete her workouts. Despite being treated for heavy menstrual bleeding and fibroids, none of her healthcare providers flagged her low iron levels. It wasn’t until she attempted to donate blood that she discovered her deficiency.
Iron supplements caused her significant discomfort. Fortunately, after consulting a hematologist, she began receiving iron infusions that provided her relief. “It was like night and day,” she reflects.
Steps to take if you suspect low iron
If you believe you may be experiencing low iron levels—perhaps you have been informed that your lab results were “slightly low” or you are facing symptoms such as fatigue, dizziness, or breathlessness—it’s crucial to consult a physician and request blood tests that include an iron panel. It is vital to advocate for your health (and it is completely acceptable if this initially feels daunting).
If you feel unsupported by your doctor, seeking out a hematologist is advisable. Both Martinez and I had success finding specialists through personal recommendations, so consider reaching out to your network for referrals (it’s likely that someone you know can offer a good suggestion, given the prevalence of iron deficiency).
Remember, you are your own best advocate. “If you’re not feeling well, you must trust yourself,” advises Martinez. However, avoid attempting to self-diagnose through online resources, even if you have access to your lab results.
“In reality, patients should not be self-analyzing their [medical] portal results,” warns Dr. Kramer. Only a qualified physician can interpret these numbers accurately. Furthermore, it’s possible to exhibit symptoms of iron deficiency despite lab results suggesting that you are *technically* in the clear.
Ultimately, whether your doctor recommends iron infusions or oral supplements, identifying the underlying cause of your deficiency is key. Neglecting this can result in missing serious health concerns and getting caught in a perpetual cycle of “maintenance” treatments.
