ONTraC Program

• Fatigue
• Weakness
• Dizziness
• Shortness of breath
• Chest pain
• Difficulty concentrating
• Hair loss
• Restless legs
• Feeling cold
• Pale skin
• Craving non-food items (e.g. ice, dirt)

• Blood loss (e.g. heavy periods, GI bleeds, nose bleeds, recent surgery, frequent blood donation)
• Nutrient deficiency (e.g. iron, Vitamin B12, Folic Acid)
• Poor iron absorption (e.g. celiac disease, gastric bypass)
• Pregnancy or breastfeeding
• Genetic disorders (e.g. thalassemia, sickle cell)
• Certain medications
• Chronic diseases (e.g. cancer, kidney or autoimmune diseases)

Hemoglobin: a protein in red blood cells that contains iron and carries oxygen. Target level 130 g/L or higher.

Ferritin: measures iron stores. Target level 50 mcg/L or higher.

There are two main sources of iron:

• Heme iron comes from meat
• Non-heme iron comes from plant sources

Heme iron is more easily absorbed by the body. Iron, Vitamin B12, Folic Acid, Vitamin C and limiting alcohol are needed in order to make healthy red blood cells and boost hemoglobin.

*Amounts may vary, check product label. Pregnant or breastfeeding women may have further dietary restrictions.

• Liver (75g) 5 mg
• Beef (75g) 3 mg
• Chicken (75g) 1 mg
• Pork (75g) 1 mg
• Clams (75g) 2 mg
• Oysters (75g) 4 mg
• Mussels (75g) 5 mg
• Sardines (75g) 2 mg
• Fish (75g) 1 mg
• Eggs (2 large) 1.5 mg

*Amounts may vary, check product label. Pregnant or breastfeeding women may have further dietary restrictions.

• Pumpkin Seeds (60ml) 4.5 mg
• Lentils (175ml) 5 mg
• Tofu (85g) 2 mg
• Kidney Beans (120ml) 2 mg
• Nuts (60ml) 1.5 mg
• Hummus (60ml) 1 mg
• Cooked Spinach (120ml) 3mg
• Cooked Kale (120ml) 1 mg
• Potato with Skin (1 large) 2 mg
• Tomato Sauce (120ml) 1 mg
• Dried Apricots (30g) 1 mg
• Oatmeal (120ml) 1.5 mg
• Cream of Wheat (120ml) 5 mg
• Dry Breakfast Cereal (37g) varies
• Bread (1 slice) 1mg
• Granola Bar (1 bar) 1mg
• Dark Chocolate (30g) 2 mg

*Amounts may vary, check product label. Pregnant or breastfeeding women may have further dietary restrictions.

Your healthcare provider may recommend starting an oral iron and/ or B12 supplement to help improve your anemia. Take the supplements as directed and contact the prescriber, Pharmacist or Family Doctor with any questions or concerns.

• Abdominal pain
• Constipation
• Diarrhea
• Bloating
• Nausea
• Dark stools

• Take oral iron on an empty stomach with a glass of orange juice or Vitamin C 500mg tablet.
• Avoid consuming substances that inhibit iron absorption, like tea, coffee, dairy, calcium, food and certain medications, within 1-2 hours of taking iron.
• You may take your iron pill once every other day.

If you have questions about oral iron supplements or the best time to take them with your other medication, speak to your Family Doctor or Pharmacist.

*Natural iron supplements available over-the-counter can be suitable for maintenance, but they often don’t contain enough elemental iron to effectively treat iron deficiency anemia.

Intravenous (IV) iron is a dark brown liquid containing iron that’s administered through a vein in your arm. It’s used to treat anemia caused by low iron levels or blood loss. IV iron can be an alternative to blood transfusions and is often used when oral iron is ineffective, your iron deficiency anemia is severe or there’s not enough time to take oral iron before surgery. The iron infusion may take 1-3 hours and could require multiple doses.

You may receive your iron infusion in the Niagara Falls Hospital (Medical Day Unit) or at a Community Infusion Clinic. An exception is if you are pregnant you must go to the St. Catharine’s Hospital (Medical Day Unit) where an OB/Gyne is on-site. You may need to pick up your iron at the pharmacy beforehand and bring it with you. Please arrive well hydrated and eat a good meal prior to your appointment. You will be relaxed in a chair or stretcher. You may bring a book, tablet, phone etc. If you are feeling okay, you should be able to drive and resume your daily activities after your infusion.

Side effects are rare in iron infusions, however can happen.

• Low blood pressure, dizziness
• Chest discomfort
• Muscle, back or joint Pain
• Headache/ fatigue
• Low grade fever
• Nausea/ vomiting
• Diarrhea
• Dark urine
• Low blood phosphate level
• Swelling/ pain at the injection site
• May cause low birth weight, preterm labour or slow fetal heart rate in pregnancy

• Trouble breathing
• Rash/ hives
• Feel itchy
• Feel faint
• Have swelling in your throat, mouth, tongue, legs or hands

You may treat “flu-like” symptoms or side effects with over-the-counter medications. Speak to your pharmacist or healthcare provider if you have any questions.

Notify the nurse if you are experiencing any side effects during your infusion. Call your family doctor or go to the nearest Emergency department, if you’ve left the infusion clinic.

IV iron is covered by Ontario Health Insurance Plan (OHIP) and Ontario Drug Benefit (ODB) for certain groups (over 65 years, under 25 years or on OW/ ODSP). If you have a private plan through work (eg. Manulife, Greenshield etc.) you will need to contact the company to see if your IV iron is paid for through your plan. You will need to provide the drug name & DIN number to the company. If you do not qualify for the above drug coverage then you will have to pay for your iron.

Eprex is a synthetic version of erythropoietin, a substance naturally produced by the kidneys to stimulate red blood cell production in response to low oxygen levels. It helps increase oxygen levels in the body by boosting red blood cell production.

Eprex is administered by subcutaneous injection in the Hospital Medical Day Unit. Your prescription is faxed to the hospital pharmacy. You might need to pick up the injection and bring it for the nurses to give. Depending on your hemoglobin level, you may require 1-4 doses, each taking less than 60 minutes. Your blood pressure will be taken prior to the injection and if it’s too high, the injection might be postponed. Blood work may be checked before your last dose. If your hemoglobin is at target, the injection will not be given.

*Taking iron is necessary to support red blood cell production when receiving Eprex.

• “Flu-like” symptoms (muscle aches, joint pain, headache, low-grade fever)
• Redness and pain at the injection site

*You may treat “flu-like” symptoms with over-the-counter medications. Speak to your pharmacist or healthcare provider if you have any questions.

• Trouble breathing
• Rash/ hives
• Itchy
• Light headedness
• Have swelling in your throat, mouth, tongue, legs or hands

• Seizures
• High blood pressure
• Blood clots
• Heart attack
• Stroke
• Heart failure

Inform your healthcare provider or go to the Emergency department, if you experience:

• Shortness of breath
• Cough
• Chest pain
• Racing heartbeat
• Persistent headache
• Swelling or pain in the groin or calf
• Weakness on one side of the body
• Sudden vision changes
• Light-headedness or fainting

*Notify the nurse if you are experiencing any side effects during your visit. Call your family doctor or go to the nearest Emergency department, if you’ve left the Medical Day Unit.

Eprex is available by prescription only. It will be ordered for you only if the benefit to you is greater than the risk.

If you have a private drug plan through work they might cover some or all of the cost of Eprex, depending on your plan. Ontario Drug Benefit and Trillium may also cover the cost of Eprex using the “Exceptional Access Program” (EAP). We can also apply for compassionate coverage or you will have to pay for your Eprex.

Iron deficiency occurs when your body lacks sufficient iron. Iron is essential to building healthy red blood cells. A lack of iron can lead to anemia.

1. Depleted iron stores – blood donations, heavy periods, recent pregnancy
2. Inadequate iron intake / absorption – vegan or vegetarian diet, nutritional deficiency, nausea & vomiting, Celiac disease
3. Increased iron demand – pregnancy increases the demand for iron, carrying multiple babies (eg. twins)

Prenatal vitamins and over-the-counter natural iron supplements may be a sufficient amount of for most pregnant women. Pregnant women who are already iron deficient, will require an oral iron supplement that contains more elemental iron.

If you’ve tried oral iron but it’s not helping or you’re unable to tolerate it, the next step is IV iron. We will book you into the ONTraC clinic to get your prescription for the IV iron. Your infusion will be booked at the Marotta Family Hospital Medical Day Unit. You will relax in a chair or stretcher while the IV iron is infused over 90 mins to 3 hours and could require multiple doses.

In 2 months, we will recheck your blood work and book you in for a follow up appointment.

If you plan to get pregnant again let your healthcare provider know that you were previously anemic and the treatment plan you received.