Iron Infusions

What is an iron infusion?

Iron infusions are often prescribed to treat some cases of iron deficiency anaemia.  It can be delivered via injection or by a drip straight into the vein. The treatment is sometimes known as ferric carboxymaltose, or the brand names, Ferinject, Monofer and Venofer.

In some patients these iron infusions can be helpful in the treatment and prevention of iron deficiency anaemia. Occasionally, however, there can be problems with how the infusion is administered, or with severe reactions to the treatment.

Why are iron infusions given?

Iron deficiency anaemia is a common type of anaemia. It’s a condition in which the blood lacks adequate healthy red blood cells. These red blood cells are essential to our health as they carry oxygen to the body’s tissues.  Iron supports the oxygen carrying capacity of haemoglobin in red blood cells and of myoglobin in muscle tissue. It also plays a crucial part in supporting many other vital processes in the human body. Low haemoglobin has a number of potentially serious health consequences.

As the name implies, iron deficiency anaemia is due to low iron levels in your body. Without enough iron, your body can’t produce enough of a substance in red blood cells that allows them to carry oxygen. It can cause a range of symptoms, including extreme fatigue, weakness, pale skin, headaches, chest pain, shortness of breath and a fast heartbeat.

Most of the time the condition is treated with dietary changes and iron supplements, that can usually be taken in pill form. In some more severe cases, however, patients are unable to get the iron they need from changes to their diet or dietary supplements.

A GP may prescribe an iron infusion if a patient:

• can’t take iron by mouth
• can’t absorb iron adequately through the stomach
• can’t absorb enough iron due to blood loss
• needs to increase their iron levels fast to avoid medical complications or a blood transfusion
• has an active inflammatory bowel disease (IBD).

The aim of the treatment is to replenish the body’s iron stores and to remedy anaemia. It is a quicker way to get iron into the body than through dietary changes and supplements which can take some time to take effect.

You should not have an iron infusion if:

• you are hypersensitive (allergic) to ferric carboxymaltose or any of the other ingredients of Ferinject, Monofer and Venofer
• you have anaemia caused by something other than iron deficiency
• you have iron overload (too much iron in your body) or disturbances in how your body makes use of iron
• you have new or ongoing infections
• you are less than 12 weeks pregnant

The treatment involves slowly infusing iron into the vein over 30 minutes to an hour. It is usually done over two rounds a week apart. If the treatment works you should start to have more energy within 2 weeks of the treatment being administered.

Iron infusions as an alternative to blood transfusions

When you lose blood from an operation, you lose iron. Iron, by building red blood cells, can help your body deal with the stress of losing blood during an operation and aid recovery. Iron infusions are sometimes used as an alternative to blood transfusion for patients with a very low ferritin level. An iron infusion may be suggested if a patient with low haemoglobin and low ferritin cannot take iron pills.

What are the risks of iron infusions?

As with all medical treatments, iron infusions don’t come without risks. Sometimes those risks can have serious consequences for the individual. Potential mild side effects can occur in up to 10% of patients. More serious side effects occur in around 1% of all cases.

The potential side effects of iron infusions can include:

• Bloating or swelling of the face, arms, hands, lower legs, or feet.
• Dizziness, faintness, or light-headedness when getting up suddenly from a sitting or lying position.
• Gastrointestinal pains such as nausea or cramps.
• Problems with breathing.
• Skin problems, including rashes.
• Chest pains.
• Low blood pressure.
• Anaphylaxis (a severe allergic reaction that can include difficulty breathing, itching, or a rash that can cover the whole body).

As well as these reactive side effects there is a risk of an extravasation injury.

You should be informed of these risks associated with iron infusions ahead of time, and be provided with a leaflet on this. You will also be directed to alert staff to any concerns or pain during the infusion.

What is an extravasation injury?

Extravasation injury is when damage is caused by the loss of the solution being introduced into the body, from the vessel into surrounding tissue spaces during an intravenous infusion. The damage can extend to involve nerves, tendons and joints and can continue for months after the initial incident. It can cause considerable ongoing pain and a loss of mobility. It can also cause long-term, or permanent skin colouring or discolouration. It has been called an unwanted ‘iron tattoo’ that is unsightly and unpleasant. This can lead to considerable emotional distress, particularly if the patient feels they were not made properly aware of the risks.

Proper protocols

Because of the serious nature of the potential complications for patients, doctors and nurses should ensure that they follow a set protocol. This should include checking the cannula site and integrity before proceeding with the infusion, checking for cannula displacement during the treatment, and flushing the cannula site before and after the treatment. If any of these procedures are not followed, the risks of extravasation injury will be increased.

If the patient reports any feelings of nausea or dizziness, or unpleasant sensations at the infusion site, the procedure should be stopped and investigated further.  The patient should be monitored for a period after the treatment before being allowed to return home.

Unfortunately, the protocols around iron infusions are not always rigorously followed, which can result in medical negligence.

Iron infusions and medical negligence

An increasing number of people are reporting medical negligence resulting as part of their iron infusion treatment. This might be because of extravasation injury, wrongly prescribed or continued treatment or lack of appropriate warning about the potential risks. When this happens, you may have been the victim of medical negligence, and may be able to claim redress.

What is medical negligence?

Medical negligence occurs when you experience treatment or care that does not meet the expected professional standards. Iron infusions claims most readily occur as a result of extravasation injury, but can also include other issues such as wrongly prescribed treatment.

The compensation you can claim for any injuries or losses, you suffer as a result of medical negligence can include:

• Compensation for pain and loss
• Compensation for loss of earnings
• Payment for ongoing treatment because of medical negligence
• Compensation for changes in lifestyle if you cannot carry out certain activities
• Covering the cost of home adaptations, extra care, or equipment
• Compensation for psychological damage

Some of these will apply to problems arising out of inadequate treatment in relation to iron infusions.

Who can make a claim?

If you have undergone iron infusion treatment and feel that it fell below a minimum professional standard of competence, and as a result you suffered a physical or psychological injury that was otherwise avoidable, you may be able to claim for medical negligence.

You can also claim if you are the next of kin of someone who cannot represent themselves, perhaps because they are children or have a mental disability.

To make a successful claim you will have to be able to prove that medical negligence has occurred.

How do you prove medical negligence took place?

The burden of proving that medical negligence took place lies with the claimant and has two distinct parts:

• You must be able to prove that the doctor or other clinician has broken their duty of care towards you.
• You must also be able to prove that any medical or mental injuries that you have suffered because of this would not have occurred.

If you do not have proof of medical negligence you cannot make a claim. It’s not medical negligence if your treatment has not been successful, or it has failed to match your expectations.

Any claim for medical negligence must fall within the legal definition of medical or clinical negligence.

If you are making a claim, it must be submitted within three years of the treatment taking place. If the person is a child, it must take place within three years of them reaching their 18^th birthday.

Establishing causation

Establishing causation can be one of the most difficult parts of any medical negligence claim. It means proving that there has been a breach in the duty of care. It relies on demonstrating that the balance of probabilities shows a breach in duty of care is the reason for the injury. Medical negligence claims can also become more complicated if there are multiple factors involved.

How much can you claim?

If you have sustained an injury because of iron infusion treatment you may be wondering how much you could claim. Each medical condition is different, and consequently each claim is different. What your compensation claim aims to do is to return you to the quality of life you were experiencing prior to the injury you received due to medical negligence. If you have been a victim of extravasation injury, for instance, you may be compensated for the permanent area of discolouration, and the ongoing symptoms of pain and weakness in the arm. It may help fund make-up to camouflage the discolouration, as well as cognitive behavioural therapy and physiotherapy to manage the ongoing symptoms.

The ultimate size of any pay-out will be dependent on your own individual case and circumstances.

Getting expert advice for a no-win, no-fee medical negligence claim

A claim for medical negligence can be time consuming, involved and sometimes distressing. It’s not something that should be entered into lightly, but if you believe you have been the victim of medical negligence you have every right to make a claim.

The complexity of medical negligence claims requires specialist legal knowledge. At Mark Reynolds Solicitors we are experienced at making successful claims for our clients. We can advise about the strength of your claim, its likelihood of success, and whether we think you should proceed.

The role of a solicitor in a medical negligence claim is to secure compensation for our client. If you require an apology from the organisation that administered your treatment, it may be appropriate to submit a complaint to a professional organisation.

For professional and sensitive advice about iron infusion medical negligence claims, call us on 0800 002 9577, or contact us using the form below.