Effects of Iron(II) Salts and Iron(III) Complexes on Trace Element Status in Children with Iron-Deficiency Anemia

Abstract

Iron-deficiency anemia (IDA) is the most common nutritional deficiency in childhood throughout the world. Although it has been shown that IRA is associated with elevated plasma copper and depleted zinc levels in children, there are conflicting results on the effect of iron supplementation on the absorption of these elements. The aim of this study was to investigate the effects of ferrous and ferric iron supplementation on the trace element status in children (n=25, aged 8-168 mo) with IDA. Fourteen of them were treated with ferric hydroxide-polymaltose complex (Ferrum, Vifor, Switzerland) (6 mg/d in the first 3 mo for initial therapy and 3 mg/kg for 3 mo as maintenance); the others were treated with a ferrous sulfate complex (FerroSanol, Schwarz, Germany) (6 mg/d in the first 3 mo for initial therapy and 3 mg/kg for 3 mo as maintenance). Plasma copper, zinc, and ceruloplasmin levels as well as hematological parameters were determined at baseline and the first, third, and sixth month of the treatment period. The hemoglobin and iron levels of patients in both groups were higher in the first and sixth months compared to baseline. Although the ceruloplasmin levels were depleted (48.9 mg/dL vs 41.4 mg/dL, p=0.035) during ferrous iron treatment, the copper and zinc levels remained unchanged. On the other hand, ferric iron supplementation led to an increase in zinc levels in the sixth month of treatment (0.77 mg/L vs 1.0 mg/L, p=0.021). The plasma copper levels were lower in the ferrous iron-treated group at the end of the first month of treatment than in the ferric irontreated group (1.06 mg/L vs 1.29 mg/L, p=0.008). In conclusion, our data showed that copper and ceruloplasmin metabolisms were affected by ferrous iron supplementation, whereas ferric iron kept them to normal levels of zinc, possibly by affecting their absorption. We conclude that the copper and zinc status of patients with IDA should be taken into consideration before and after iron therapy.

Iron deficiency anemia and levels of oxidative stress induced by treatment modality

“…Sozmen et al . did not find any toxic effect of ferrous formulations on RBC and plasma in pediatric IDA patients . In the present study, TAOC level increased promptly in the PO group, while oxidative stress peculiar to IDA decreased.…”

“…Alterations in antioxidant state as a result of iron therapies via different dosage routes have not been elucidated fully. The absorption process after parenteral iron might last for at least 4 weeks and thus the generation of free radicals might be prolonged . Therefore in the present study the patients were followed until 13 weeks after termination of oral iron therapy, and blood samples were collected to measure these alterations.…”

Efficacy, Tolerability, and Acceptability of Iron Hydroxide Polymaltose Complex versus Ferrous Sulfate: A Randomized Trial in Pediatric Patients with Iron Deficiency Anemia

“…A number of studies have previously demonstrated that IPC achieves a significant increase in Hb levels in children with IDA [11, 12, 16–18]. The rate of the erythropoietic response to IPC appears to be dose dependent.…”

Iron Deficiency Anemia;

“…Some previous studies show superiority of Iron Polymaltose complex as treatment of iron deficiency anemia achieving a significant increase in Hb levels in children with IDA. [8][9][10][11][12] In a randomized trail of 49 iron deficiency anemic infants, Murahovschi et al found that with ferrous sulfate there was faster increase in Hb during the first month of treatment which then became slower after 1 month compared to those given Iron Polymaltose complex, both at a dose of 4mg/kg/day.…”