Treatment of iron deficiency anemia

Classification of iron supplements

All agents for correcting iron deficiency are broadly divided by route of administration into oral and parenteral.

Oral drugs are the mainstay of outpatient practice. They are divided into two subgroups according to the valence of the active ingredient:

1. Ferric (Fe III) compounds. These are complexes rather than salts. They include iron [III] hydroxide polymaltose complex (Maltofer, Ferrum Lek, Fenyuls Complex) and iron [III] protein succinylate (Ferlatum). In modern clinical practice, they are preferred due to a higher safety profile and better tolerability.
2. Ferrous (Fe II) salts. Classified by the type of anion: sulfates (Actiferrin, Sorbifer Durules, Tardiferon), gluconates (Totema), fumarates (Ferretab), and chlorides. About 30% of patients voluntarily stop taking them due to frequent gastrointestinal side effects.

Parenteral forms (e.g., iron [III] hydroxide dextran) are used much less frequently and are represented solely by ferric compounds.

Principles of oral dosing

The dosage of elemental iron and duration of treatment depend on the severity of anemia, which is assessed by the hemoglobin (Hb) level. The course of therapy is always long-term — from 3 to 6 months.

• Mild anemia (Hb > 90 g/L): 3 mg/kg is prescribed, the course lasts 3 months.
• Moderate anemia (Hb 70–90 g/L): for the first 3 months, a therapeutic dose of 3–5 mg/kg is given, followed by another 3 months of a maintenance dose of 3 mg/kg. Total course — 6 months.
• Severe anemia (Hb < 70 g/L): for the first 3 months, the maximum therapeutic dose of 5–7 mg/kg is used; from the 4th to the 6th month, it is reduced to 3–5 mg/kg. Total course is also 6 months.

For children under 3 years old, there is an important restriction: the maximum daily dose of iron salt preparations should not exceed 3 mg/kg regardless of the severity of anemia, as exceeding this poses a risk of serious toxic effects.

Efficacy assessment and alternative methods

Response to therapy is assessed in two stages:

• Early criterion (7–10 days): development of a reticulocyte crisis (increase in reticulocyte count).
• Late criterion (4 weeks): a reliable increase in hemoglobin level by at least 10 g/L from baseline.

If oral administration is impossible or ineffective (refractoriness, malabsorption syndrome, severe posthemorrhagic anemia, urgent conditions), parenteral administration is indicated. However, it carries risks: allergic reactions up to anaphylaxis, dyspepsia, and the danger of hemosiderosis due to bypassing the physiological barriers of iron absorption.

In extreme cases, when the hemoglobin level drops below 60 g/L, red blood cell transfusion is indicated. A mandatory condition of treatment is the elimination of the primary cause of iron deficiency, as well as a sparing regimen and dietary correction.

Class and exam questions

What else to study on this topic

• Mechanism of iron absorption in the gastrointestinal tract
• Differences in the pharmacokinetics of ferrous salts and ferric complexes
• Side effects of iron therapy and methods for their correction
• Dietary recommendations for iron deficiency anemia in children
• Diagnostics of malabsorption syndrome as a cause of refractory IDA

Other topics in "Chapter 10. Diseases of the Blood and Blood-Forming Organs"

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