World Journal of Pediatrics

, Volume 12, Issue 1, pp 109–113 | Cite as

Intravenous iron sucrose for children with iron deficiency anemia: a single institution study

  • Elpis MantadakisEmail author
  • Emmanouela Tsouvala
  • Varvara Xanthopoulou
  • Athanassios Chatzimichael
Original article



Intravenous iron sucrose is not recommended by its manufacturers for use in children despite extensive safety and efficacy data in adults.


We reviewed the experience of our department between January, 2011 and February, 2014 with the use of intravenous iron sucrose in children ≤14 years of age who failed in oral iron therapy for iron deficiency anemia (IDA).


Twelve children (6 females) aged 1.2-14 years (median age 8.9 years) received at least one dose of intravenous iron sucrose. Ten patients had IDA inadequately treated or non-responsive to oral iron therapy. One patient received therapy for blood transfusion avoidance and one for presumed iron refractory iron deficiency anemia (IRIDA). Iron sucrose infusions were given on alternate days up to three times per week. The number of infusions per patient ranged from 2 to 6 (median, 3), the individual doses from 100 mg to 200 mg (median, 200 mg), and the total doses from 200 mg to 1200 mg (median, 400 mg). Iron sucrose was effective in raising the hemoglobin concentration to normal in all patients with IDA, i.e., from 7.6±2.38 g/dL to 12.4±0.64 g/dL, within 31-42 days after the first infusion. The single patient with IRIDA demonstrated a 1.8 g/dL rise. Injection site disorders in three cases and transient taste perversion in one case were the only side effects.


Intravenous iron sucrose appears to be safe and very effective in children with IDA who do not respond or cannot tolerate oral iron therapy.

Key words

adverse effects iron deficiency iron sucrose parenteral iron 


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  1. 1.
    Eden AN, Sandoval C. Iron deficiency in infants and toddlers in the United States. Pediatr Hematol Oncol 2012;29:704–709.PubMedGoogle Scholar
  2. 2.
    Oski FA. Is bovine milk a health hazard? Pediatrics 1985;75:182–186.PubMedGoogle Scholar
  3. 3.
    Schröder O, Mickisch O, Seidler U, de Weerth A, Dignass AU, Herfarth H, et al. Intravenous iron sucrose versus oral iron supplementation for the treatment of iron deficiency anemia in patients with inflammatory bowel disease—a randomized, controlled, open-label, multicenter study. Am J Gastroenterol 2005;100:2503–2509.PubMedCrossRefGoogle Scholar
  4. 4.
    Auerbach M, Coyne D, Ballard H. Intravenous iron: from anathema to standard of care. Am J Hematol 2008;83:580–588.PubMedCrossRefGoogle Scholar
  5. 5.
    Fletes R, Lazarus JM, Gage J, Chertow GM. Suspected iron dextran-related adverse drug events in hemodialysis patients. Am J Kidney Dis 2001;37:743–749.PubMedCrossRefGoogle Scholar
  6. 6.
    Bastit L, Vandebroek A, Altintas S, Gaede B, Pintér T, Suto TS, et al. Randomized, multicenter, controlled trial comparing the efficacy and safety of darbepoetin alpha administered every 3 weeks with or without intravenous iron in patients with chemotherapy-induced anemia. J Clin Oncol 2008;26:1611–1618.PubMedCrossRefGoogle Scholar
  7. 7.
    Akarsu S, Taskin E, Yilmaz E, Yilmaz H, Kilic M, Aygun AD. Treatment of iron deficiency anemia with intravenous iron preparations. Acta Haematol 2006;116:51–57.PubMedCrossRefGoogle Scholar
  8. 8.
    Pinsk V, Levy J, Moser A, Yerushalmi B, Kapelushnik J. Efficacy and safety of intravenous iron sucrose therapy in a group of children with iron deficiency anemia. Isr Med Assoc J 2008;10:335–338.PubMedGoogle Scholar
  9. 9.
    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.PubMedPubMedCentralCrossRefGoogle Scholar
  10. 10.
    Hollowell JG, van Assendelft OW, Gunter EW, Lewis BG, Najjar M, Pfeiffer C, et al. Hematological and iron-related analytes—reference data for persons aged 1 year and over: United States, 1988–94. Vital Health Stat 11 2005:1–156.Google Scholar
  11. 11.
    Moorani KN, Asim S. Parenteral iron sucrose in iron deficiency anaemia of paediatric chronic kidney disease. J Ayub Med Coll Abbottabad 2011;23:47–50.PubMedGoogle Scholar
  12. 12.
    De Falco L, Sanchez M, Silvestri L, Kannengiesser C, Muckenthaler MU, Iolascon A, et al. Iron refractory iron deficiency anemia. Haematologica 2013;98:845–853.PubMedPubMedCentralCrossRefGoogle Scholar
  13. 13.
    Auerbach M, Ballard H. Clinical use of intravenous iron: administration, efficacy, and safety. Hematology Am Soc Hematol Educ Program 2010;2010:338–347.PubMedCrossRefGoogle Scholar
  14. 14.
    Pollak A, Hayde M, Hayn M, Herkner K, Lombard KA, Lubec G, et al. Effect of intravenous iron supplementation on erythropoiesis in erythropoietin-treated premature infants. Pediatrics 2001;107:78–85.PubMedCrossRefGoogle Scholar
  15. 15.
    Critchley J, Dundar Y. Adverse events associated with intravenous iron infusion (low-molecular-weight iron dextran and iron sucrose): a systematic review. Transfus Altern Transfus Med 2007;9:8–36.CrossRefGoogle Scholar
  16. 16.
    Sav T, Tokgoz B, Sipahioglu MH, Deveci M, Sari I, Oymak O, et al. Is there a difference between the allergic potencies of the iron sucrose and low molecular weight iron dextran? Ren Fail 2007;29:423–426.PubMedCrossRefGoogle Scholar
  17. 17.
    Chertow GM, Mason PD, Vaage-Nilsen O, Ahlmen J. Update on adverse drug events associated with parenteral iron. Nephrol Dial Transplant 2006;21:378–382.PubMedCrossRefGoogle Scholar
  18. 18.
    Auerbach M, Al Talib K. Low-molecular weight iron dextran and iron sucrose have similar comparative safety profiles in chronic kidney disease. Kidney Int 2008;73:528–530.PubMedCrossRefGoogle Scholar
  19. 19.
    Moniem KA, Bhandari S. Tolerability and efficacy of parenteral iron therapy in hemodialysis patients, a comparison of preparations. Transfus Alternat Transfus Med 2007;9:37–42.CrossRefGoogle Scholar
  20. 20.
    St Peter WL, Obrador GT, Roberts TL, Collins AJ. Trends in intravenous iron use among dialysis patients in the United States (1994–2002). Am J Kidney Dis 2005;46:650–660.PubMedCrossRefGoogle Scholar
  21. 21.
    Leijn E, Monnens LA, Cornelissen EA. Intravenous iron supplementation in children on hemodialysis. J Nephrol 2004;17:423–426.PubMedGoogle Scholar
  22. 22.
    Bodemar G, Kechagias S, Almer S, Danielson BG. Treatment of anaemia in inflammatory bowel disease with iron sucrose. Scand J Gastroenterol 2004;39:454–458.PubMedCrossRefGoogle Scholar
  23. 23.
    Auerbach M, Goodnough LT, Picard D, Maniatis A. The role of intravenous iron in anemia management and transfusion avoidance. Transfusion 2008;48:988–1000.PubMedGoogle Scholar
  24. 24.
    Chandler G, Harchowal J, Macdougall IC. Intravenous iron sucrose: establishing a safe dose. Am J Kidney Dis 2001;38:988–991.PubMedCrossRefGoogle Scholar
  25. 25.
    Anbu AT, Kemp T, O’donnell K, Smith PA, Bradbury MG. Low incidence of adverse events following 90-minute and 3-minute infusions of intravenous iron sucrose in children on erythropoietin. Acta Paediatr 2005;94:1738–1741.PubMedCrossRefGoogle Scholar
  26. 26.
    Plummer ES, Crary SE, McCavit TL, Buchanan GR. Intravenous low molecular weight iron dextran in children with iron deficiency anemia unresponsive to oral iron. Pediatr Blood Cancer 2013;60:1747–1752.PubMedCrossRefGoogle Scholar
  27. 27.
    Fragoulakis V, Kourlaba G, Goumenos D, Konstantoulakis M, Maniadakis N. Economic evaluation of intravenous iron treatments in the management of anemia patients in Greece. Clinicoecon Outcomes Res 2012;4:127–134.PubMedPubMedCentralGoogle Scholar

Copyright information

© Children's Hospital, Zhejiang University School of Medicine and Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Elpis Mantadakis
    • 1
    Email author
  • Emmanouela Tsouvala
    • 1
  • Varvara Xanthopoulou
    • 1
  • Athanassios Chatzimichael
    • 1
  1. 1.Department of Pediatrics, Democritus University of Thrace Faculty of MedicineUniversity General Hospital of EvrosAlexandroupolis, ThraceGreece

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