Iron-deficiency anemia affects millions of people around the world. Although iron-deficiency anemia is usually easily treated, it may cause impaired neurodevelopment in young children if left untreated. American researchers, therefore, determined whether ferrous sulfate can effectively resolve iron-deficiency anemia in children.
Iron-deficiency anemia (IDA) occurs when the body’s iron stores become diminished. This leads to decreased levels of hemoglobin, which helps red blood cells carry oxygen throughout the body. Symptoms of IDA include irritability and fatigue. Worryingly, it can also impair short-and long-term neurodevelopment in young children. Children can easily become anemic for various reasons. Fortunately, hemoglobin levels can be easily restored with oral iron preparations – usually ferrous sulfate. However, this common preparation has an unpleasant taste and can cause adverse gastrointestinal effects.
A recent double-blinded study published in JAMA compared ferrous sulfate with iron polysaccharide complex, a better-tasting, and better-tolerated iron preparation. The researchers wanted to see which was more effective at resolving IDA in young children in the US. Children between nine and 48 months of age with nutritional IDA were randomly assigned to one of two groups. One group was treated with oral ferrous sulfate (28 children) and the other group with oral iron polysaccharide complex (31 children) once daily at bedtime. The children were followed-up every four weeks for 12 weeks. During these sessions, blood samples were taken to measure levels of hemoglobin and other factors involved in iron homeostasis, and to assess diet, adverse effects and compliance.
Overall, ferrous sulfate was a much better treatment option. Although children were more likely to consume the iron complex without difficulty and compliance was better with the iron complex, the mean hemoglobin levels increased significantly with ferrous sulfate. Ferrous sulfate resolved more cases of IDA and improved other factors involved in iron homeostasis to a greater degree than the iron complex. More adverse effects occurred with the iron complex, with more cases of diarrhea reported.
Current recommendations suggest that children receive one to three doses of 2-6 mg/kg ferrous sulfate per day. However, this study demonstrates that a low dose of ferrous sulfate (3 mg/kg) administered once a day on an empty stomach can effectively resolve IDA in young children. Patients are more likely to take their medicine if it is only once a day and this may also enhance iron absorption. It is possible that even lower doses or reducing the frequency of doses may also be effective, but this must be studied further.
Unfortunately, the authors cannot guarantee that these results will apply to the general population. Since patients were monitored closely in this study their compliance levels are likely to be higher than in non-clinical settings. This study was also undertaken at a single institute and a high number of patients came from a low socioeconomic background. Some patients had such severe IDA that they needed a blood transfusion prior to this study. Despite these limitations, the authors are optimistic that a daily low-dose of ferrous sulfate will improve iron-deficiency anemia outcomes in the general population.
Written by Natasha Tetlow, PhD
Powers JM, Buchanan GR, Adix L, et al. Effect of low-dose ferrous sulfate vs iron polysaccharide complex on hemoglobin concentration in young children with nutritional iron-deficiency anemia. JAMA. 2017; 317(22):2297-2304.