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Responsiveness to parenteral iron therapy in children with oral iron-refractory iron-deficiency anemia
Mehmet Akin1, Enver Atay, Osman Oztekin
1Department of Pediatric Hematology, Denizli State Hospital , Denizli , Turkey.
Insights
Intravenous iron sucrose therapy effectively treats iron-refractory iron-deficiency anemia (IRIDA) in children, but repeated doses may not further increase hemoglobin and can lead to harmful hyperferritinemia.
Area of Science:
- Pediatric Hematology
- Iron Metabolism Disorders
Background:
- Iron-refractory iron-deficiency anemia (IRIDA) is a rare genetic disorder.
- Intravenous (IV) iron-carbohydrate complexes are used to treat iron deficiency in children with IRIDA.
- Optimal IV iron treatment protocols for pediatric IRIDA remain undetermined.
Purpose of the Study:
- To evaluate the responsiveness of children with IRIDA to IV iron sucrose therapy.
- To determine the optimal dosing strategy for IV iron in pediatric IRIDA.
Main Methods:
- A cohort of 11 children (ages 2-13 years) with IRIDA, unresponsive to oral iron, received IV iron sucrose therapy.
- Hemoglobin and ferritin levels were monitored before and after therapy at various time points.
Main Results:
- Hemoglobin and ferritin levels significantly increased after the first IV iron sucrose dose.
- Hemoglobin levels remained stable with subsequent therapies, while ferritin levels continued to rise.
- Repeated IV iron administration showed no additional benefit for hemoglobin but increased the risk of hyperferritinemia.
Conclusions:
- IRIDA should be suspected in pediatric iron-deficiency anemia cases refractory to oral iron.
- A single administration of IV iron sucrose may be sufficient for IRIDA treatment in children.
- Further IV iron administration offers no hemoglobin benefit and risks hyperferritinemia.
Unlabelled:
Intravenous (IV) ferric iron (Fe)-carbohydrate complexes are used for treating Fe deficiency in children with iron-refractory iron-deficiency anemia (IRIDA). An optimal treatment has yet to be determined. There are relatively little publications on the responsiveness to IV iron therapy in children with IRIDA.
Patients And Method:
This study analyzed responses to IV iron sucrose therapy given to 11 children, ranging in age from 2 to 13 years (mean 4.8 years), with iron-deficiency anemia who were unresponsive to oral iron therapy.
Results:
The hemoglobin and ferritin values (mean) of the 11 children with IRIDA were 7.7 g/dL and 4.8 ng/mL at diagnosis. Both hemoglobin and ferritin levels increased to 9.5 g/dL, and 24 ng/mL, respectively, at 6 weeks after the first therapy. Although the level of hemoglobin was steady at 6 months after the first, and 6 weeks after the second therapy, the ferritin levels continued to increase up to 30 ng/mL and 47 ng/mL at 6 months after the first and 6 weeks after the second therapy, respectively.
Conclusion:
We recommend that IRIDA should be considered in patients presenting with iron-deficiency anemia of unknown cause that is unresponsive to oral iron therapy. Our results suggest that IV iron therapy should be administered only once in cases of IRIDA. Continued administration of IV iron would be of no benefit to increase hemoglobin levels. On the contrary, ferritin levels may continue to increase resulting in untoward effects of hyperferritinemia.
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