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Parenteral iron therapy in children with iron 
Parenteral iron therapy in children with iron
  Jelena Roganovic
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I read with interest the article by Mantadakis et al entitled "Intravenous iron sucrose for children with iron deficiency anemia: a single institution study".[1] The article has raised a very interesting issue. There are very few published studies on parenteral iron administration in pediatric practice for nonrenal indication.[2] Besides, because of reported hypersensitivity, pediatric hematologists are usually reluctant to give parenteral iron formulations. Finally, either European Medicines Agency or Food and Drug Administration does not approve most intravenous iron agents for pediatric use. Thereby, as opposed to countless oral iron preparations, there are only few intravenous iron products for children.
We recently published our single-institution experience in intravenous iron treatment for children with iron deficiency anemia (IDA) who failed to respond to oral iron supplementation.[3] A total of 76 intravenous iron infusions (33 iron sucrose and 43 iron gluconate infusions) were given to 12 children aged from 13 months to 14 years (median: 5.8 years). Five children had no compliance, 2 were intolerant, and 5 were non-responsive to oral iron preparations. Infusions were given every 3 to 7 days (average time: 6.3 days) until required amount was achieved. Daily dosage of the infusion was 5 to 7 mg of elemental iron per kilogram, with a maximum single dose of 200 mg. Before infusion of the first dose to each patient, a test dose was given. Intravenous iron was an effective and safe therapy. The mean pretreatment hemoglobin level was 8.7¡À1.7 g/dL, and it was elevated to 11.7¡À1.0 g/dL two months after the first infusion. One mild adverse reaction was due to the infusion; the patient experienced headache and transient mild hypotension after the third intravenous infusion of iron sucrose.
In conclusion, pediatricians should be aware that intravenous iron might be a safe and rapid means to treat children with IDA who fail to respond to oral iron preparations due to intolerance, poor adherence, or iron malabsorption.[4] Patients should be closely monitored for signs of hypersensitivity for at least 30 minutes after each intravenous infusion of an iron preparation. The advantages of intravenous iron products include the use of one or few infusions, which could eliminate the need for prolonged course of oral iron treatment and problems of poor compliance. The disadvantages are higher cost and potential serious adverse effects. Prospective well-designed studies involving larger population are needed to clarify the proper dosage and administration, and to determine the safety and effi cacy of intravenous iron therapy in children.
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 Crary SE, Hall K, Buchanan GR. Intravenous iron sucrose for children with iron deficiency failing to respond to oral iron therapy. Pediatr Blood Cancer 2011;56:615-619.
3 Roganović J, Brgodac E, Đorđević A. Parenteral iron therapy in children with iron deficiency anemia. Paediatr Today 2015;11:24-29.
4 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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