Scott Harding-Lister

Intravenous iron therapy is an effective treatment for iron‑deficiency anaemia when oral supplements are unsuitable or poorly tolerated. Iron injections and infusions are routinely used during pregnancy, after childbirth, in chronic illness and for patients who need to correct their iron levels quickly. Although modern preparations are safer than earlier formulations, iron administered directly into the bloodstream carries a risk of iron extravasation – leakage of the iron solution into the surrounding tissues. When this happens the iron can stain the skin, causing a permanent brown mark that can be psychologically distressing. In some cases the injury results from negligence. This blog explains what iron extravasation is, why iron staining occurs, and when you may be able to bring a clinical negligence claim.

What is iron extravasation?

Extravasation occurs when a drug or solution leaks out of the vein into the adjacent tissues.  When mixed as an infusion, the solution is a dark brown. Even small quantities leaking into the skin can be deposited and cause staining. 

How does iron staining happen?

During an intravenous iron infusion the nurse or doctor inserts a cannula into a vein, usually in the forearm. If the cannula is not properly sited, secured or monitored, the iron solution can infiltrate the tissues. Factors that increase the risk include:

• Poor cannulation technique and site choice – using a distal forearm vein and avoiding sites of flexion such as the wrist or antecubital fossa. Securing the cannula and using an extension set helps prevent movement.
• Failure to check patency and monitor the infusion – the cannula should be checked before administration to ensure the vein is patent and should not be covered with a bandage. Close observation allows early detection of swelling, pain or leakage so that the infusion can be stopped.
• Administering infusions at night or in busy clinics – this can be a particular problem when there are a reduced number of staff.  
• Multiple cannulation attempts – repeated attempts to access a vein increase the risk of damage.

When iron extravasation occurs, patients may feel a degree of pain or tingling around the cannula site. The area can swell and become hard. Over the following days a brown or grey iron stain develops as the iron deposits in the skin. The discolouration can be permanent and may spread beyond the original site. Some patients also develop other symptoms such as blistering.  

Psychological and physical impact

The physical consequences of iron staining injuries go beyond a cosmetic blemish. Patients may become self‑conscious and anxious about exposing the affected limb and may experience depression or loss of confidence. In addition, there may be an ongoing risk of neuropathic pain, numbness or sensitivity.

Are all iron infusion injuries negligent?

Not every iron infusion injury results from medical negligence. Extravasation is a known complication and a small risk exists even when the procedure is performed with care. However, healthcare providers owe patients a duty to minimise the risk and to obtain informed consent. The seminal UK case of Montgomery v Lanarkshire Health Board requires clinicians to inform patients of any material risks and to discuss reasonable alternatives. Failure to provide sufficient information means patients cannot make an informed decision and may constitute a breach of duty.

In our experience of these case we found recurring issues that often indicate negligence:

• Failure to advise patients of risks and alternatives.
• No documented consent process – either written or verbal.
• Lack of monitoring and documentation of adverse events.
• Multiple unsuccessful attempts at cannulation.
• Ignoring alarms on infusion pumps or patient complaints of pain.

If any of these failings contributed to your iron staining injury, you may have grounds for a claim. In the United Kingdom, compensation claims must usually be brought within three years of the date of injury or the date you became aware of the negligence. Exceptions apply for children and people lacking capacity. As an experienced clinical negligence solicitor and registered nurse, I can assess whether the care you received fell below an acceptable standard.

What does a claim involve?

A clinical negligence claim requires proof of three elements:

1. Duty of care – the healthcare professional owed you a duty to provide a reasonable standard of care.
2. Breach of duty – the clinician failed to meet that standard. Examples include not warning about the risk of iron extravasation, inserting the cannula incorrectly, failing to secure or monitor the infusion, or ignoring complaints of pain.
3. Causation and loss – you must show that the breach caused your injury and that you have suffered harm. Harm includes physical symptoms, psychological distress, additional medical costs, lost earnings and the need for treatments such as laser therapy. Permanent skin discolouration and the need for camouflage products are compensable losses.

Evidence is crucial. Medical records, incident reports, photographs of the staining, witness statements and expert opinions help establish the standard of care and the cause of the injury. My role is to gather this evidence, instruct appropriate medical experts and present a compelling case on your behalf.

Treatment options for iron staining injuries

Unfortunately, the iron stain often persists despite treatment. Laser therapy can sometimes lighten the discolouration, but it usually requires specialist expertise and multiple sessions, and success varies from patient to patient. It is rarely available on the NHS because it is considered cosmetic. Specialist skin camouflage products offer another option. A consultation with a skin camouflage practitioner can help find a long‑lasting make‑up that conceals the injury. These treatments can be costly and time consuming; compensation can help cover these expenses. Psychotherapy or counselling may also be appropriate for those experiencing anxiety or depression due to the injury.

Why choose Scott Harding‑Lister?

Iron extravasation cases are complex and require a solicitor with both medical insight and legal expertise. As a solicitor who is also a registered nurse, I understand how iron infusions should be administered and what constitutes a breach of duty. I work closely with independent medical experts, including plastic surgeons and psychologists, to assess the full impact of your injury and to quantify your losses. 

Clients often tell me that they felt unheard when they reported pain during the infusion, and that they were never warned about the risk of skin staining. I listen carefully to your account and identify all areas where the care may have fallen below standard. Where appropriate, I will pursue your claim on a no win, no fee basis, meaning you will not pay my fees if your case is unsuccessful. I also provide clear advice on legal costs and funding so there are no surprises.

Taking the next step

If you have suffered an iron staining injury following an iron infusion or injection, you may be entitled to compensation. The time limit for starting a claim is generally three years from the date of injury or the date you became aware of the negligence. Delays can jeopardise your case because evidence may be lost and witnesses’ memories may fade.

I offer a free initial consultation to discuss your experience, review your medical records and advise whether you have a potential claim. You can contact me by telephone or email using the details below or by completing the enquiry form on this site. Please include photographs of your iron staining and a brief description of the treatment you received. There is no obligation to proceed, and any discussion is confidential.

Contact details

Scott Harding‑Lister – Specialist Clinical Negligence Solicitor and Registered Nurse
Phone: 020 3972 9011
Email: shardinglister@scomo.com
Address: Scott‑Moncrieff & Associates Ltd, Temple Chambers, 3‑7 Temple Ave, London, EC4Y 0HP

Conclusion

Intravenous iron therapy can transform the lives of people with iron‑deficiency anaemia, but when iron extravasation occurs it can leave patients with a permanent reminder of their treatment. Iron staining is often preventable through proper cannulation technique, careful monitoring and honest communication about risks. If you were not properly warned of the risk or if your clinicians ignored signs of an infusion problem, you may have a legal claim. Seeking timely advice from a specialist solicitor can help you secure compensation for the physical and psychological impact of your injury and support your recovery.