Iron Deficiency and Iron Infusions: What Australians Need to Know

Iron deficiency is one of the most common nutritional issues affecting Australians. It can lead to iron deficiency anaemia, a condition where the body lacks enough healthy red blood cells to carry oxygen effectively. When left untreated, it can cause fatigue, shortness of breath, and other serious health problems.

While oral iron supplements are typically the first step in treatment, intravenous (IV) iron infusions are increasingly used for people who need faster or more effective correction.

This article explores the symptoms, causes, diagnosis, and treatment of iron deficiency, with a special focus on IV iron, including new expert guidelines for its safe use.

What Is Iron Deficiency?

Iron is essential for producing haemoglobin, the protein in red blood cells that transports oxygen throughout your body. When iron levels drop, the body can’t produce enough haemoglobin, leading to iron deficiency or iron deficiency anaemia.

Many people with low iron don’t have anaemia but still experience symptoms, including tiredness, reduced concentration, and paleness.

Common Causes of Iron Deficiency

Heavy menstrual bleeding
Pregnancy and breastfeeding
Low dietary iron intake
Poor absorption (e.g. from coeliac disease or after gastric surgery)
Chronic blood loss (e.g. peptic ulcers, bowel polyps, cancer)
Frequent blood donation

Symptoms of Iron Deficiency

Early symptoms may be subtle but can include:

Fatigue and weakness
Pale skin
Shortness of breath
Headaches or dizziness
Cold hands and feet
Brittle nails or hair thinning
Unusual cravings (e.g. ice, dirt)
Poor appetite in children

Diagnosing Iron Deficiency

If your doctor suspects iron deficiency, they may order blood tests to assess:

Ferritin – a measure of iron storage
Haemoglobin and haematocrit – levels of red blood cells
Red blood cell size and colour

In some cases, further investigations may be needed, such as:

Endoscopy to check for bleeding ulcers
Colonoscopy to assess for bowel bleeding
Pelvic ultrasound to assess uterine causes in women

Treatment Options for Iron Deficiency

1. Oral Iron Supplements

The first line of treatment is often oral iron tablets. Your GP will recommend a suitable dose. To help with absorption:

Take iron on an empty stomach if tolerated
Avoid taking it with antacids
Take with a source of vitamin C (e.g. orange juice)

Oral iron may take several months to correct iron levels. Side effects include constipation, nausea, and black stools.

2. Intravenous (IV) Iron Infusions

When oral iron isn’t suitable—due to poor absorption, side effects, or urgent need—IV iron infusions are considered. This involves delivering iron directly into the bloodstream, often in a single session.

When IV iron is recommended:

Severe anaemia
Iron deficiency in late pregnancy
Intolerance or failure of oral iron
Before major surgery
Chronic kidney disease or cancer-related anaemia

IV Iron: New Guidelines for Safe Use

The latest expert consensus guidelines from 2024 provide a comprehensive protocol for safe IV iron administration. Key points include:

Pre-infusion assessment for allergy risk
Monitoring during and after infusion
Management of adverse reactions, including rare allergic responses
Monitoring for hypophosphataemia (low phosphate levels after treatment)
Proper documentation and follow-up blood tests

There are different formulations of IV iron available in Australia, including iron polymaltose, ferric carboxymaltose, and iron sucrose. Your doctor will choose the most suitable one for you.

Risks of Iron Infusion

IV iron is generally safe but may cause:

Headaches
Temporary low phosphate levels
Mild allergic reactions
Rare anaphylactic reactions (extremely rare)

Infusions should always be administered in a medical setting with emergency care available.

Special Considerations in Pregnancy

Pregnant women often require extra iron. Untreated iron deficiency during pregnancy can result in:

Low birth weight
Preterm delivery
Maternal fatigue and increased infection risk

Oral iron is usually tried first, but IV iron is considered safe in the second and third trimesters when necessary.

How to Prevent Iron Deficiency

Eat Iron-Rich Foods

Include these in your daily diet:

Lean red meat and poultry
Seafood
Legumes and lentils
Leafy green vegetables (e.g. spinach)
Iron-fortified cereals
Dried fruits (e.g. apricots, raisins)

Boost Absorption with Vitamin C

Eat vitamin C-rich foods with your meals to help your body absorb iron:

Citrus fruits
Tomatoes
Capsicum
Strawberries
Broccoli
Kiwi

Should You Get an Iron Infusion?

You may benefit from an iron infusion if:

You are severely iron deficient
You have tried oral iron and experienced side effects
You are pregnant and oral iron isn’t working
You have a condition that blocks absorption

Speak with your GP to discuss whether this treatment is right for you. They will assess your iron levels, determine the cause of your deficiency, and advise the most appropriate treatment plan.

Final Thoughts

Iron deficiency is widespread but manageable. Whether treated with diet, oral supplements, or IV infusions, the key is timely diagnosis and personalised care. If you suspect low iron, avoid self-medicating—talk to your doctor about testing and treatment options.

References

Van Doren L, Steinheiser M, Boykin K, et al. Expert consensus guidelines: Intravenous iron uses, formulations, administration, and management of reactions. American Journal of Hematology. 2024. https://pubmed.ncbi.nlm.nih.gov/38282557/
Camaschella C. Iron deficiency. Blood. 2019;133(1):30–39. https://pubmed.ncbi.nlm.nih.gov/30401704/
Mayo Clinic. Iron deficiency anaemia overview. https://www.mayoclinic.org
RACGP Red Book – Preventive Activities in General Practice. https://www.racgp.org.au/clinical-resources/clinical-guidelines/red-book
Australian Prescriber – Intravenous iron products: a practical guide. https://www.nps.org.au/australian-prescriber/articles/intravenous-iron-products-a-practical-guide