Use of oral iron in managing iron deficiency anemia in children with intestinal failure

• Main Authors: Badr Alsaleem, Nora Albanyan, Ahmad Alamer, Syed Mohammed Basheeruddin Asdaq, Yahya Mohzari, Mohannad M. Alrahili, Amna B. Albasheer, Ahmed A. Alrashed, Abdulhakeem S. Alamri, Walaa F. Alsanie, Majid Alhomrani
• Format: Article
• Language: English
• Published: Elsevier 2021-12-01
• Series: Journal of King Saud University: Science
• Subjects: Intestinal failure; Iron deficiency anemia; Oral iron; Total parenteral nutrition; Children; Ferritin
• Online Access: http://www.sciencedirect.com/science/article/pii/S1018364721002639

Background & Objectives: As intestinal failure (IF) inhibits the digestive system from absorbing nutrients, total parenteral nutrition (TPN) is required to provide all of a person's nutritional demands. In children with malabsorptive conditions like IF, iron deficiency anemia (IDA) is common. This study used a quasi-experimental approach to assess the efficacy and safety of oral iron therapy in treating IDA in TPN-dependent children with IF. Materials and Methods: Sixteen pediatric patients with an ongoing history of IF, TPN dependency, and iron deficiency anemia were enrolled and given an oral iron syrup dose of ferric hydroxide polymaltose complex (6 mg/kg/day in 2–3 separate doses of elemental iron) after receiving ethical approval and parental consent. Blood tests were done to measure serum iron, ferritin, complete iron-binding capacity [TIBC], transferrin saturation [TSAT], and hemoglobin (Hb) level at the time of inclusion (T0), 14 (T14), and 30 days after treatment (T30). Results: The mean age was 7.13 (±1.99) and female were 12 (75%). No remarkable change in Hb level was noted in the first and second subsequent follow-ups, notwithstanding, the normal estimation of the serum ferritin level significantly increased during the first follow-up (on fourteenth day) which further enhanced by second follow-up (30th day). The aggregate of the total iron binding capacity (TIBC) declined during the course of oral iron therapy with a reduction in transferrin saturation. Interpretation & Conclusion: The data suggest that oral iron therapy is unsuccessful in the treatment of IDA in children with IF. There is no substantial improvement in hemoglobin level or iron profile aside from serum ferritin. In order to avoid using parenteral iron in IF patients, an additional supportive system is needed to aid in the integration of oral iron therapy.