Oral Ferrous Sulfate Research Articles

Intravenous iron is non-inferior to oral iron regarding cell growth and iron metabolism in colorectal cancer associated with iron-deficiency anaemia

Oral iron promotes intestinal tumourigenesis in animal models. In humans, expression of iron transport proteins are altered in colorectal cancer. This study examined whether the route of iron therapy alters iron transport and tumour growth. Colorectal adenocarcinoma patients with pre-operative iron deficiency anaemia received oral ferrous sulphate (n = 15), or intravenous ferric carboxymaltose (n = 15). Paired (normal and tumour tissues) samples were compared for expression of iron loading, iron transporters, proliferation, apoptosis and Wnt signalling using immunohistochemistry and RT-PCR. Iron loading was increased in tumour and distributed to the stroma in intravenous treatment and to the epithelium in oral treatment. Protein and mRNA expression of proliferation and iron transporters were increased in tumours compared to normal tissues but there were no significant differences between the treatment groups. However, intravenous iron treatment reduced ferritin mRNA levels in tumours and replenished body iron stores. Iron distribution to non-epithelial cells in intravenous iron suggests that iron is less bioavailable to tumour cells. Therefore, intravenous iron may be a better option in the treatment of colorectal cancer patients with iron deficiency anaemia due to its efficiency in replenishing iron levels while its effect on proliferation and iron metabolism is similar to that of oral iron treatment.

Iron preparations for women of reproductive age with iron deficiency anaemia in pregnancy (FRIDA): a systematic review and network meta-analysis

Numerous iron preparations are available for the treatment of iron deficiency anaemia in pregnancy. We aimed to provide a summary of the effectiveness and safety of iron preparations used in this setting. We did a systematic review and network meta-analysis of randomised trials. We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, trial registers, and grey literature for trials published in any language from Jan 1, 2011, to Feb 28, 2021. We included trials including pregnant women with iron deficiency anaemia and evaluating iron preparations, irrespective of administration route, with at least 60 mg of elemental iron, in comparison with another iron or non-iron preparation. Three authors independently selected studies, extracted data, and did a risk of bias assessment using the Cochrane tool (version 1.0). The primary outcome was the effectiveness of iron preparations, evaluated by changes in haemoglobin concentration at 4 weeks from baseline. The secondary outcomes were change in serum ferritin concentration at 4 weeks from baseline and treatment-related severe and non-severe adverse events. We did random-effects pairwise and network meta-analyses. Side-effects were reported descriptively for each trial. This study is registered with PROSPERO, CRD42018100822. Among 3037 records screened, 128 full-text articles were further assessed for eligibility. Of the 53 eligible trials (reporting on 9145 women), 30 (15 interventions; 3243 women) contributed data to the network meta-analysis for haemoglobin and 15 (nine interventions; 1396 women) for serum ferritin. The risk of bias varied across the trials contributing to network meta-analysis, with 22 of 30 trials in the network meta-analysis for haemoglobin judged to have a high or medium global risk of bias. Compared with oral ferrous sulfate, intravenous iron sucrose improved both haemoglobin (mean difference 7·17 g/L, 95% CI 2·62-11·73; seven trials) and serum ferritin (mean difference 49·66 μg/L, 13·63-85·69; four trials), and intravenous ferric carboxymaltose improved haemoglobin (mean difference 8·52 g/L, 0·51-16·53; one trial). The evidence for other interventions compared with ferrous sulfate was insufficient. The most common side-effects with oral iron preparations were gastrointestinal effects (nausea, vomiting, and altered bowel movements). Side-effects were less common with parenteral iron preparations, although these included local pain, skin irratation, and, on rare occasions, allergic reactions. Iron preparations for treatment of iron deficiency anaemia in pregnancy vary in effectiveness, with good evidence of benefit for intravenous iron sucrose and some evidence for intravenous ferric carboxymaltose. Clinicians and policy makers should consider the effectiveness of individual preparations before administration, to ensure effective treatment. None.

Impact of Acid Suppression Therapy on Iron Supplementation in the Pediatric Intensive Care Unit.

We assessed the impact of acid suppression therapy (i.e., ranitidine or proton pump inhibitors) on iron supplementation and its ability to maintain or alter laboratory values that are commonly associated with anemia. This was a prospective, observational trial. The primary outcome was changes in serum iron levels from baseline. Secondary outcomes were changes in hemoglobin (Hgb) and hematocrit (Hct), transfusions, and maintenance of an alkalotic gastric pH. Thirty-four patients (mean 24 ± 43 months) met inclusion criteria. The serum iron levels increased to 50.9 ± 24.6 mcg/dL by day 3. The mean difference from baseline was 1.5 mcg/dL (95% CI, 1.14-1.98, p = 0.0056). Gastric pH increased to 4.68 ± 1.49 on day 5. The mean Hgb and Hct increased on day 5 to 10 ± 1.06 g/dL and 29.6% ± 3.27%, respectively. The mean difference of Hgb was 1.15 g/dL (95% CI, 0.51-1.78, p = 0.0009). The mean difference of Hct was 3.04% (95% CI, 1.11-4.97, p = 0.0032). The use of antacids along with oral ferrous sulfate supplementation did not affect the absorption of iron. Serum iron, Hgb, and Hct all showed statistically significant increases despite combined antacid and iron therapy. Thus, despite use of antacids, combination use showed increases in iron absorption.

Ferric carboxymaltose vs. ferrous sulfate for the treatment of anemia in advanced chronic kidney disease: an observational retrospective study and cost analysis

In non-dialysis-dependent chronic kidney disease (NDD-CKD), erythropoiesis-stimulating agents (ESAs) and iron supplementation are essential for anemia management. Ferric carboxymaltose (FCM) is a relatively novel intravenous iron formulation used in different clinical settings, although scarce data exist in NDD-CKD patients. Primary objective of this study was to retrospectively evaluate the efficacy of FCM compared with oral ferrous sulfate for the treatment of iron-deficiency anemia in a cohort of NDD-CKD patients, considering also the treatment costs. This was a monocentric, retrospective observational study reviewing 349 NDD-CKD patients attending an outpatient clinic between June 2013 and December 2016. Patients were treated by either FCM intravenous infusion or oral ferrous sulfate. We collected serum values of hemoglobin, ferritin and transferrin saturation (TSAT) and ESAs doses at 12 and 18 months. The costs related to both treatments were also analysed. 239 patients were treated with FCM intravenous infusion and 110 patients with oral ferrous sulfate. The two groups were not statistically different for age, BMI and eGFR values. At 18 months, hemoglobin, serum ferritin and TSAT values increased significantly from baseline in the FCM group, compared with the ferrous sulfate group. ESAs dose and rate of infusion decreased only in the FCM group. At 18 months, the treatment costs, analysed per week, was higher in the ferrous sulfate group, compared with the FCM group, and this was mostly due to a reduction in ESAs prescription in the FCM group. Routine intravenous FCM treatment in an outpatient clinic of NDD-CKD patients results in better correction of iron-deficiency anemia when compared to ferrous sulfate. In addition to this, treating NDD-CKD patients with FCM leads to a significant reduction of the treatment costs by reducing ESAs use.

Compliance and Efficacy of Oral Lactoferrin versus Ferrous Sulfate in Treatment of Nutritional Iron Deficiency Anemia during Second Trimester among Egyptian Ladies

Background: Nutritional iron deficiency anemia is of a major concern in Egypt, especially during pregnancy. The most commonly used treatment is oral iron mainly as ferrous sulfate. Unfortunately, ferrous sulfate has low efficacy with many adverse effects. Lactoferrin is a glycoprotein which belongs to proteins which have the ability to bind and transfer iron. This study was done to assess the compliance, efficacy and safety of lactoferrin in comparison to ferrous sulfate. Methods: This randomized clinical trial was conducted in outpatient clinic under supervision of Department of Obstetrics and Gynecology, Faculty of medicine, Ain Shams University, Cairo, Egypt from August 2019 to February 2020. 140 women with iron deficiency anemia in second trimester were recruited and randomly assigned to either group. First group received lactoferrin 200 mg sachets once daily and second group received 100 mg of dried ferrous sulfate capsules twice daily for 4 consecutive weeks. Compliance to treatment, efficacy and side effects were recorded. Results: Compliance is better in lactoferrin group in comparison to ferrous sulfate group. Maternal side effects were significantly less common in lactoferrin group than in ferrous sulfate group. The increase in hemoglobin was significantly higher in lactoferrin group. Number of cases achieved Hb level ≥10.5 was more frequent in lactoferrin group. Conclusion: Oral lactoferrin is more tolerated and effective as compared to traditional treatment by ferrous sulfate.

Oral and Intravenous Iron Therapy Differentially Alter the On- and Off-Tumor Microbiota in Anemic Colorectal Cancer Patients.

Simple SummaryAnemia is commonly associated with colorectal cancer and often requires intervention with therapeutic iron. However, iron is required for growth by the majority of colonic bacteria, leading to competition for free luminal iron. Hence, this leaves the potential for the route of iron administration to lead to differential gut bacterial populations. This study aimed to investigate the differences in on- and off-tumor bacterial populations following oral and intravenous therapy in anemic colorectal cancer patients. The following iron therapies were shown to be differential to bacterial diversity, microbial populations, and predictive metagenomics, inferring that oral iron-treated patients may have a potentially more procarcinogenic microbiota compared to intravenous iron-treated patients. Overall, this suggests that intravenous iron may be a more beneficial treatment for anemia in colorectal cancer, in order to limit microbial perturbations associated with oral iron.Iron deficiency anemia is a common complication of colorectal cancer and may require iron therapy. Oral iron can increase the iron available to gut bacteria and may alter the colonic microbiota. We performed an intervention study to compare oral and intravenous iron therapy on the colonic tumor-associated (on-tumor) and paired non-tumor-associated adjacent (off-tumor) microbiota. Anemic patients with colorectal adenocarcinoma received either oral ferrous sulphate (n = 16) or intravenous ferric carboxymaltose (n = 24). On- and off-tumor biopsies were obtained post-surgery and microbial profiling was performed using 16S ribosomal RNA analysis. Off-tumor α- and β-diversity were significantly different between iron treatment groups. No differences in on-tumor diversity were observed. Off-tumor microbiota of oral iron-treated patients showed higher abundances of the orders Clostridiales, Cytophagales, and Anaeroplasmatales compared to intravenous iron-treated patients. The on-tumor microbiota was enriched with the orders Lactobacillales and Alteromonadales in the oral and intravenous iron groups, respectively. The on- and off-tumor microbiota associated with intravenous iron-treated patients infers increased abundances of enzymes involved in iron sequestration and anti-inflammatory/oncogenic metabolite production, compared to oral iron-treated patients. Collectively, this suggests that intravenous iron may be a more appropriate therapy to limit adverse microbial outcomes compared to oral iron.

Assessment of Erythropoiesis-Stimulating Agents for Anemia Treatment among Chronic Kidney Disease Patients: A Descriptive, Retrospective Study

Background: Renal anemia is a cause of significant morbidity, and to lesser extent mortality in patients with chronic kidney disease (CKD), the leading causes of anemia in CKD primarily are the lack of erythropoietin (EPO) and iron. Thus, effective management is possible using oral and intravenous (IV) iron preparation and genetically engineered erythropoiesis-stimulating agents such as EPO. This study aimed to assess the effect of EPO in the treatment of anemia among hemodialysis (HD) patients. Methods: A descriptive, retrospective hospital-based study was conducted in Elshaheeda Salma Hospital, Khartoum, Sudan. All patients who were anemic or had a history of anemia and undergoing HD during the period (January to June 2018) were recruited. Data were collected using a checklist and analyzed with the Statistical Package for the Social Sciences software. Results: A total of 191 anemic patients were included: 60% of them were males, and more than half of the participants were aged between 41 and 65 years. Clinically, the average duration of the dialysis among participants was 7.7 ± 5 years, and 97% of them had two dialysis sessions per week. Patients were used either IV or subcutaneous injection of EPO. 8000 IU/week were the most prescribed (52.2%) EPO dose. Whereas, only 6% and 18% were taking 100 mg IV and 150 mg oral ferrous sulfate, respectively. Furthermore, 70% of them were taking 5 mg folic acid. Moreover, the mean hemoglobin level among the participants at the end of the study was 10 ± 2.1 g/dl. Conclusion: EPO was effective in treating renal anemia in HD patients. Among the studied patients, 8000 IU/week was the most frequently used dose. The present study highlights significant low adherence to international guidelines in the management of anemia in patients on HD.

Lactoferrin Efficacy versus Ferrous Sulfate in Treatment of Children with Iron Deficiency Anemia

AbstractLactoferrin (LF) is an iron-binding globular glycoprotein that is structurally and chemically similar to serum transferrin. Many studies have been done to evaluate the effect of oral LF administration on iron deficiency anemia (IDA) with controversial results. This study was designed to compare the efficacy of LF versus oral ferrous sulfate (OFS) therapy in the treatment of children with IDA. A significant increase in mean hemoglobin and serum iron concentrations was noted in the group that received oral bovine LF (11.06 ± 0.96 and 42.79 ± 6.14, respectively) versus the group that received OFS (10.24 ± 0.57 and 28.94 ± 5.05, respectively, with p < 0.001 for each) after 30 days of the treatment with fewer side effects (9.3 vs. 33.3% with p = 0.043). Oral bovine LF is a more effective and safer alternative in treating iron deficiency and IDA compared with OFS with clinical benefits of fewer side effects and better patient compliance.

Efficacy of intravenous versus oral iron in the treatment of anaemia in pregnancy-A comparative study

Introduction: One of the most common medical problems in pregnancy is iron deficiency anemia throughout the developing world1-5 with the burden of disease impacting in both mother and newborn. Anaemia affects nearly half of all the pregnant women in the world. Data shows that it affects approximately 52% patients in the developing and 23% patients in the developed world. Materials and Methods: A prospective study conducted on pregnant women in 26 to 34 weeks of gestation which comes under inclusion criteria. Duration of the study was 18 months.100 patients were taken 50 in each group, Blood indices such as Hb, MCV, serum ferritin, reticulocyte count and adverse drug reactions were compared. Results and Conclusion: Both intravenous and oral iron supplements were associated with increment of blood indices although rise was significantly higher intravenous group. Also intravenous iron is better tolerated compared to oral group. Thus, it can be concluded that IV iron therapy is much more effective in improving iron deficiency in pregnancy than oral. Keywords: Pregnancy, Hemoglobin, Iron sucrose, Iron deficiency anemia, Oral ferrous sulphate.

Effect of oral iron and intravenous iron sucrose on pregnancy related outcome among pregnant females with iron deficiency anemia

Introduction: Intravenous iron sucrose and oral iron therapy are the primary therapeutic modalities for management of iron deficiency anaemia during pregnancy, but its efficacy during pregnancy is still a matter of argument among healthcare personnel. Therefore the objective of this study is to compare the effect of oral iron and intravenous iron sucrose on pregnancy related outcome among pregnant females with iron deficiency anemia. Materials and Methods: Randomized clinical trial was conducted among females between 14 to 36 weeks gestation with iron deficiency anemia who were managed either with oral ferrous sulphate or intravenous iron sucrose therapy. Chi-square test was used for statistical analysis with p Results: About 11.25% of the study subjects had the complication of abruption/ Post-Partum hemorrhage or had the need of blood transfusion in oral group. No significant difference in respect to maternal complications as well as mode of delivery was observed in between the two groups. In intravenous group proportion of appropriate for gestational age newborns (AGA) were significantly higher than the oral group (p Conclusions: Intravenous iron sucrose use for treatment of iron deficiency anaemia could reduce morbidities from iron deficiency and have better foetal outcome in terms of appropriate for gestational age in newborns. Keywords: Anaemia, Haemoglobin, Iron sucrose.

A 12 Year-Old Girl with Severe Iron Deficiency Anemia Secondary to Chronic Pediculosis Infestation

A 12 year-old female presented to an outside emergency department with her grandmother due to worsening fatigue over the preceding six months. She also reported intermittent right-sided abdominal discomfort for two months. The patient's past medical history was only remarkable for chronic infestation withPediculus humanus capitis(head louse), reportedly treated multiple times with topical medications without resolution. The infection had been persistent for six years. She did not consume excessive amounts of cow's milk. Physical exam was remarkable for pallor, tachycardia, systolic ejection murmur and visible nits. Laboratory studies showed hemoglobin 4.7 g/dL, mean corpuscular volume (MCV) 53.4 fL, reticulocytes 3.9%, white blood cell count 14.2 x 103 /µL, platelet count 449 x 103 /µL, total iron binding capacity (TIBC) 472 µg/dL, serum iron 8 µg/dL, iron saturation 2%, and ferritin 2 ng/mL. Peripheral blood smear showed a severe microcytic hypochromic anemia with anisopoikilocytosis, without schistocytes or blasts. She was premenarchal. Stool was negative for occult blood, ova and parasites, and celiac studies were negative. A diagnosis of iron deficiency of anemia (IDA) was made by the classic presentation of microcytic, hypochromic anemia with hypoferritinemia and elevated TIBC, along with an inappropriately low reticulocyte count. The most common etiologies of iron deficiency anemia in children were ruled out by history and laboratory evaluation, making chronic pediculosis the most likely cause in this patient. She received aggressive treatment for pediculosis, packed red blood cell transfusions, and oral ferrous sulfate. By day 65 after presentation, her laboratory values had normalized (hemoglobin of 13.6 g/dL, MCV of 80.3 fL, ferritin of 28 ng/mL). Pediculosis infestation remained resolved. Iron deficiency is the leading etiology of anemia worldwide and the most common hematologic disorder. Parasitic and vector-borne infections are a common cause of IDA internationally, but uncommon in developed countries. Severe iron deficiency secondary to pediculosis in children is an exceedingly rare entity despite high infestation rates, with nearly 40% of North American children affected.Pediculus humanusis an Arthropod species of sucking lice belonging to the familyPediculidae. The two subspecies arePediculus humanus capitis(head louse) andPediculus humanus humanus(body louse). The average child with pediculosis infestation will average 0.008 mL of blood loss per day due to louse consumption; however, heavily infested children can lose up to 0.7 mL per day. Thus, the patient may have had greater than 1.5 liters of blood consumed during her period of infestation. To our knowledge, this is the only reported case of a child in the United States with severe IDA secondary to chronic severe lice infestation. Iron deficiency is likely an under-recognized complication of severe and/or chronic pediculosis. In patients with history of mental health conditions, homelessness, or children who are in neglectful social situations, an evaluation of hemoglobin and iron status by the pediatrician may be a useful adjunct in severe cases. Disclosures No relevant conflicts of interest to declare.

S3042 Iron-Induced Anemia

INTRODUCTION: Iron deficiency anemia (IDA) is a common condition affecting a large portion of the world’s population. In a systematic analysis study, it was found that approximately one in five women globally have IDA. The most common treatment is oral iron pills, which is considered a benign therapy, however can present with some serious gastrointestinal complications such as mucosal necrosis, ulceration or ischemia in long-term usage. CASE DESCRIPTION/METHODS: A 39 year old woman with history of IDA, vitamin B12 deficiency, gastric bypass surgery, cholecystectomy, and lumbago presents with oxycodone addiction. Patient takes 325mg oral ferrous sulfate daily, therapeutic vitamin b12 injections and 10 pills of 30mg oxycodone daily for chronic pain. Laboratory studies revealed severe anemia: Hb 5g/dL, Hct 21.4%, MCV 46fL, iron 8mcg/dL, ferritin 1.64 ng/mL, TIBC 408mcg/dL, transferrin saturation 2%. CT abdomen was significant for hepatosplenomegaly. Patient was started on PPI and transfused with pRBC. EGD revealed a large non-bleeding superficial ulcer. Colonoscopy revealed diverticulosis of the sigmoid with non-bleeding internal hemorrhoids. Histopathological exam of the gastric biopsy revealed gastric mucosa with an iron pill-induced ulcer, which revealed iron crystals upon staining, consistent with iron-pill gastropathy. DISCUSSION: World Health Organization reports that 25% of the world’s population is diagnosed with anemia, most commonly IDA. Treatment includes oral iron supplements, with side effects including constipation, and dark stool. An under-recognized under-reported life-threatening complication of long term use of iron pills/tablet therapy is focal erosive mucosal damage of the upper GI tract. In excess, iron accumulates in the fundic glands, and lamina propria, producing hemosiderin deposits. Ferrous is oxidized to ferric acid causing epithelial injury to the gastric and duodenal mucosa. Although seen in iron overload conditions such as hemochromatosis and iron pill overdose, it may also occur with standard therapeutic oral iron therapy. In summary, iron-pill induced gastritis is an under-reported, elusive and potentially life-threatening condition caused by iron tablets/pills. Since IDA is a common condition, education regarding proper administration of oral iron is vital. Alternatively, liquid iron supplement is less toxic to gastric mucosa and should be recommended, as the liquid formulation does not concentrate focally thereby does not cause mucosal erosion.Figure 1.: Esophagogastroduodenoscopy image at the gastroesophageal junction revealing large superficial non-bleeding gastric ulcer with no stigmata of bleeding was found at the anastomosis.Figure 2.: Esophagogastroduodenoscopy image at the gastric cardia revealing a large superficial non-bleeding gastric ulcer with no stigmata of bleeding was found at the anastomosis.Figure 3.: Microscopic image of biopsy from the gastric ulcer revealing disrupted mucosa with iron crystal deposits on the epithelial surface and within the mucosa, stained with Prussian blue iron stain, magnified at ×400.

S2119 Upper Gastrointestinal Bleeding Caused by Iron Pill-Induced Gastric Ulcers

INTRODUCTION: The WHO reports that iron deficiency anemia (IDA) affects approximately 25% of the world's population. Iron supplementation via oral ferrous sulfate tablet is the most commonly prescribed treatment for IDA. It is known that high doses of oral iron can cause GI tract injury. However, it is not a common association at therapeutic doses of iron. CASE DESCRIPTION/METHODS: 75-year-old-male with PMH of afib on warfarin, CAD, CHF with preserved EF, aortic stenosis status post TAVR, and AV block status post pacemaker presented to ED with several days of epistaxis. Epistaxis ceased shortly after nasal packing. However, his hospital course was complicated by supratherapeutic INR and melena. Despite warfarin being held for a week, melena continued with down trending HgB, prompting EGD and colonoscopy. Initial endoscopy was unremarkable, and initial colonoscopy was poorly prepared revealing only copious blood and clots throughout. Even though bidirectional endoscopy was negative for active source, the patient continued to have dropping hemoglobin requiring 14 units of packed RBC. After 10 days the patient underwent repeat endoscopy, revealing multiple actively bleeding gastric fundus ulcers that were clipped. Fundic ulcers biopsies revealed features of iron pill-induced gastritis on iron staining. Patient's HbG stabilized status post EGD with clipping. DISCUSSION: Treatment for IDA is with oral iron supplements due to cost and efficacy. However, adverse outcomes, i.e. gastritis, can result due to iron oxidation. The level of gastritis seen here, is not seen at therapeutic dosages; making it easily missed in geriatric populations who have impaired gastric motility. Biopsy is the mainstay of diagnosis, and shows extracellular deposits of brown material. Liquid form of iron supplementation is much less toxic to the gastric mucosa and does not result in the injury to epithelium seen with iron tablets. This is thought to be because the liquid formulation cannot concentrate as easily into one site. Encouraging patients on iron pills to drink enough water with pill ingestion and avoid taking it at bedtime might reduce the risk of this problem. In conclusion, we recommend more studies in elderly populations with risk factors of impaired gastric motility for more conclusive results. In the meantime, it would be safer to prescribe these populations liquid iron supplementation.Figure 1.: Gastric mucosa biopsy with iron staining.

Comparison between oral ferrous sulfate and intravenous ferric carboxymaltose in children with restless sleep disorder.

Recent work has identified clinical and polysomnographic features of a newly defined pediatric sleep disorder, restless sleep disorder (RSD). One of these features is low serum ferritin. In this retrospective, pilot study, we assess the response to iron supplementation. Children were given oral ferrous sulfate (FS) or intravenous ferric carboxymaltose (IV FCM). Children 5-18 years old with a diagnosis of RSD were evaluated clinically. Serum ferritin, iron profile, and video-polysomnography were obtained at baseline. Oral or IV iron supplementation was offered as part of routine care. Oral FS was one 325 mg tablet daily or 3 mg/kg/day liquid for 3 months. IV FCM was 15 mg/kg, up to 750 mg as a single infusion. Adverse effects were assessed. Ferritin and iron profile were checked after 2-3 months. Eight weeks after FCM, the phosphorus level was checked. Clinical Global Impression (CGI) scale was obtained pre- and posttreatment. A total of 15 children received oral FS and 15 IV FCM. Baseline RSD severity, age, gender, or pretreatment lab values did not differ significantly between groups. CGI-improvement median score was "minimally improved" after oral FS and "much improved" after IV FCM (effect size 1.008, p < 0.023). All iron parameters were found to be significantly higher after intravenous iron treatment than oral iron, especially ferritin (effect size 3.743, p < 0.00003). Adverse effects: constipation, three with FS; noncompliance, one with FS; syncope, one with FCM infusion; and hypophosphatemia, zero post-FCM. In this retrospective, clinical case series, RSD responded to iron supplementation with improvement in both clinical and laboratory parameters. The response was greater with IV FCM than oral FS.

Iron Deficiency Anemia in Pregnancy: Intravenous Iron Sucrose versus Oral Iron Sulfate

Introduction: Injectable iron sucrose and oral ferrous sulfate both are used for the correctionof anaemia in second and third trimester of pregnancy. But injectable iron is supposed to bemore effective than oral iron, as it needs less time for correction of anaemia and efficacy ismore. Oral iron is cost effective but more time consuming.The objective of the study was to compare the safety of intravenous iron sucrose complex inthe treatment of iron deficiency anemia in third trimester of pregnancy. To compare theefficacy of intravenous iron with oral iron.&#x0D; Method: A randomised controlled trial was conducted in which pregnant women with irondeficiency were sequentially selected from the pregnant women attended antenatal clinic ofOPD of Institute of Child and Maternal Health (ICMH) and assigned either to injectable or tooral ferrous sulfate by random number table. Each study patient was given the total calculatedamount of injectable iron sucrose {Hb deficit (gm/l) × body weight (kg) × 0.24+ storage ironmg } in divided dose 200 mg in 200 ml normal saline intravenously over 1 hour everyalternate day . Each patient of the control group was given ferrous sulfate 200mg orally threetimes a day for 4 weeks. Pregnant women follow up at 4 weeks and 8 weeks after gettreatment by oral and injectable iron. During follow up monitored for adverse effects, clinicaland laboratory response and haemoglobin percentage were observed.&#x0D; Result: There were 75 patients in injectable group and 75 patients in oral group. Injectablegroup achieved a significantly higher Hb level (11.49 ± 0.39) than oral group Hb level (10.39± 0.75) after 8 weeks of treatment. Injectable group showed no major side effects, only twopatient had complains .One patient complain of epigastic pain and one patient complain oftachycardia while in oral group complain of nausea and vomiting, epigastic pain, constipation,allergic reaction was found in 42.0%, 39.3%,35.7% and 3.6% respectively.&#x0D; Conclusion: Iron sucrose complex appears to be a safe and effective in the treatment ofiron deficiency anemia.&#x0D; Bangladesh J Obstet Gynaecol, 2018; Vol. 33(1) : 40-44

Comparative Analysis of Haematinic Effect of Dhatryarista with Standard Ferrous Sulphate in Tannic Acid Induced Iron Deficiency Anaemia in Albino Wistar Rats

Background: Iron deficiency anemia affects more than 1.2 billions individuals worldwide.Iron deficiency is caused by physiologically increased iron requirements in children, adolescents, young and pregnant women, by reduced iron intake, or by pathological defective absorption or chronic blood loss.Treatment modalities include both oral and parenteral therapies.Objectives:a)To study the improvement in haemoglobin after giving dhatryarista in IDA.b) To compare the effect of Dhatryarista (in different concentrations) with standard oral formulation Ferrous sulphate in terms of haemoglobin.Materials and methods:The study was conducted for the period of two months in department of Pharmacology KIMS,bhubaneswar. Total 24 Albino wistar rats were taken and divided into 4 groups containing 6 rats each.Anaemia was induced by adding tannic acid in diet of 24 rats by 21days.After induction of anaemia, Group II, Group III and Group IV rats were given standard drug(Ferrous sulphate),Dhatryarista sample 1 and Dhatryarista sample 2 respectively, alongwith normal diet for next 30 days. Blood samples were taken in day 1, day 21 and day 53.Results:All the values are expressed as a Mean±SEM(standard error of mean).Significant decrease in haemoglobin were observed, when compared between day 1 and day 21,while significant increase in haemoglobin was observed after 30 days of administration of test and standard drug.Conclusion:The administration of tannic acid to rats caused anaemia characterized by reducing hematological parameters.The oral administration of Dhatryarista in the dose of 4.32ml/kg/day P.O and 8.64ml/kg/day P.O significantly increased haemoglobin level.The results demonstrated that higher doses of the plant extract didnot show any signs of acute toxicity in animals.

Delayed iron improves iron status without altering malaria risk in severe malarial anemia

WHO guidelines recommend concurrent iron and antimalarial treatment in children with malaria and iron deficiency, but iron may not be well absorbed or utilized during a malaria episode. We aimed to determine whether starting iron 28 d after antimalarial treatment in children with severe malaria and iron deficiency would improve iron status and lower malaria risk. We conducted a randomized clinical trial on the effect of immediate compared with delayed iron treatment in Ugandan children 18 mo-5 y of age with 2 forms of severe malaria: cerebral malaria (CM; n=79) or severe malarial anemia (SMA; n=77). Asymptomatic community children (CC; n=83) were enrolled as a comparison group. Children with iron deficiency, defined as zinc protoporphyrin (ZPP) ≥ 80 µmol/mol heme, were randomly assigned to receive a 3-mo course of daily oral ferrous sulfate (2 mg · kg-1 · d-1) either concurrently with antimalarial treatment (immediate arm) or 28 d after receiving antimalarial treatment (delayed arm). Children were followed for 12 mo. All children with CM or SMA, and 35 (42.2%) CC, were iron-deficient and were randomly assigned to immediate or delayed iron treatment. Immediate compared with delayed iron had no effect in any of the 3 study groups on the primary study outcomes (hemoglobin concentration and prevalence of ZPP≥80 µmol/mol heme at 6 mo, malaria incidence over 12 mo). However, after 12 mo, children with SMA in the delayed compared with the immediate arm had a lower prevalence of iron deficiency defined by ZPP (29.4% compared with 65.6%, P=0.006), a lower mean concentration of soluble transferrin receptor (6.1 compared with 7.8 mg/L, P=0.03), and showed a trend toward fewer episodes of severe malaria (incidence rate ratio: 0.39; 95% CI: 0.14, 1.12). In children with SMA, delayed iron treatment did not increase hemoglobin concentration, but did improve long-term iron status over 12 mo without affecting malaria incidence.This trial was registered at clinicaltrials.gov as NCT01093989.

Successful Rapid Drug Desensitization to Ferric Carboxymaltose in Four Patients

An iron hypersensitivity reaction can develop during infusion. Here we present four cases of Rapid Drug Desensitization (RDD) as an option for the treatment of these patients. Urticaria appeared in the second hour of an IV iron sucrose infusion (ISI) performed 8 years previously in case 1 and drug provocation with IV ferric carboxymaltose was performed, but urticaria developed on the arm where the drug was administered immediately after infusing 60 cc. Case 2 developed tongue swelling and shortness of breath within minutes of the IV ISI. Case 3 developed shortness of breath within three minutes after the first dose of IV ISI. Case 4 with iron deficiency anemia reported swelling in the throat, lips and shortness of breath after taking an unknown oral iron therapy. On the 14th day of oral ferrous sulfate therapy, the patient presented with pruritus and skin eruptions occurring 2 hours after drug ingestion. Fifteen RDDs were successfully performed in these cases.

Comparative Study of Intravenous Iron Sucrose Vs Oral Ferrous Sulfate Therapy for Uncomplicated Iron Deficiency Anemia

Background: Iron deficiency anemia (IDA) is one of the most frequent nutritional deficiency leading to morbidity and mortality in whole world. Oral iron therapy as well as intravenous (IV) iron therapy can be given to treat the IDA patients.&#x0D; Objective: To compare the efficacy and hematological changes of Oral and IV iron preparation in patients with uncomplicated iron deficiency anemia.&#x0D; Method: An interventional, prospective study in patients with uncomplicated IDA anemia receiving IV iron sucrose and Oral iron ferrous sulfate were included. Clinical history, baseline hemoglobin, anemia indices data were recorded in a case record form. A total number of 80 patients were enrolled in this study. 40 patients (Group A) were treated with IV iron sucrose and another 40 patients (Group B) were treated with oral iron ferrous sulfate. After therapy Hemoglobin level, RBC indices and adverse drug reactions (ADRs) were observed.&#x0D; Place and period of Study: Study was carried out in the Department of Hematology at Dhaka Medical College Hospital (DMCH), from July 2015 to June 2016.&#x0D; Results: The mean age of total participants was 35.77 ± 16.08 (range of 13 – 75 years). In this study female (72.5%) is predominant than male (27.5%). Oral and IV iron preparations significantly (P&lt;0.0001) improved mean hemoglobin, anemia indices at the end of study. However, mean increase in hemoglobin were significant (P&lt;0.0001) with IV iron sucrose (7.6 ± 2.9) gm/dl, as compared to Oral ferrous sulfate (6.4± 2.2)gm/dl, after 2 months of therapy. In this study Hemoglobin increases in group A (IV iron arm) almost 1mg/kg/week and in group B (oral iron arm) 0.8 mg/dl/week).Surprisingly, ADRs were more in patients treated with oral ferrous sulfate (38%) compared to iron sucrose (26%).&#x0D; Conclusion: IV iron sucrose improves hemoglobin, anemia indices and replenish iron stores rapidly and is well tolerated than oral iron preparations.&#x0D; J Dhaka Medical College, Vol. 27, No.2, October, 2018, Page 175-181

Comparison of Oral Ferrous Sulfate to Intravenous Ferric Carboxymaltose in Antepartum Iron Deficiency Anemia

Comparison of Oral Ferrous Sulfate to Intravenous Ferric Carboxymaltose in Antepartum Iron Deficiency Anemia