Why is it important to test your iron and how can intravenous iron infusions help you?

Iron is vital for many bodily functions, including oxygen transport, immune health, and energy production. One of the key markers for assessing your body’s iron status is ferritin. Low ferritin often signals iron deficiency, a condition that can lead to fatigue, weakness, and impaired cognitive function. While oral iron supplements are commonly used to replenish iron levels, intravenous (IV) iron supplementation has emerged as a faster and more effective alternative in certain cases.

In this post, we’ll explore the importance of ferritin levels, the advantages of IV iron supplementation over oral iron, and when this treatment is required.

What Is Ferritin?

Ferritin is a protein that stores iron inside cells and releases it when needed. Most of the body’s ferritin is found in organs like the liver, spleen and bone marrow, but a small amount circulates in the bloodstream. Measuring serum ferritin provides an estimate of your body’s total iron stores, making it an essential test for diagnosing iron deficiency and overload.

Ferritin Levels: What They Mean

Ferritin levels are typically measured in nanograms per milliliter (ng/mL), and the normal range can vary slightly depending on the laboratory. However, general reference ranges are as follows:

• Men: 24-336 ng/mL
• Women: 11-307 ng/mL
  (Sources: Mayo Clinic Labs , LabCorp )

Low Ferritin: Iron Deficiency

When ferritin levels fall below 30 ng/mL, iron deficiency is likely. Common symptoms include fatigue, pale skin, dizziness, shortness of breath, and difficulty concentrating. Low ferritin can result from inadequate iron intake (especially in vegans and vegetarians), chronic blood loss (e.g., heavy menstruation or gastrointestinal bleeding), increased iron demands (e.g., during pregnancy or for athletes), or malabsorption conditions like celiac disease or inflammatory bowel disease.

Normal & High Ferritin Levels

For individuals with normal ferritin levels (approximately 30-300 ng/mL), symptoms may be due to factors other than iron deficiency, such as inflammation or infection. On the other hand, ferritin levels above 300 ng/mL may indicate iron overload or inflammation, often associated with conditions like hemochromatosis, chronic liver disease, or cancer.

When Is Iron Supplementation Required?

Iron supplementation is often required when ferritin levels are low, but the choice between oral and intravenous iron depends on several factors, such as the severity of the deficiency, the cause, and the patient’s response to oral iron.

Oral Iron Supplementation

Oral iron, such as ferrous sulfate, ferrous fumarate, or ferrous gluconate, is a common first-line treatment for iron deficiency. While effective for many people, oral iron has several drawbacks:

• Slow Absorption: Oral iron can take weeks or months to replenish iron stores, making it less suitable for patients with severe deficiencies.
• Side Effects: Gastrointestinal side effects, such as nausea, constipation, and diarrhea, are common with oral iron supplements. This can lead to poor adherence.
• Malabsorption: Certain medical conditions, such as celiac disease or inflammatory bowel disease, can impair iron absorption, making oral iron less effective.

Advantages of Intravenous (IV) Iron Supplementation

Intravenous iron offers several advantages over oral iron, particularly in cases of severe deficiency, malabsorption, or when a rapid increase in iron levels is needed.

1. Rapid Restoration of Iron Stores
   • IV iron replenishes iron stores much faster than oral supplements, which is crucial for patients with severe anaemia or chronic conditions where quick recovery is necessary. Studies show that IV iron can rapidly increase hemoglobin and ferritin levels compared to oral iron, which may take several weeks or months.
2. Fewer Gastrointestinal Side Effects
   • Unlike oral iron, IV iron bypasses the gastrointestinal tract, reducing the risk of common side effects such as nausea, constipation, and abdominal discomfort. This makes it a better option for individuals who cannot tolerate oral iron.
3. Effective for Malabsorption
   • Patients with conditions that affect iron absorption, such as inflammatory bowel disease (IBD), celiac disease, or after bariatric surgery, often do not respond well to oral iron supplements. IV iron circumvents this issue by delivering iron directly into the bloodstream.
4. Improved Compliance
   • Due to its fast and effective delivery, patients receiving IV iron typically require fewer treatments, leading to improved adherence compared to daily oral supplements.
5. Recommended in Certain Chronic Conditions
   • IV iron is particularly beneficial for patients with chronic kidney disease (CKD) or heart failure, where oral iron may not be effective. It is also often used in cancer patients receiving chemotherapy, who are at risk for anaemia but may have difficulty absorbing oral iron.

When Is IV Iron Supplementation Necessary?

IV iron supplementation is typically recommended in the following cases:

1. Severe Iron Deficiency or Iron Deficiency Anaemia
   • When ferritin levels are critically low (<15-30 ng/mL) and symptoms of iron deficiency anaemia are severe, IV iron can quickly restore iron levels, especially in cases where oral iron has not been effective or is poorly tolerated.
2. Chronic Kidney Disease (CKD)
   • Patients with CKD often develop anaemia and require iron supplementation. Oral iron is less effective in this population, making IV iron the preferred treatment.
3. Malabsorption Syndromes
   • For individuals with gastrointestinal disorders such as Crohn’s disease, ulcerative colitis, or after gastric bypass surgery, IV iron is the most effective method of restoring iron levels since oral iron may not be absorbed properly.
4. Pregnancy
   • Pregnant women with iron deficiency anaemia who do not respond to oral iron or require a rapid increase in iron stores may benefit from IV iron, particularly in the second and third trimesters.
5. Severe Blood Loss
   • Patients recovering from surgery or experiencing chronic blood loss (e.g., from heavy menstruation or gastrointestinal bleeding) may require IV iron to quickly replenish iron stores.

Conclusion

Ferritin levels are a critical marker for assessing iron status in the body. When ferritin levels are low, iron supplementation is necessary, but the choice between oral and intravenous iron depends on individual factors such as the severity of the deficiency, absorption issues, and how quickly iron needs to be restored. IV iron supplementation offers several advantages over oral iron, including faster replenishment of iron stores, fewer side effects, and better effectiveness in cases of malabsorption.

If you suspect you have iron deficiency or are experiencing related symptoms, it is very straightforward to check your ferritin levels. You may have ferritin levels measured as part of a blood test panel you have already had, or we can run a test for you at Effect Doctors. If you have a ferritin test with us and you are found to have an iron deficiency and then you have an iron infusion with us, we will discount the cost of the test from the infusion cost.

References:

1. Mayo Clinic Labs: Ferritin Blood Test. Available at: Mayo Clinic Labs
2. LabCorp: Ferritin Serum. Available at: LabCorp
3. Macdougall IC, et al. “Intravenous Iron Therapy in Patients with Chronic Kidney Disease: Recent Evidence and Future Directions.” Clin Kidney J. 2017. PubMed
4. Tussing-Humphreys LM, et al. “Oral vs Intravenous Iron Therapy for Postpartum Anemia.” Am J Obstet Gynecol. 2019. PubMed
5. Litton E, et al. “Intravenous Versus Oral Iron Supplementation for the Treatment of Iron Deficiency Anaemia.” Cochrane Database Syst Rev. 2019. Cochrane
6. Anker SD, et al. “Ferric Carboxymaltose in Patients with Heart Failure and Iron Deficiency.” N Engl J Med. 2009. PubMed