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Treatment of iron deficiency anemia

The goal of treatment of iron deficiency is to eliminate iron deficiency and restore its reserves in the body. Etiological treatment involves the elimination of causes leading to the development of iron deficiency.


An important link in the treatment of IDA is the proper organization of the regime and nutrition. An effective treatment and preventive measure is a long stay in the fresh air. Children need to be spared: physical activity restriction, additional sleep, favorable psychological climate, should be exempted from visiting the children's institution. Older children are exempt from exercise and sports until recovery.


Appointment of nutrition for patients with IDA is of great importance. It is necessary to eliminate the existing feeding defects and prescribe a balanced diet for the main food ingredients.

In breastfed babies, first of all, the mother’s nutrition should be adjusted. During the entire period of breastfeeding a woman should take iron supplements or multivitamins enriched with iron at the rate of 40-60 mg of elemental iron per day.

When artificial feeding, children should receive adapted milk formulas containing iron (the iron content in the starting mixtures is 5-8 mg / l, in the following - up to 14 mg / l). The first lure must be dishes rich in iron salts - cabbage, zucchini, potatoes, carrots. Starting from 6 months you can enter meat dishes in the form of minced meat (up to 60 g at the age of up to 8 months and up to 70 g daily - after 8 months).

The diet should include fruit and berry juices and purees, which are not only sources of iron, but also sources of acids (ascorbic, succinic, glutamic, pyruvic), which improve the absorption of heme iron. Preference is given to juices and purees of industrial production enriched with iron.

When building a diet in older children, it must be borne in mind that the heme iron contained in meat dishes is best absorbed in the digestive tract. Among meat products, a significant amount of iron contains beef liver (6.8–20.7 mg / 100 g), as well as beef (3.61–4.3 mg / 100 g). From vegetable products, especially rich in iron are legumes and soybeans (4.6-7.0 mg / 100 g), dill, lettuce, parsley (4.7-6.4 mg / 100 g), plums (3.2 mg / 100 d). Recommendations for diet therapy of IDA apples have long been recognized as untenable, since the amount of iron in them is relatively small (0.9-1.58 mg / 100 g), in addition, the absorption of iron from them is difficult due to the presence of pectin.

In the diet should be a sufficient amount of fruit and vegetable juices, decoctions. In the broth hips, for example, in addition to ascorbic acid and carotene, contains a lot of succinic acid. Natural antioxidants (retinol, alpha-tocopherol and ascorbic acid) are rich in black currants, citrus fruits, blackberries, sea buckthorn, black chokeberry, nuts, nettle leaves, lettuce, wild strawberries. In the diet, it is advisable to include seafood (crabs, krill, sea kale) and fish, which will ensure the intake of iodine, manganese and copper.

Medication therapy for sideropenia.

Basic principles of treatment of iron deficiency anemia

• It is impossible to compensate for iron deficiency without medicinal iron-containing drugs.

• Therapy of iron deficiency should be carried out primarily with oral iron supplements.

• Therapy for iron deficiency anemia should not be stopped after normalization of hemoglobin levels.

• Blood transfusions for iron deficiency anemia should be carried out only for health reasons.

The basis of drug therapy for sideropenia and IDA are iron preparations, which are divided into two groups: salt (ionic) and non-salt (non-ionic) iron-containing drugs.

Saline preparations of iron include iron (II) sulfate: actiferrin, tardiferon, ferroplex; ferric chloride (II): hemofer; iron (II) gluconate: totem; iron (II) fumarate: ferronate.

The group of non-salt iron preparations is represented by a hydroxide-polymaltose complex of ferric iron (maltofer, maltofer foul, ferrum lek) and a hydroxide-sucrose complex of ferric iron (venofer for intravenous administration).

The separation of these two groups of drugs is based on differences in the structure and mechanisms of iron absorption from salt and non-salt compounds.

Iron absorption from salt compounds occurs predominantly in the divalent form. Compounds of ferrous iron penetrate into the mucosal cells of the intestinal mucosa (pass the "mucosal barrier"), and then into the bloodstream through a mechanism of passive diffusion. In the bloodstream, the process of reduction of ferrous iron to the trivalent form (with the participation of ferroxidase-I) and compounds with transferrin and ferritin occurs. Formed pool of deposited iron, which is used by the body.

It should be borne in mind that when using salt preparations of iron in 10-40% of children, side effects may develop, the frequency of which depends on the dose of the drug. The most frequently undesirable symptoms are from the gastrointestinal tract (nausea, vomiting, epigastric discomfort, abdominal pain, diarrhea, or constipation). In children of the first year of life, the onset of ferrotherapy may be accompanied by anxiety, increased regurgitation, dilution and increased stools. There is also a metallic taste during the first days of treatment, darkening of the tooth enamel and gums.

Salt preparations of iron have a high acute accuracy and the potential for damage to the cells of the body under the action of oxidative (oxidative) stress. When bivalent iron is oxidized to trivalent, free electrons are released and high-reactive free radicals are formed, which, among other damaging effects, activate lipid peroxidation. At the same time, pronounced violations of the antioxidant status are often defined as a decrease in the level of alpha-tocopherol, beta-carotene, ceruloplasmin and transferrin with an increase in the level of bilirubin and ascorbate. Free radical processes are particularly dangerous for the substance of the brain, since the cell membranes of neurons are rich in polyunsaturated fatty acids, and the cerebrospinal fluid has a low iron-binding activity.

In addition, salt preparations of iron interact with food components, drugs, which complicates the absorption of iron, and their recommended administration 1 hour before meals may enhance the damaging effect of Fe (II) compounds on the intestinal mucosa, up to the development of necrosis.
The foregoing determines the strict observance of a number of rules when using iron salt-containing preparations.

New effective and safe drugs for the correction of iron deficiency include drugs that are non-salt iron compounds based on a ferric hydroxide-polymaltose complex: maltofer, ferum lex. The structure of the complex consists of multi-core hydroxide-Fe (III) centers surrounded by non-covalently bound polymaltose molecules. The absorption of iron in the form of a hydroxide-polymaltose complex is provided by the entry of Fe (III) from the intestine into the blood through active absorption. At the same time, iron is transferred through the brush border of the membrane on the protein carrier and released to bind to transferrin and ferritin. This complex is stable and does not release iron ions under physiological conditions, i.e. it does not cause a prooxidant reaction. Iron in the polynuclear "nucleus" is associated with a structure similar to serum ferritin. The acute toxicity of the hydroxide-polymaltose complex is very low, it is about 10 times less than that of iron sulfate.

It is now proven that non-salt iron preparations are tolerated by children significantly better than salt preparations, although there is no significant difference in efficacy between the two groups of drugs. The lack of interaction with food components allows them to be used during meals. In addition, they have sufficient bioavailability, high safety, good organoleptic properties, adherence to reception (compliance) reaches 100%.

Taking into account the good tolerability, low toxicity and a high degree of utilization of non-ionized, macromolecular, water-soluble iron from the hydroxide-polymaltose complex, maltofer (Switzerland, Vifor Inc.) can be considered the best drug for treating various iron deficiency conditions in children and adolescents.

The choice of iron and its dosage form, depending on age.

Children of early and preschool age, it is preferable to assign iron-containing drugs, produced in the form of drops or syrup (Appendix 2, 3). School-age children are best to prescribe iron supplements in the form of tablets, pills, capsules. They are slowly absorbed, providing a prolonged and uniform absorption of drug iron in the intestine and good compliance (adherence to treatment).

Salt iron preparations should be taken 1 hour before meals and washed down with a solution of ascorbic acid or fruit juices. Non-salt iron preparations are taken during or after a meal.

Parenteral iron preparations should be used only for special indications: conditions after resection of the stomach, small intestine; intestinal absorption disorder syndrome; nonspecific ulcerative colitis; chronic enterocolitis.

Daily therapeutic dose of oral iron preparations in the treatment of iron deficiency anemia.

After selecting the drug and its method of application, it is necessary to determine the daily daily dose and the frequency of administration:

• for children up to 3 years - 3 mg / kg / day. elemental iron for saline iron preparations; 5 mg / kg / day. elemental iron - for non-salt iron preparations,

• for children over 3 years old - 45-60 mg / day. elemental iron

• for teenagers - up to 80-120 mg / day. (up to 200 mg / day. in severe cases) of elemental iron.

Depending on the severity of IDA, children at the age of one year the following doses of elemental iron per day are recommended: mild - 25 mg, moderate - 25-50 mg, severe - 50 mg. For children aged 1 to 12 years, 50 mg, 50-100 mg and 100 mg of elemental iron per day are prescribed, respectively. The daily dose of the drug is divided into 3 doses.

In the case of the choice of a salt preparation of iron, the treatment should be started with 1/2 or 1/4 of the therapeutic dose, increasing it within 7-10 days to complete, the so-called “trapezoidal technique”. It is necessary to monitor the symptoms of individual intolerance: nausea, vomiting, abdominal pain, dyspepsia.

Non-salt iron preparations do not require the use of a gradual dose increase technique. Preparations of this group begin immediately in a therapeutic dose.

Duration of ferrotherapy.

The duration of the main course of treatment with iron preparations is 6-10 weeks, depending on the severity of the identified iron deficiency anemia. After a stable normalization of hemoglobin level in order to create a depot of iron in the body, a prophylactic course of an iron preparation in a dose equal to 1/2 therapeutic dose is prescribed. The duration of a prophylactic course with iron preparations depends on the severity of anemia: for mild anemia, 6–8 weeks, for moderate anemia, 8–10 weeks, for severe anemia, 10–12 weeks. Thus, the duration of therapy for IDA depends on the severity of anemia and averages 3-6 months.

Insufficient duration of treatment with iron preparations or cessation of treatment after reaching a normal level of hemoglobin is a prerequisite for the development of relapses due to the lack of iron stores in the body.

Criteria for the effectiveness of ferrotherapy:

• subjective improvement of well-being at 4-5 days of therapy,

• the appearance of a reticulocyte crisis (2-10-fold increase in the number of reticulocytes compared with the initial value) on the 7-10 day of therapy,

• a significant increase in hemoglobin at 3-4 weeks,

• full normalization of clinical and laboratory parameters by the end of the course of treatment.

Refractoriness to the conducted ferrotherapy is due to inadequate dose, insufficient duration of therapy, continued loss of iron from the body, or lack of sideropenia. In the case of ineffective therapy and progression of anemia, the child should be sent to the hospital for in-depth examination.

Iron preparations are ineffective and unsafe in the acute period of an inflammatory disease in a child (ARVI, pneumonia, purulent otitis, purulent angina, etc.), since iron will accumulate in the focus of inflammation, cause toxic reactions and provoke growth of gram-negative flora.

Therapy of latent iron deficiency (LAD) is also necessary, as well as IDA. The treatment is carried out with all iron-containing drugs in a half therapeutic dose until the parameters of serum ferritin are normalized. Duration of drug administration in children with LJ at a dose of 1.0-2.0 mg / kg / day. ranges from 4 to 8 weeks.

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Treatment of iron deficiency anemia

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