From the Guidelines
Iron deficiency anemia in children should be treated with oral iron supplements, typically ferrous sulfate at a dose of 3-6 mg/kg/day of elemental iron divided into 1-3 daily doses for 3-6 months, and for children who cannot tolerate oral iron, intravenous iron formulations such as iron sucrose are recommended due to their lower risk of adverse effects compared to iron dextran 1.
Treatment Options
- Oral iron supplements are the first line of treatment for iron deficiency anemia in children, with ferrous sulfate being a common choice
- Newer iron preparations such as iron polysaccharide complexes, carbonyl iron, and iron bis-glycinate chelate may improve tolerability and reduce gastrointestinal side effects
- For children who cannot tolerate oral iron, intravenous iron formulations such as iron sucrose, ferric carboxymaltose, or iron dextran may be considered under medical supervision ### Intravenous Iron Formulations
- Iron sucrose is the most studied intravenous iron preparation in children and has a lower risk of adverse effects compared to iron dextran 1
- Ferric carboxymaltose and iron dextran are also available, but iron dextran has a higher risk of allergic reactions and requires a test dose before administration ### Monitoring and Follow-up
- Iron therapy effectiveness should be monitored by checking hemoglobin levels after 4 weeks of treatment, with an expected increase of approximately 1 g/dL per month
- Treatment should continue for at least 3 months after hemoglobin normalizes to replenish iron stores
- Pairing iron supplements with vitamin C-rich foods or juices can enhance absorption, while calcium-rich foods, tea, coffee, and antacids should be avoided within 2 hours of iron administration as they inhibit absorption 2, 3
From the FDA Drug Label
INJECTAFER is a prescription iron replacement medicine used for the treatment of: iron deficiency anemia (IDA) in: adults and children 1 year of age and older who cannot tolerate iron taken by mouth (oral) or who have not responded well to oral iron. Venofer treatment may be repeated if iron deficiency reoccurs. For iron maintenance treatment: Administer Venofer at a dose of 0.5 mg/kg, not to exceed 100 mg per dose, every two weeks for 12 weeks given undiluted by slow intravenous injection over 5 minutes or diluted in 0. 9% NaCl at a concentration of 1 to 2 mg/mL and administered over 5 to 60 minutes.
The treatment options for iron deficiency anemia in children include:
- Intravenous iron replacement with ferric carboxymaltose (Injectafer) for children 1 year of age and older who cannot tolerate oral iron or have not responded well to oral iron 4.
- Intravenous iron maintenance treatment with iron sucrose (Venofer) at a dose of 0.5 mg/kg, not to exceed 100 mg per dose, every two weeks for 12 weeks for children 2 years of age and older with hemodialysis-dependent chronic kidney disease (HDD-CKD) 5. Note that the dosing for iron replacement treatment in pediatric patients with non-dialysis dependent chronic kidney disease (NDD-CKD) or peritoneal dialysis-dependent chronic kidney disease (PDD-CKD) has not been established for Venofer 5.
From the Research
Treatment Options for Iron Deficiency Anemia in Children
- Oral iron supplementation is the first-line treatment for iron deficiency anemia, with ferrous sulfate being a commonly used preparation 6, 7
- Parenteral iron therapy, including intravenous and intramuscular administration, can be used in cases where oral iron supplementation is not effective or tolerated 8, 9
- New iron preparations, such as iron polymaltose complexes and combined iron and zinc, have been shown to be effective in treating iron deficiency anemia in children 10, 7
Efficacy and Safety of Different Iron Preparations
- Ferrous sulfate has been shown to have a better clinical response and fewer adverse effects compared to iron polymaltose complex in some studies 7
- Iron polymaltose complexes and combined iron and zinc preparations have been shown to be effective and well-tolerated in other studies 10
- Intravenous iron infusions have been shown to be safe and effective in pediatric patients who have failed oral iron supplementation, with improved adherence and fewer adverse effects compared to oral iron therapy 9
Considerations for Treatment
- The choice of iron preparation and route of administration should be individualized based on the child's specific needs and circumstances 8, 6
- Regular monitoring of hemoglobin levels and other hematological parameters is necessary to assess the effectiveness of treatment and adjust the dosage as needed 10, 9
- Dietary counseling and nutritional education are important for preventing iron deficiency anemia and ensuring adequate iron intake 6