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Low-certainty evidence suggests that IBD-related anemia treatment with [[Intravenous iron infusion|Intravenous (IV) iron infusion]] may be more effective than [[Oral iron|oral iron therapy]], with fewer people needing to stop treatment early due to adverse effects.<ref name=":0">{{cite journal | vauthors = Gordon M, Sinopoulou V, Iheozor-Ejiofor Z, Iqbal T, Allen P, Hoque S, Engineer J, Akobeng AK | display-authors = 6 | title = Interventions for treating iron deficiency anaemia in inflammatory bowel disease | journal = The Cochrane Database of Systematic Reviews | volume = 1 | issue = 1 | pages = CD013529 | date = January 2021 | pmid = 33471939 | pmc = 8092475 | doi = 10.1002/14651858.CD013529.pub2 }}</ref> The type of iron preparation may be an important determinant of clinical benefit. Moderate-certainty evidence suggests response to treatment may be higher when IV [[ferric carboxymaltose]], rather than IV [[iron sucrose]] preparation is used, despite very-low certainty evidence of increased adverse effects, including bleeding, in those receiving ferric carboxymaltose treatment.<ref name=":0" />
 
In many cases, use of intravenous iron such as ferric carboxymaltose has lower risks of adverse events than a blood transfusion and as long as the person is stable is a better alternative.<ref>{{cite journal | vauthors = Moore RA, Gaskell H, Rose P, Allan J | title = Meta-analysis of efficacy and safety of intravenous ferric carboxymaltose (Ferinject) from clinical trial reports and published trial data | journal = BMC Blood Disorders | volume = 11 | pages = 4 | date = September 2011 | pmid = 21942989 | pmc = 3206450 | doi = 10.1186/1471-2326-11-4 | doi-access = free }}</ref> Ultimately this always remains a clinical decision based on local guidelines, although National Guidelines are increasingly stipulating IV iron in certain groups of patients.<ref>{{cite journal | vauthors = Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GM, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P | display-authors = 6 | title = 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC | journal = European Heart Journal | volume = 37 | issue = 27 | pages = 2129–2200 | date = July 2016 | pmid = 27206819 | doi = 10.1093/eurheartj/ehw128 | author22 = ESC Scientific Document Group | doi-access = free }}</ref><ref>{{cite journal | vauthors = Dignass AU, Gasche C, Bettenworth D, Birgegård G, Danese S, Gisbert JP, Gomollon F, Iqbal T, Katsanos K, Koutroubakis I, Magro F, Savoye G, Stein J, Vavricka S | display-authors = 6 | title = European consensus on the diagnosis and management of iron deficiency and anaemia in inflammatory bowel diseases | journal = Journal of Crohn's & Colitis | volume = 9 | issue = 3 | pages = 211–222 | date = March 2015 | pmid = 25518052 | doi = 10.1093/ecco-jcc/jju009 | doi-access = free }}</ref>
 
A Cochrane review of controlled trials comparing [[Intravenous iron infusion|intravenous (IV) iron therapy]] with oral iron supplements in people with [[chronic kidney disease]], found low-certainty evidence that people receiving IV-iron treatment were 1.71 times as likely to reach their target [[hemoglobin]] levels.<ref name=":1">{{cite journal | vauthors = O'Lone EL, Hodson EM, Nistor I, Bolignano D, Webster AC, Craig JC | title = Parenteral versus oral iron therapy for adults and children with chronic kidney disease | journal = The Cochrane Database of Systematic Reviews | volume = 2019 | issue = 2 | pages = CD007857 | date = February 2019 | pmid = 30790278 | pmc = 6384096 | doi = 10.1002/14651858.CD007857.pub3 | collaboration = Cochrane Kidney and Transplant Group }}</ref> Overall, hemoglobin was 0.71g/dl higher than those treated with oral iron supplements. Iron stores in the liver, estimated by serum [[ferritin]], were also 224.84&nbsp;µg/L higher in those receiving IV-iron.<ref name=":1" /> However, there was also low-certainty evidence that allergic reactions were more likely following IV-iron therapy. It was unclear whether type of iron therapy administration affects the risk of death from any cause, including cardiovascular, nor whether it may alter the number of people who may require a blood transfusion or dialysis.<ref name=":1" />