Iron deficiency: a new alternative when oral iron fails

Abstract

Iron deficiency is the most common nutritional deficiency worldwide. The estimated prevalence in the US is about 7% among preschool-aged children and 10%-20% among adolescent females. Although most patients will not develop overt anemia, even mild deficiency may cause acute symptoms and result in long-term cognitive defects, underscoring the importance of effective treatment. In theory, correction of iron deficiency is simple: deliver sufficient amounts of bio-available iron to the duodenum and upper jejunum and let nature takes its course. In practice, therapeutic doses of oral iron often are accompanied by unpleasant gastrointestinal symptoms, and the formulations suitable for young children are all unpalatable to some degree. Thus, compliance with oral iron is often poor, and even excellent compliance may be inadequate for individuals with malabsorption or ongoing blood loss. The original parenteral iron formulation, high molecular weight iron dextran, is no longer available in the US due to its relatively high incidence of hypersensitivity reactions. Although low-molecular weight iron dextran is less likely to cause such reactions, test doses and careful monitoring for anaphylaxis are still recommended. Two newer parenteral formulations, iron sucrose and sodium ferric gluconate, are considered relatively safe and are approved for both adults and children, but typically require multiple doses to achieve adequate iron replacement. A newer iron formulation, ferric carboxymaltose, requires no test dose and the recommended infusion time is only 15 minutes. Although not yet approved for pediatric use, it is approved in both Europe and the US for adults “who have intolerance to oral iron or have had unsatisfactory response to oral iron.” In this volume of The Journal, Powers et al report their experience using ferric carboxymaltose in 72 children and adolescents with iron deficiency anemia. Mild, transient side effects were experienced by only 16% of patients, and almost one-half of the subjects required only a single infusion; all but one patient demonstrated improved hematologic values, with two-thirds showing a complete hematologic response. Although expensive compared with other parenteral formulations—all of which, in turn, are much more expensive than oral iron—its convenience and safety profile may make it an attractive option for many patients in whom oral iron therapy is not feasible. Article page 212 ▶ Intravenous Ferric Carboxymaltose in Children with Iron Deficiency Anemia Who Respond Poorly to Oral IronThe Journal of PediatricsVol. 180PreviewTo assess the benefits and risks of intravenous (IV) ferric carboxymaltose (FCM) in children with iron deficiency anemia (IDA). Full-Text PDF