EFFICACY AND SAFETY OF INTRAVENOUS IRON IN CHILDREN WITH IRON DEFICIENCY ANAEMIA POORLY COMPLIANT TO ORAL IRON THERAPY

Authors

  • Mirza Muhammad Ahsan Baig Allama iqbal memorial teaching hospital,sialkot
  • Samina Batool Allama Iqbal Memorial Teaching Hospital, Sialkot-Pakistan
  • Taiba Aslam Allama Iqbal Memorial Teaching Hospital, Sialkot-Pakistan
  • Muhammad Rafique Allama Iqbal Memorial Teaching Hospital, Sialkot-Pakistan
  • Sadia Batool Allama Iqbal Memorial Teaching Hospital, Sialkot-Pakistan
  • Osama Anwaar Birmingham Heartlands Hospital-United Kingdom
  • Saman Zahid Khawaja Safdar Medical College, Sialkot-Pakistan

DOI:

https://doi.org/10.55519/JAMC-02-9365

Keywords:

Children, effectiveness, iron deficiency anemia, intravenous iron therapy

Abstract

Background: Iron deficiency is the most common nutritional deficiency worldwide. Common causes of IDA in children are excessive consumption of cow’s milk and prolonged breast feeding with delayed and poor weaning. Oral iron is the first line of treatment in children with IDA but occasionally there is inadequate response due to poor compliance. The objective of this study is to assess the effectiveness and safety of intravenous iron in children with IDA, poorly compliant to oral iron therapy. Methods: This study consisted of 90 children from 12–60 months with IDA who were not responding adequately to oral iron therapy. Total iron requirement was calculated and given intravenously (IV) in two divided doses over two consecutive days. Participants were followed up at 2 and 4 weeks to assess the rise in haemoglobin level. Any adverse event was also noted. SPSS version 25 was used for statistical analysis. Results: Of the 90 enrolled children the mean age was 23.1±10.7 months, 47 (52.2%) were males and 43(47.8%) were females. The mean ferritin level before IV iron therapy was 3.75±2.53 ng/ml and mean haemoglobin was 5.9±1.3 g/dL. After IV iron therapy the haemoglobin level was raised to 8.38±1.09 g/dl and 9.74±0.88 g/dl at 2 and 4 weeks respectively which was statistically significant (p<0.05). The adverse events were fever in 3 (3.3%) and urticaria in 2 (2.2%) patients. Conclusion: Intravenous iron therapy is effective and safe to raise the haemoglobin levels in children with IDA who are poorly compliant to oral iron therapy.

References

da Silva Lopes K, Yamaji N, Rahman MO, Suto M, Takemoto Y, Garcia-Casal MN, et al. Nutrition‐specific interventions for preventing and controlling anaemia throughout the life cycle: an overview of systematic reviews. Cochrane Database Syst Rev 2021;9(9):CD013092.

Engle-Stone R, Aaron GJ, Huang J, Wirth JP, Namaste SM, Williams AM, et al. Predictors of anemia in preschool children: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project. Am J Clin Nutr 2017;106(Suppl 1):S402–15.

Jamnok J, Sanchaisuriya K, Sanchaisuriya P, Fucharoen G, Fucharoen S, Ahmed F. Factors associated with anaemia and iron deficiency among women of reproductive age in Northeast Thailand: a cross-sectional study. BMC Public Health 2020;20(1):102.

Owaidah T, Al-Numair N, Al-Suliman A, Zolaly M, Hasanato R, Al Zahrani F, et al. Iron Deficiency and Iron Deficiency Anemia Are Common Epidemiological Conditions in Saudi Arabia: Report of the National Epidemiological Survey. Anemia 2020;2020:6642568.

Clark KM, Li M, Zhu B, Liang F, Shao J, Zhang Y, Ji C, et al. Breastfeeding, mixed, or formula feeding at 9 months of age and the prevalence of iron deficiency and iron deficiency anemia in two cohorts of infants in China. J Pediatr 2017;181:56–61.

6Abu-Ouf NM, Jan MM. The impact of maternal iron deficiency and iron deficiency anemia on child's health. Saudi Med J 2015;36(2):146–9.

Kumar D, Qureshi ZN, Albadwawi MS. Iron deficiency anemia in infants of Hatta suburb-UAE. Int Arch Nurs Health Care 2019;5:121.

DeLoughery TG. Safety of oral and intravenous iron. Acta Haematol 2019;142(1):8–12.

Carsley S, Fu R, Borkhoff CM, Reid N, Baginska E, Birken CS, et al. Iron deficiency screening for children at 18 months: a cost-utility analysis. CMAJ Open 2019;7(4):E689–98.

Moraleda C, Rabinovich NR, Menéndez C. Are infants less than 6 months of age a neglected group for anemia prevention in low-income countries? Am J Trop Med Hyg 2018;98(3):647–9.

Mantadakis E. Advances in pediatric intravenous iron therapy. Pediatr Blood Cancer 2016;63(1):11–6.

Powers JM, Buchanan GR, Adix L, Zhang S, Gao A, McCavit TL. Effect of low-dose ferrous sulfate vs iron polysaccharide complex on hemoglobin concentration in young children with nutritional iron-deficiency anemia: a randomized clinical trial. JAMA 2017;317(22):2297–304.

Lanzkowsky P. Iron-deficiency anemia. In: Lanzkowsky's Manual of Pediatric Hematology and Oncology: Elsevier, 2016; p.69–83.

Powers JM, Shamoun M, McCavit TL, Adix L, Buchanan GR. Intravenous ferric carboxymaltose in children with iron deficiency anemia WHO respond poorly to oral iron. 2017;180:212–6.

Miniero R, Talarico V, Galati MC, Giancotti L, Saracco P, Raiola G. Iron Deficiency and Iron Deficiency Anemia in Children. InIron Deficiency Anemia; IntechOpen: London, UK. 2019; p.23–38.

Okam MM, Koch TA, Tran MH. Iron supplementation, response in iron-deficiency anemia: analysis of five trials. Am J Med 2017;130(8):991–e1.

Mantadakis E, Tsouvala E, Xanthopoulou V, Chatzimichael A. Intravenous iron sucrose for children with iron deficiency anemia: a single institution study. World J Pediatr 2016;12(1):109–13.

Akin M, Sarbay H, Guler S, Balci YI, Polat A. Response to parenteral iron therapy distinguish unexplained refractory iron deficiency anemia from iron-refractory iron deficiency anemia. Int J Lab Hematol 2016;38(2):167–71.

Pinsk V, Levy J, Moser DA, Yerushalmi B, Kapelushnik J. Efficacy and safety of intravenous iron sucrose therapy in a group of children with iron deficiency anemia. Isr Med Assoc 2008;10(5):335–81.

Sabe R, Vatsayan A, Mahran A, Khalili AS, Ahuja S, Sferra TJ. Safety and Efficacy of Intravenous Iron Sucrose for Iron-Deficiency Anemia in Children and Adolescents with Inflammatory Bowel Disease. Glob Pediatr Health 2019;6:2333794X19870981.

Nazir F, Khurshid A, Talib MA. Intravenous iron sucrose in malnourished children with iron deficiency anemia. Prof Med J 2020;27(9):1867–71.

Haldar P, Kant S, Yadav V, Majhi J, Malhotra S, Kaur R, et al. Effect of intravenous iron sucrose on hemoglobin level, when administered in a standard-dose, to anemic pregnant women in rural Northern India. J Family Med Prim Care 2018;7(4):762–8.

Kaneva K, Chow E, Rosenfield CG, Kelly MJ. Intravenous Iron Sucrose for Children with Iron Deficiency Anemia. J Pediatr Hematol Oncol 2017;39(5):e259–62.

Mantadakis E. Intravenous iron: safe and underutilized in children. Pediatr Blood Cancer 2018;65(6):e27016.

Nestor JA, Afridi FA, Suarez R, Karem JB, Hardiman M, Hunter K, et al. Intravenous Iron Infusions in Pediatric Patients: A Single Institution Assessment of Efficacy and Adverse Effects of IV Iron Infusions. Blood 2019;134(Suppl_1):5872.

Zaman S, Shah SA, Jehanzeb K, Sabir S, Rashid HU, Haq ZU. Effect of intravenous iron therapy on serum ferritin and haemogobin levels in children reporting with iron defeciency anaemia. Pak Armed Forces Med J 2020;70(5):1344–48.

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Published

2022-03-03