Informed Consent to Receive Intravenous Iron Replacement Therapy
The patient understands that the administration of iron comes with the following risks, included but not limited to:
- Anaphylactic reactions, which in rare cases may be potentially fatal
- Paravenous leakage- leakage of iron at injection site, potentially leading to long lasting skin discolouration
- Skin Irritations
- Headaches, light headiness
- Tachycardia, Hyper/Hypotension
- Nausea, Stomach pain, Constipation, Diarrhoea and Vomiting
Minor reactions to iron infusion may last up to 48 hours post injection. For full list of reactions, please see below.
Understanding these risks, patient gives authority for staff of My HealthCity to administer all necessary first aid and/or resuscitation measures, including alerting an ambulance and my Emergency Contact, in the unlikely event that an adverse or anaphylactic reaction occurs.
As iron infusion is not suitable for patients in some conditions, patient declares that none of the below listed is applicable:
- Pregnancy in the first trimester
- Dialysis
- Allergy to Ferric Carboxymaltose
- Iron overload/Haemochromotis
- Under the age of 14 years
- Non-iron deficiency related anaemia
- Suffering from fever/sepsis
The patient, as stated below, has read information provided on this document. The patient understands that procedure is undertaken entirely at own risk and cost and is requesting medical intervention in the form of Intravenous Iron Infusion.