Ferinject intravenous iron in obstetric patients

How does Ferinject work?

Ferinject contains tiny particles of iron with a sugar coating. This means that the iron is released steadily and can be stored and used by your body to help maintain your iron levels.

Ferinject is not a blood product.

Why do I need it?

Early detection and appropriate management of iron deficiency anaemia may prevent otherwise unnecessary blood transfusion.

If left untreated, anaemia can make you feel very tired. You may feel short of breath or your heartbeat can go very fast and you can feel your heart beating in your chest (palpitations). If you get too unwell, there are increased chances that you might need a blood transfusion.

When do I receive it?

Whether to give Ferinject is a consultant decision, and is decided with the patient. This is usually because your blood test (haemoglobin and ferritin) reveal that you have chronic iron deficiency anaemia and do not tolerate iron tablets, or they are not working well.

When and how will I receive it?

We will invite you to attend a two-hour appointment at the Day Assessment Unit (DAU) at Heartlands Hospital or the Maternity Assessment Centre (MAC) at Good Hope Hospital.

The midwife will explain the treatment to you and perform a set of observations including blood pressure, heart rate and temperature. A cannula/intravenous line will then be inserted into your hand or arm by the midwife to allow the intravenous iron to be started. This cannula will be removed before you leave.

• Please do not take any iron supplements for 48 hours before your appointment to have the Ferinject infusion
• We give Ferinject by a diluted infusion, given directly into a vein in your hand or arm
• The infusion itself will take 30 minutes to run through but there are checks our medical professionals will need to do to ensure patient safety
  • It might be a good idea to bring something to read, and a snack, as you can eat and drink normally while having the infusion
• We will monitor you closely while having the infusion, and you will be able to go home after the appointment, as long as you feel well

Potential problems

• Ferinject is generally safe unless you have a known sensitivity or allergy to iron supplements or a liver problem, or you are in the first trimester (first 12 weeks) of pregnancy
• Fewer than 1% (1 in 100) of people will experience an allergic reaction
• Up to 10% (10 in 100) of people may experience headache, dizziness, nausea and vomiting, rash, muscle cramps, diarrhoea, constipation, low or high blood pressure, flushing, abnormal liver function and injection site reactions
• In fewer than 0.1% (1 in 1,000) of people, these allergic reactions (also called anaphylactic reactions) may become severe or life threatening 
• On rare occasions, fluid can leak out of the cannula or the needle in your vein and lead to discolouration or staining of the skin, which occasionally can be permanent

Other medicines and Ferinject

Please tell your doctor or midwife if you are using, have recently used or might use any other medicines. This includes prescribed medicines and non-prescription medicines.

Please note that you must not take iron tablets or supplements for 48 hours before you have Ferinject. You can restart the iron tablets but not until at least five days after your Ferinject infusion.

Driving and using machines

Ferinject is unlikely to impair your ability to drive or operate machinery.

When must I not receive Ferinject?

You must not receive Ferinject if:

• you are allergic to ferric carboxymaltose or any other similar composition
• you have experienced serious allergic reactions to other injectable iron preparations
• if you have anaemia not caused by iron deficiency
• if you have an iron overload (too much iron in your body), are at risk of it (for example, due to sickle cell disease) or have disturbances in the utilisation of iron
• you are in the first trimester (first 12 weeks) of pregnancy. However, it can safely be used in the second and third trimester (between 13 and 40 weeks), and when breast feeding
• you have current infection, asthma, eczema, an inflammatory or immune condition (e.g. rheumatoid arthritis, systemic lupus erythematosus), or any other condition which means your liver function is not normal

When will I feel better?

The time taken for your haemoglobin levels to improve is different for everyone. It will depend on how iron deficient and anaemic you are, and how efficient your bone marrow is at making new red blood cells.

Will I need a follow-up appointment?

Yes, you will need a blood test to check your haemoglobin and feritin levels two weeks after your Ferinject infusion to make sure your iron levels have improved.