Çocuklarda Demir Eksikliği Anemisi Tedavisinde Ağızdan Günde Tek, İki veya Üç Doz Ferröz Sülfat Verilmesinin Karşılaştırması

Year 2011, Volume: 11 Issue: 3, 102 - 107, 01.07.2011

Resul Yılmaz Yusuf Ziya Aral Yıldız Dallar

https://doi.org/10.5222/j.child.2011.102

Abstract

Amaç: Bu çalışmada demir eksikliği anemisi tanısı konulan altı yaşından küçük çocuklarda 6 mg/kg/gün dozunda günde tek doz, iki doz ve üç dozda üç ay süreyle verilen iki değerlikli oral demirin ferroz sülfat etkinliği karşılaştırılması amaçlandı. Yöntemler: Ardışık 156 anemik çocuk yaş ve cinsiyeti uygun olacak şekilde 3 gruba rastgele dağıtıldı. Başvuruda, 1. ay ve 3. ay sonunda hematolojik parametreler ölçüldü. İstatistiksel değerlendirmede X2 testi, tek yönlü varyans analizi ve tekrarlı ölçümler varyans analizi kullanıldı. Bulgular: Yüz elli altı vakanın 90’ı araştırmayı tamamladı. Her 3 grupta grup içi başlangıç, 1. ay ve 3. ay ortalama hemoglobin, ortalama eritrosit hacmi, serum demiri ve ferritin düzeyinde istatistiksel olarak anlamlı artış ve eritrosit dağılım genişliği ve total demir bağlama kapasitesinde de azalma saptandı, ancak gruplar arasında fark yoktu. Her üç grupta da hafif ishal, kabızlık, bulantı gibi gastrointestinal yan etkiler görüldü. Yan etki açısından gruplar arasında fark gözlenmedi. Sonuç: Günlük tedavi önerilen vakalarda günde tek doz uygulama günde 2 ve 3 doz uygulama kadar etkili olup, yan etki açısından da fark gözlenmemiştir. Bu nedenle tek doz tedavinin hasta uyumunu arttırabileceğinden tercih edilebileceğini önermekteyiz.

Keywords

Demir eksikliği anemisi, günlük tedavi, çocuk, demir tedavisi, yan etki, ferröz sülfat

The Comparison of the Efficiency of Once, Twice or Three Times Daily Oral Doses of Ferrous Sulphate in the Treatment of Iron Deficiency Anemia Among Children

Abstract

Objective: We aimed to compare the effectiveness of once, twice or three times daily oral 6 mg/kg ferrous sulphate treatment in three months period in children below 6 years of age with iron deficiency anemia.Methods: One hundred and fifty six children with iron deficiency anemia were randomized to three age, and sex- matched groups consequetively. Hematologic parameters at admission, first, and third months of treatment were studied. For statistical analysis X2 test, one way analysis of variance and repeated measures analysis of variance were used. Results: Ninety of 156 subjects completed the trial. There was a significant rise in mean hemoglobin, mean corpuscular volume, serum iron and ferritin levels and decrease in red cell distribution width and total iron binding capacity in all three groups when values were compared at admission, 1st and 3rd months of treatment but there was not a statistical difference between groups. Mild gastrointestinal side effects of iron treatment were observed in all three groups and there was no statistically significant difference between the groups with respect to side effects. Conclusion: In treated cases, single dose iron treatment was as effective as twice or three times daily iron treatment and there was no difference between side effects of iron treatmemt. In this way, single dose daily iron regimen could improve the compliance with treatment of iron deficiency anemia in children

Keywords

Iron deficiency anemia, daily treatment, children, iron therapy, ferrous sulphate

References

• 1. Fairbanks V, Beutler E. Iron metabolism. In: Beutler E, Lichtman M, eds. Williams Hematology. 6 ed. New York, NY: McGraw-Hill, 2001:447.
• 2. Andrews N, Ullrich CK, Fleming MD. Disorders of iron metabolism and sideroblastic anemia. In: Orkin SH, Nathan D, Ginsburg D, Look AT, Fisher DE, eds. Nathan and Oski’s Hematology of Infancy and Childhood. 7 ed. Philadelphia: Saunders Elsevier, 2009:522-70.
• 3. Kınık S, Altay Ç. Demir metabolizması ve demir eksikliği anemisi. In: Özalp İ, Yurdakök M, Coşkun T, eds. Pediatride gelişmeler. 1 ed. Ankara: Sinem Basımevi 1999:745-65.
• 4. Jacobs P, Wood L. Hematology of malnutrition, part one. Dis Mon 2003;49(10):555-618. http://dx.doi.org/10.1016/S0011-5029(03)00131-7
• 5. Brugnara C. Iron deficiency and erythropoiesis: new diagnostic approaches. Clin Chem 2003;49(10):1573-8. http://dx.doi.org/10.1373/49.10.1573 PMid:14500582
• 6. Carter RC, Jacobson JL, Burden MJ, Armony-Sivan R, Dodge NC, Angelilli ML, et al. Iron deficiency anemia and cognitive function in infancy. Pediatrics 2010;126(2):e427- 34. http://dx.doi.org/10.1542/peds.2009-2097 PMid:20660551 PMCid:3235644
• 7. Madan N, Rusia U, Sikka M, Sharma S, Shankar N. Developmental and neurophysiologic deficits in iron deficiency in children. Indian J Pediatr 2011;78(1):58-64. http://dx.doi.org/10.1007/s12098-010-0192-0 PMid:20953851
• 8. Walter T, De Andraca I, Chadud P, Perales CG. Iron deficiency anemia: adverse effects on infant psychomotor development. Pediatrics 1989;84(1):7-17. PMid:2472596
• 9. Karabiber H, Özgen Ü, Özcan C, Soylu H, Kutlu O, Sarıbaş S, et al. Demir eksikliği anemili çocuklarda tedavinin mental skor ve uyarılmış potansiyellere etkisi. UHOD 2000;10(4):194-8.
• 10. World Health Organization. Iron deficiency: Indicators for Assessment and Strategies for Prevention. Geneva, Switzerland: World Health Organization; 1997.
• 11. Yurdakök K, İnce OT. Çocuklarda demir eksikliği anemisini önleme yaklaşımları. Çocuk Sağlığı ve Hastalıkları Dergisi 2009;52(4):224-31.
• 12. Zlotkin S, Arthur P, Antwi KY, Yeung G. Randomized, controlled trial of single versus 3-times-daily ferrous sulfate drops for treatment of anemia. Pediatrics 2001;108(3):613-6. http://dx.doi.org/10.1542/peds.108.3.613 PMid:11533326
• 13. Glader B. Iron deficiency anemia. In: Kliegman RM, Behrman RE, Jensen HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18 ed. Philadelphia: Saunders Elsevier 2007:2014-7.
• 14. Bharti S. Feasibility of” Directly observed home-based twicedaily iron therapy” (DOHBIT) for management of anemia in rural patients: A pilot study. Indian J Med Sci 2004; 58(10):431. PMid:15523164
• 15. Grant CC, Wall CR, Brewster D, Nicholson R, Whitehall J, Super L, et al. Policy statement on iron deficiency in pre school aged children. J Paediatr Child Health 2007;43(7- 8):513-21. http://dx.doi.org/10.1111/j.1440-1754.2007.01128.x PMid:17635678
• 16. Tavil B, Sipahi T, Gökçe H, Akar N. Effect of twice weekly versus daily iron treatment in Turkish children with iron deficiency anemia. Pediatr Hematol Oncol 2003;20(4):319-26. PMid:12746164
• 17. Siddiqui IA, Rahman MA, Jaleel A. Efficacy of daily vs. weekly supplementation of iron in schoolchildren with low iron status. J Trop Pediatr 2004;50(5):276-8. http://dx.doi.org/10.1093/tropej/50.5.276 PMid:15510758
• 18. Buchanan GR. The tragedy of iron deficiency during infancy and early childhood. J Pediatr 1999;135(4):413-5. http://dx.doi.org/10.1016/S0022-3476(99)70161-7
• 19. Bahar A, Karademir F, Göçmen İ, Sevgican U, Gültepe M, Ziya M. Çocuklardaki demir eksikliği anemisinin tedavisinde üç değişik ilacın karşılaştırılması. Türkiye Klinikleri J Pediatr 2002;11(1):1-5.
• 20. Lanzkowsky P. Manual of pediatric hematology and oncology. London, UK: Elsevier Academic Press, 2005.
• 21. Galloway R, McGuire J. Determinants of compliance with iron supplementation: supplies, side effects, or psychology? Soc Sci Med 1994;39(3):381-90. http://dx.doi.org/10.1016/0277-9536(94)90135-X
• 22. Ünüvar E, Oğuz F, Şahin K, Sıdal M. Üç değerlikli” Ferrik” demirin iki farklı dozda kullanımının çocukluk çağı demir eksikliği anemisindeki etkinliği. Türk Pediatri Arşivi 1999; 34(4):187-90.
• 23. Provan D. Mechanisms and management of iron deficiency anaemia. Br J Haematol 1999;105(Suppl 1):19-26. PMid:10330929
• 24. Beard JL. Weekly iron intervention: the case for intermittent iron supplementation. Am J Clin Nutr 1998;68(2):209-12. PMid:9701171
• 25. Ruivard M, Feillet-Coudray C, Rambeau M, Gerbaud L, Mazur A, Rayssiguier Y, et al. Effect of daily versus twice weekly long-term iron supplementation on iron absorption and status in iron-deficient women: a stable isotope study. Clin Biochem 2006;39(7):700-7.
• 26. Tezel G, Celkan T, Özkan A, Apak H, Yüksel L, İY. Çocukluk çağı demir eksikliği anemisi tedavisinde günlük ve haftalık demir tedavilerinin karşılaştırılması. Çocuk Dergisi 2004;4:107-12.
• 27. Mumtaz Z, Shahab S, Butt N, Rab MA, DeMuynck A. Daily iron supplementation is more effective than twice weekly iron supplementation in pregnant women in Pakistan in a randomized double-blind clinical trial. J Nutr 2000; 130(11):2697-702. PMid:11053509
• 28. de Barrio M, Fuentes V, Tornero P, Sánchez I, Zubeldia J, Herrero T. Anaphylaxis to oral iron salts. desensitization protocol for tolerance induction. J Investig Allergol Clin Immunol 2008;18(4):305-8. PMid:18714540
• 29. Gürel D, Karatekin G, Nuhoğlu A. Demir eksikliği anemisinde Fe++ ile Fe+++ preparatlarının etkinliklerinin değerlendirilmesi. Turkiye Klinikleri J Pediatr 2000;9(2):88-91.
• 30. Jaber L, Rigler S, Taya A, Tebi F, Baloum M, Yaniv I, et al. Iron polymaltose versus ferrous gluconate in the prevention of iron deficiency anemia of infancy. J Pediatr Hematol Oncol 2010;32(8):585-8. http://dx.doi.org/10.1097/MPH.0b013e3181ec0f2c PMid:20930652
• 31. Geltman PL, Hironaka LK, Mehta SD, Padilla P, Rodrigues P, Meyers AF, et al. Iron supplementation of low-income infants: a randomized clinical trial of adherence with ferrous fumarate sprinkles versus ferrous sulfate drops. J Pediatr 2009;154(5):738-43. http://dx.doi.org/10.1016/j.jpeds.2008.11.003 PMid:19111318