What is iron?

Iron is needed by blood cells to transport oxygen around the body and give us energy. Iron is important for muscle strength and brain function. Blood tests can be used to check iron levels. When iron levels are low, your child may feel tired and not able to do their usual activities. Some children with low iron can develop anaemia.

Why does my child need an iron infusion?

Low iron levels are usually treated effectively with iron tablets or liquid. Some patients need to have iron given through a vein (intravenous or IV) as an infusion. 

Some reasons for needing an iron infusion include:

• Low iron levels that have not improved with iron tablets or liquid
• Patients that cannot take iron tablets or liquid because of side effects (e.g. constipation) or problems with absorption (e.g. Crohn’s disease)
• Kidney or heart problems
• When a blood transfusion is not suitable (e.g. for religious reasons)
• Very low haemoglobin levels due to low iron (iron deficiency anaemia) that need to be increased quickly (e.g. prior to surgery)

Iron infusions may cause side effects, including rare but serious allergic reactions – see possible side effects below for more information.

What to tell your child’s Doctor before an iron infusion:

• If your child has had a reaction to any type of iron injection or infusion before
• If your child has had an iron infusion before
• If your child is unwell at the moment  
• If they have other allergies, asthma or eczema
• If they have ever had liver problems or high iron levels
• Note: IV iron should be avoided in the first trimester of pregnancy

Questions to ask your child’s doctor before the iron infusion:

• Why does my child need IV iron?
• What are some of the side effects? (see below)
• How long will it take for the iron infusion to work?
• Does my child need another blood test?
• If your child is taking iron tablets or liquid, these are normally stopped for at least one week after the iron infusion is given – check with your doctor when to start taking iron tablets or liquid again

Possible side effects

Speak to your child’s doctor if you are worried about any of the following possible side effects.

Common side effects (1-10% of patients):

• Headache
• Dizziness
• Flushing (redness of the skin, especially the cheeks or neck)
• Nausea
• Muscle or joint pain
• Changes in taste (e.g. metallic taste)
• Blood pressure changes (low or high blood pressure)
• Low phosphate levels

Rare side effects (less than 1% of patients)

• Serious allergic reactions such as anaphylaxis can occur and may be life-threatening 
• Your child will be closely monitored during the infusion and for 30 minutes afterwards

Alert nursing staff immediately if you/your child:

• Shows any signs of an allergic reaction (e.g. swelling of the lips, mouth or throat, or difficulty breathing [short of breath, puffing when speaking])

Very rare side effects:

• Permanent brown staining of the skin can occur around the injection site

Alert nursing staff immediately if you/your child:

Has any pain or swelling around their IV line or you notice any change in the colour of the skin near the IV line.

There may be other side effects that are not listed in this fact sheet. If you notice anything unusual or are worried about your child, speak to your doctor.

What happens on the day of the iron infusion?

• Iron infusions are usually given in the Day Medical Unit at the Royal Children’s Hospital, sometimes patients will have the infusion on a different ward if they are in hospital for another reason
• Before the infusion starts, a nurse will weigh your child and check their vital signs (pulse, blood pressure, temperature, breathing rate)
• Your child will need to have an IV line inserted if they don’t have one  
• The nurse will start the iron infusion (dark brown solution) which may run over different periods of time depending on the amount ordered – ask your doctor or nurse how long the infusion will take
• Your child’s vital signs and IV line will be checked by a nurse during the infusion and for 30 minutes after it has finished 

Key points to remember

• Tell your doctor if your child has had a reaction to an iron infusion before
• Alert nursing staff immediately if you/your child shows any signs of an allergic reaction during their iron infusion (e.g. swelling of the lips, mouth or throat, or difficulty breathing [short of breath, puffing when speaking])
• Alert nursing staff immediately if you/your child has any pain or swelling around their IV line or you notice any change in the colour of the skin near the IV line

For more information

• This fact sheet has been made to provide advice about the use of this medicine in children and should be read in addition to the information at NPS MedicineWise.
• Kids Health Info fact sheet: Medicines for children and medicine reactions
• Talk to your doctor or pharmacist
• The Therapeutic Goods Administration: Consumers

Common questions our doctors are asked

Is an iron infusion a blood product?

No, iron infusions are medications that are manufactured. Blood products are substances that are derived from donated human blood.

Developed by The Royal Children's Hospital Quality and Improvement and Clinical Haematology Departments. We acknowledge the input of RCH consumers and carers. 

Developed August 2022. 

Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit www.rchfoundation.org.au