In early childhood, iron deficiency anemia (IDA) is often caused by factors such as poor dietary intake, rapid growth, and gastrointestinal blood loss, leading to a range of symptoms from irritability to severe conditions like heart failure. Timely treatment is crucial to prevent long-term neurocognitive impairments and other complications. While oral iron supplementation is the first line of treatment due to its efficacy and low cost, gastrointestinal side effects can lead to poor adherence, making alternative treatment strategies necessary.

For children who do not respond to or cannot tolerate oral iron therapy, particularly those with gastrointestinal disorders or severe IDA requiring rapid treatment, parenteral (intravenous) iron therapy is an effective alternative. Studies have shown that newer intravenous iron formulations, such as ferric carboxymaltose, are safe and effective for pediatric use. These formulations offer the advantage of fewer side effects, better adherence, and more efficient iron replenishment. As evidence supporting the use of intravenous iron in pediatric IDA grows, there is a need for more research to optimize dosing regimens and better understand the long-term safety and efficacy of these treatments.

Reference: Roganovic J. Parenteral iron therapy in children with iron deficiency anemia. World J Clin Cases. 2024 May 6;12(13):2138-2142. doi: 10.12998/wjcc.v12.i13.2138. PMID: 38808346; PMCID: PMC11129126.

Iron deficiency, affecting over a quarter of the global population, is particularly concerning in conditions like iron deficiency anemia (IDA) and hemoglobinopathies. While dietary intake generally maintains iron balance, certain factors like vegetarian diets or chronic medication use can disrupt this balance. In particular, low-dose aspirin use has been linked to iron deficiency in elderly individuals, even in the absence of gastrointestinal bleeding.

Recent studies suggest that aspirin’s iron-chelating metabolites, such as salicylic acid and its derivatives, might act similarly to combination iron chelation therapy, incrementally increasing iron excretion over time. This could explain the observed cases of IDA in long-term, low-dose aspirin users. The risk may be heightened in individuals with low dietary iron intake, such as vegetarians, or those with increased iron demands due to physical activity. However, in non-vegetarians, normal dietary iron intake may offset the increased excretion, maintaining iron balance. Further research is needed to fully understand the impact of these aspirin metabolites on iron metabolism and their broader implications in conditions like cancer, neurodegeneration, and diseases involving oxidative stress and ferroptosis.

Reference: Kontoghiorghes GJ. The Puzzle of Aspirin and Iron Deficiency: The Vital Missing Link of the Iron-Chelating Metabolites. Int J Mol Sci. 2024 May 9;25(10):5150. doi: 10.3390/ijms25105150. PMID: 38791185; PMCID: PMC11121054.

A prospective cohort study investigated the impact of implementing a standardized protocol for managing antepartum anemia on the utilization of intravenous iron sucrose and clinical outcomes. The protocol included serial third trimester hemoglobin assessments, oral iron supplementation for hemoglobin levels between 9.5-11 g/dL, and intravenous iron sucrose for hemoglobin levels below 9.5 g/dL. The study compared outcomes from six months before and after the protocol's implementation, involving 1423 women with antepartum hemoglobin levels below 11.0 g/dL.

The findings revealed that implementing the standardized protocol significantly increased the utilization of intravenous iron sucrose, with 80% higher odds of administration compared to the pre-implementation group. Additionally, there was a slight improvement in predelivery hemoglobin levels in the post-implementation group. However, no significant differences were observed in blood transfusion rates between the two groups. The study concludes that standardized protocols for managing antepartum anemia can improve intravenous iron sucrose use and enhance predelivery hemoglobin levels.

Reference: Hamm RF, Wang EY, Levine LD, Speranza RJ, Srinivas SK. Implementation of a protocol for management of antepartum iron deficiency anemia: a prospective cohort study. Am J Obstet Gynecol MFM. 2022 Mar;4(2):100533. doi: 10.1016/j.ajogmf.2021.100533. Epub 2021 Nov 20. PMID: 34808403; PMCID: PMC9115863.