Treatment of Iron Deficiency Anemia

The regular response of iron-deficiency anemia to adequate amounts of iron is an important diagnostic and therapeutic feature.

Oral Iron:
Oral administration of simple ferrous salts (e.g., sulfate, gluconate, fumarate) provides inexpensive and satisfactory therapy. No evidence shows that addition of any trace metal, vitamin, or other hematinic substance significantly increases the response to simple ferrous salts. One problem encountered with administration of oral iron to young children is that liquid FeSO4nhas an unpleasant taste, but sometimes the taste can be camouflaged by mixing with flavored syrup. Other, better-tasting preparations are available over the counter, but these are much more expensive than simple liquid FeSO4. Aside from the unpleasant taste, intolerance to oral iron is uncommon in young children, although older children and adolescents sometimes have gastrointestinal complaints. Problems with constipation can be minimized by increasing water and fiber intake. For some children, abdominal discomfort can be minimized by administering iron with food, recognizing that this may decrease iron absorption to some extent.

The therapeutic dose should be calculated in terms of elemental iron; ferrous sulfate is 20% elemental iron by weight. A daily total dose of 4–6 mg/kg of elemental iron in 3 divided doses provides an optimal amount of iron for the stimulated bone marrow to use.

Parenteral Iron:
A parenteral iron preparation (iron dextran) is an effective form of iron when given in a properly calculated dose, but the response to parenteral iron is no more rapid or complete than that obtained with proper oral administration of iron, unless malabsorption is a factor. An occasional complication of iron dextran has been anaphylaxis.

Dietary Advice:
While adequate iron medication is given, the family must be educated about the patient’s diet, and the milk consumption should be limited to a reasonable quantity, preferably 500 mL (1 pint)/24 hr or less. This reduction has a dual effect: The amount of iron-rich foods is increased, and blood loss from intolerance to cow’s milk proteins are reduced. When the re-education of child and parent is not successful, parenteral iron medication rarely may be indicated. Iron deficiency can be prevented in high-risk populations by providing iron-fortified formula or cereals during infancy. Iron deficiency in adolescent females secondary to abnormal uterine blood flow loss is treated with iron and hormone therapy.

Response to Treatment:
Within 72–96 hr after administration of iron to an anemic child, peripheral reticulocytosis is noted.The height of this response is inversely proportional to the severity of the anemia. Reticulocytosis is followed by a rise in the hemoglobin level, which may increase as much as 0.5 g/dL/24 hr. Iron medication should be continued for 8 wk after blood values are normal.

Failure of Treatment:
Failures of iron therapy occur when a child does not receive the prescribed medication, when iron is given in a form that is poorly absorbed, or when there is continuing unrecognized blood loss, such as intestinal or pulmonary loss, or loss with menstrual periods. Therapeutic failure of iron medication may indicate that the original diagnosis of nutritional iron deficiency was incorrect.