Low ferritin means your body's iron stores are running low, and it is one of the more common findings when someone in BC asks for bloodwork because they feel tired all the time. BC's clinical guideline lists oral iron as the usual first step. An IV iron infusion is a prescription treatment that a clinician may consider in specific situations, such as when oral iron has not been tolerated or has not worked. An individual assessment and recent bloodwork decide which route fits.
This article explains what ferritin is, which tests are involved, why oral iron usually comes first, when IV iron may be considered, what a screening visit at Skin Art MD in Burnaby covers, and when to see your family physician or urgent care instead. It is general information, not a diagnosis or a treatment plan.
What is ferritin, and what does "low ferritin" mean?
Ferritin is a protein that stores iron, and the amount in your blood gives an estimate of how much iron your body has in reserve. A low ferritin result usually points to depleted iron stores, even before haemoglobin drops.
Iron stores can fall for many reasons: heavy menstrual periods, pregnancy, blood donation, a diet with little iron, conditions that affect absorption in the gut (such as celiac disease or a past bariatric surgery), or slow blood loss from the digestive tract. Finding the reason matters as much as the number itself.
Two points often cause confusion:
- A "normal" lab range is not the whole story. Labs print a reference range, but clinicians interpret ferritin alongside your symptoms, history and other results. The BC Guidelines document Iron Deficiency – Investigation and Management (gov.bc.ca, as of October 2026) describes how clinicians in the province approach this.
- Ferritin can look higher than your true stores. Ferritin rises with inflammation, infection and some chronic conditions, so a mid-range result does not always rule out low iron. This is one reason other tests are usually checked at the same time.
Is low ferritin the reason I feel tired?
It might be one reason, but fatigue has many possible causes, and low ferritin is only one of them. Thyroid problems, sleep issues, low mood, other vitamin deficiencies, medications and many medical conditions can all feel similar.
That is why a careful history matters. If you have been told "your bloodwork is fine" but still feel unwell, it is reasonable to ask which tests were done and what the results were. You are entitled to a copy of your own lab results, and many people in BC can view them through the province's online health record tools.
Which blood tests are usually involved?
A typical iron work-up includes a complete blood count (CBC) and serum ferritin, and often other markers that help interpret them. The exact panel depends on the person and on the clinician ordering it.
Tests commonly discussed include:
- CBC – haemoglobin, red cell size and other measures that show whether anaemia is present
- Ferritin – an estimate of iron stores
- Iron, transferrin saturation or TIBC – how much iron is circulating and available
- CRP or other inflammation markers – to help interpret ferritin
- Kidney function (such as eGFR) – often checked before IV treatments
- Other tests – such as B12, thyroid or celiac screening, when the history suggests them
For IV iron screening, clinics generally ask for recent results, commonly within the past three months. If your family physician has already ordered bloodwork, bring a copy; it may save repeat testing. Lab tests ordered by a naturopathic physician are generally not billed to MSP, so there may be a lab fee. Check with the lab and your extended health plan before booking.
Why is oral iron usually tried first?
According to the BC Guidelines on iron deficiency (gov.bc.ca, as of October 2026), oral iron is the usual first-line approach for most adults. It is widely available, taken at home, and does not require a clinic visit for each dose.
Oral iron does not suit everyone. Some people notice stomach upset, constipation or nausea, and how it is taken (timing, dose schedule, what it is taken with) can affect both tolerance and absorption. A pharmacist, your family physician or a naturopathic physician can talk through options. If you have tried iron before and stopped because of side effects, that history is useful information for whoever assesses you next.
Rechecking bloodwork after a period on oral iron is part of the process; it shows whether stores are responding. Individual results vary.
When might an IV iron infusion be considered?
IV iron is a prescription drug given through a vein under clinical supervision, and it is considered case by case rather than as a default. The BC Guidelines describe situations where intravenous iron may be considered, which generally include:
- oral iron has not been tolerated despite adjustments
- oral iron has not raised iron stores after an adequate trial
- ongoing blood loss is more than oral iron can keep up with
- a condition affects iron absorption in the gut
- other circumstances identified by your physician or the treating clinician
IV iron is available in several prescription formulations, and the choice belongs to the prescriber. Whether it is appropriate for you depends on your history, current medications, allergies, pregnancy status, kidney function and lab results. Assessment decides; a request alone does not.
Just as important: an IV infusion addresses iron stores, not the cause of the deficiency. If the cause has not been looked into, especially in men or in people after menopause, your family physician should be involved, because the guideline recommends investigating possible sources of blood loss.
What happens at an Iron IV screening at Skin Art MD?
The first step is a 15-minute Iron IV screening consultation with our naturopathic physician, where your history and recent labs are reviewed. No infusion is given at that first visit.
At Skin Art MD in Burnaby (Metrotown), naturopathic visits are with Dr. Ekaterina Krantsevich Riehl, BSc, ND, a registered naturopathic physician in BC. The screening covers:
- your symptoms, health history and current medications or supplements
- any history with oral iron, and what happened
- recent bloodwork (bring copies if you have them), or which tests are needed if you do not
- allergies, pregnancy status and other screening questions relevant to IV treatment
- whether IV iron is reasonable to consider, or whether another route, or a referral back to your family physician, makes more sense
If IV iron is appropriate, the next steps are typically: a prescription, the drug dispensed through a pharmacy, a separate infusion visit with monitoring during and after the infusion, and follow-up bloodwork later to see how stores have changed. According to the College of Complementary Health Professionals of BC (cchpbc.ca), naturopathic physicians who prescribe or administer certain drugs must meet the college's additional certification requirements. With your consent, results can be shared with your family physician so your care stays connected.
You can learn more about how naturopathic visits work on our naturopathic medicine page.
What side effects can happen with IV iron?
Like any prescription medication, IV iron can cause side effects, and they are reviewed with you before treatment. HealthLinkBC and your pharmacist are good neutral sources for drug-specific information.
Side effects that are commonly described in drug information include:
- headache, nausea, flushing or a change in taste during or after the infusion
- muscle or joint aches, or flu-like symptoms in the day or two afterwards
- discomfort, swelling or brown skin staining at the IV site if the drug leaks outside the vein
- changes in blood pressure
- less commonly, allergic reactions, which is why infusions are given with monitoring and why staff ask about allergies beforehand
Some formulations can affect phosphate levels, which your prescriber may consider when choosing a product. If you notice anything unusual after an infusion, contact the clinic, call HealthLinkBC at 8-1-1, or seek urgent care if symptoms are severe.
Will MSP, PharmaCare or extended health cover it?
Coverage usually splits into separate pieces, and each is checked separately. The drug, the clinic visit and the lab tests are often handled by different payers.
- The drug: IV iron is a prescription medication dispensed by a pharmacy. Depending on the product and your situation, BC PharmaCare coverage may require Special Authority, a request submitted by the prescriber (gov.bc.ca, as of October 2026). Your PharmaCare plan and deductible also affect what you pay. Private drug plans set their own rules.
- The visit: MSP does not cover naturopathic visits for most people. MSP may cover a limited number of naturopathic visits for eligible premium-assistance recipients; check with Health Insurance BC. Many extended health plans reimburse naturopathic visits up to a yearly limit.
- Labs: tests ordered by a naturopathic physician are generally paid privately or through extended health.
Ask your insurer before you book, and keep your receipts. We can explain what each charge is for at your screening.
When should I see my family physician or urgent care instead?
See a family physician or walk-in clinic when fatigue is new, unexplained or getting worse, and especially when iron deficiency is found without a clear cause. Call 9-1-1 or go to an emergency department for chest pain, severe shortness of breath, fainting, black or bloody stools, vomiting blood or very heavy bleeding.
If you do not have a family physician, the Health Connect Registry (gov.bc.ca) lets you join the provincial wait list, and HealthLinkBC at 8-1-1 offers nurse advice at any hour. Urgent and Primary Care Centres are another option for same-day concerns. A naturopathic visit can sit alongside this care; it does not replace medical investigation.
Frequently asked questions
Can I book an iron infusion without a referral?
You can book an Iron IV screening without a referral. Whether an infusion follows depends on your history, recent bloodwork and the prescriber's assessment.
Can I use bloodwork my family doctor ordered?
Usually, yes, if it is recent (commonly within three months) and includes the needed tests. Bring a copy or a printout from your online health record.
How long does an infusion visit take?
It depends on the formulation and on monitoring time afterwards. Timing is explained at your screening, before any infusion is booked.
Will I need follow-up bloodwork?
Yes. Iron studies are typically rechecked some weeks after treatment to see how stores have changed. Individual results vary.
Is IV iron right for pregnancy?
Iron needs in pregnancy are managed with your maternity care provider. Tell us if you are pregnant or may be; that changes the assessment.
Booking
If you have low ferritin on recent bloodwork, or you are tired and have not had iron tested, you can book a 15-minute naturopathic screening at Skin Art MD in Burnaby (Metrotown), serving Greater Vancouver. Bring any recent lab results and a list of your medications and supplements. We will go through your history, explain the options, and let you know if your family physician should be the next stop.
