What is iron deficiency?

Iron deficiency occurs when your body does not have enough iron to meet its physiological needs. It can occur with or without anaemia and may still cause significant symptoms even when haemoglobin levels are within the laboratory reference range.

What is anaemia?

Anaemia is a condition where the haemoglobin level in the blood is low, meaning the blood cannot carry oxygen as efficiently as it should. Haemoglobin is found inside red blood cells and is responsible for delivering oxygen to tissues throughout the body.

The most common cause of anaemia is iron deficiency, but anaemia can also result from other causes such as vitamin deficiencies, chronic inflammation, blood loss, or bone marrow conditions.

Importantly, anaemia represents a later stage of iron deficiency. Many people have low iron stores and experience symptoms before haemoglobin levels fall. This is why iron deficiency can be present even when someone is told they are “not anaemic”.

What are the symptoms of iron deficiency?

Iron deficiency can cause a wide range of symptoms, many of which are non-specific and easily overlooked. Common symptoms include:

• Persistent or unexplained fatigue
• Reduced exercise tolerance or shortness of breath
• Brain fog, poor concentration, or memory difficulties
• Headaches
• Restless legs or poor sleep
• Hair thinning or hair loss
• Brittle nails
• Dizziness or light-headedness
• Palpitations
• Craving ice or other non-food items (pica)

Symptoms generally occur even before anaemia develops.

Why does fixing iron deficiency matter?

Iron is essential for oxygen delivery, energy production, cognitive function, muscle performance, and immune health. Untreated iron deficiency can significantly impact quality of life, daily functioning, and work capacity.

In certain groups, including women of reproductive age, pregnant patients, those with gastrointestinal conditions, or chronic blood loss (i.e. from heavy periods), ongoing iron deficiency may lead to recurrent symptoms and progression to anaemia if not addressed appropriately.

Why is iron important during pregnancy?

Iron requirements increase significantly during pregnancy to support:

• Expansion of maternal blood volume
• Placental development
• Fetal growth and brain development

Iron deficiency during pregnancy can contribute to maternal fatigue, reduced exercise tolerance, and may increase the risk of complications if left untreated.  Good iron stores are also very important around delivery, as it is normal to lose some blood with delivery, and iron stores are required to replenish this blood.

Lastly, there is emerging evidence that good iron stores at delivery help;

• Assist in establishing breastfeeding
• Improve material wellbeing post delivery, assisting in preventing postpartum depression
• Prevent iron deficiency in newborn infants and children

Are iron infusions safe?

Modern intravenous iron preparations are very safe when administered in an appropriate clinical setting. Serious reactions are rare.
Skin staining is uncommon and occurs at a rate well below that reported in published literature at our clinics, reflecting careful technique and extensive staff experience.

Are iron infusions safe during pregnancy?

Yes. Iron deficiency is common in pregnancy and can affect both maternal wellbeing and pregnancy outcomes. Intravenous iron is considered safe in pregnancy when clinically indicated, particularly in the second and third trimesters.

Treatment decisions are individualised and based on gestation, severity of deficiency and symptoms. All pregnant patients are assessed carefully, with specialist oversight. We perform over 1,000 iron infusions in pregnant women every year.

My doctor said my iron levels are normal, so could I still be iron deficient?

Yes. Iron deficiency is frequently under-recognised. Laboratory reference ranges may not reflect optimal iron stores, particularly in symptomatic patients. Many people may experience symptoms with ferritin levels below ~50 µg/L, despite being told their results are “normal”. As a specialist clinic, we interpret iron studies in clinical context rather than relying on a single laboratory value.

Why do I have symptoms when my haemoglobin is still normal?

Haemoglobin reflects red blood cell levels, not iron stores. Iron deficiency will develop before haemoglobin falls, meaning your body may be struggling to supply iron to muscles, the brain, and other tissues despite a “normal” haemoglobin result.

This is known as non-anaemic iron deficiency (NAID), and it is a well-recognised cause of fatigue, cognitive symptoms, and reduced physical performance.

What blood tests are used to assess iron deficiency?

Iron deficiency is not diagnosed using a single test. We assess a combination of results, including:

• Ferritin (iron stores)
• Transferrin saturation
• Serum iron
• Total iron binding capacity
• Haemoglobin and red cell indices

Together, these provide a more accurate picture of iron status.  We also take into account patient’s symptoms and potential risk of deficiency by asking about menstrual losses, gastrointestinal diseases, exercise status and a number of other factors.

Do I need a referral to attend The Iron Infusion Clinic?

You do not need a referral.  If you have blood tests demonstrating iron deficiency that are less than four months old, then you can book in with us.  We also welcome referrals from other referring health practitioners.

If you feel as though you might be iron deficient and you don’t have recent blood test results, patients can access our Iron Screening Tool, from which we can rapidly arrange a blood test for you and and follow-up treatment for your iron deficiency if appropriate.

Who will I see at the clinic?

All clinic sites are staffed by both Consultant Haematologists and Nurse Practitioners.

Depending on your clinical needs, you may be seen by:

• A Haematologist
• A Nurse Practitioner, with specific training in anaemia and iron deficiency.
• Or both, working together within a coordinated care model

This ensures timely access to care while maintaining specialist-level assessment and oversight.

What is a Nurse Practitioner?

A Nurse Practitioner (NP) is an advanced practice clinician with:

• A Master’s degree or higher
• Extensive postgraduate clinical experience
• Authority to assess patients, diagnose conditions, order investigations/blood tests, the ability to prescribe medications, and manage treatment plans

Nurse Practitioners are highly skilled clinicians who practise autonomously within their scope and work closely with medical specialists.

How are Nurse Practitioners trained at The Iron Infusion Clinic?

All Nurse Practitioners at The Iron Infusion Clinic are personally trained and credentialed by Dr Joel Collins, Consultant Haematologist.

Training includes:

• Comprehensive assessment of iron deficiency
• Advanced interpretation of iron studies
• Safe prescribing and administration of intravenous iron
• Recognition and management of adverse reactions
• Clear escalation pathways for complex or atypical cases

Is there specialist medical oversight?

Yes. All clinical care across all sites occurs under direct haematologist involvement.

Dr Joel Collins:

• Personally trains all Nurse Practitioners
• Develops and reviews all clinical protocols
• Is involved in clinical decision-making across the clinics
• Reviews complex cases and referrals

This ensures consistent, high-quality care regardless of which clinic you attend.

Will my GP or specialist be informed?

With your consent, we provide a formal medical letter to your GP and/or other treating specialists outlining:

• The indication for treatment
• The iron formulation used
• Follow-up and monitoring recommendations

This is also uploaded to your health record.

What follow-up is required after an infusion?

Repeat blood tests may be recommended after treatment. We provide clear, individualised guidance regarding monitoring and next steps and we will communicate this to you, as well as to your GP and any other specialists involved in your healthcare.

Can iron deficiency recur?

Yes. Iron deficiency can recur if the underlying cause persists (such has heavy periods). Our approach focuses not only on iron replacement, but also on identifying and addressing contributing factors, with appropriate investigation or referral recommendations where required.