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Correspondence: Parenteral iron therapy in children with iron 
Correspondence: Parenteral iron therapy in children with iron
  Elpis Mantadakis
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Intravenous (IV) iron is rarely used as a therapeutic alternative to oral iron for the treatment of iron deficiency anemia (IDA) in children outside the context of chronic kidney disease. Our study[1] and the above letter by Roganovic in this issue show that time has come to challenge the widespread belief that parenteral iron be avoided in children unless severe malabsorption or a life-threatening condition is present. Several small but notable pediatric studies document that IV iron appears to be safe and extremely effective in relieving IDA associated various underlying conditions.[2] Although more pediatric dose-finding, safety, and efficacy studies are needed, off-label front line use of IV iron will in all likelihood increase in the near future, because of the availability of newer IV iron products (ferumoxytol, ferric carboxymaltose and iron isomaltoside) that allow correction of the estimated iron deficit at a single setting. Moreover, IV iron therapy may prove to be more cost-effective compared to oral therapy because despite higher acquisition costs, it is equally or more effective and is not plagued by poor compliance and/or absorption that are major problems with oral therapy. Provided that the pediatricians ordering and administering IV iron pay close attention to the management of anaphylaxis and to the specific product used, as incorrect selection or substitution of one product for another without proper dosage adjustment may result in serious over- or under-dosing, IV iron should strongly be considered in diseases associated with moderate to severe IDA, particularly in children unresponsive to oral iron and adolescent girls with heavy uterine bleeding.
1 Mantadakis E, Tsouvala E, Xanthopoulou V, Chatzimichael A. Intravenous iron sucrose for children with iron deficiency anemia: a single institution study. World J Pediatr 2016;12:109- 113.  
2 Mantadakis E. Advances in pediatric intravenous iron therapy. Pediatr Blood Cancer 2015 Sep 16. [Epub ahead of print] doi: 10.1002/pbc.25752.  
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