Efficacy of iron supplementation on fatigue and physical capacity in non-anaemic iron-deficient adults: a systematic review of randomised controlled trials Effect of Helicobacter pylori eradication therapy in iron deficiency anaemia of pregnancy – A pilot study A comparison between intravenous iron polymaltose complex (Ferrum Hausmann®) and oral ferrous fumarate in the treatment of iron deficiency anaemia in pregnancy Intermittent oral iron supplementation during pregnancy. A prospective randomized, controlled trial of intravenous versus oral iron for moderate iron deficiency anaemia of pregnancy. A randomized controlled trial of oral heme iron polypeptide versus oral iron supplementation for the treatment of anaemia in peritoneal dialysis patients: HEMATOCRIT trial. Association of anaemia in primary care patients with chronic kidney disease: cross sectional study of quality improvement in chronic kidney disease (QICKD) trial data Further Observations on the Relation between Iron and Folate Status in Pregnancy Iron-deficiency anaemia and its effect on worker productivity and activity patterns. The effect of intravenous and oral iron administration on perioperative anaemia and transfusion requirements in patients undergoing elective cardiac surgery: a randomized clinical trial. Persistence of goiter despite oral iodine supplementation in goitrous children with iron deficiency anemia in Côte d'Ivoire. Iron deficiency anaemia: continuous versus intermittent treatment in anaemic children. The effects of iron supplementation during pregnancy, given by traditional birth attendants, on the prevalence of anaemia and malaria. Randomised placebo-controlled trial of iron supplementation and malaria chemoprophylaxis for prevention of severe anaemia and malaria in Tanzanian infants Anaemia treatment trials in a rural population of Tanzania. Riboflavin deficiency and iron absorption in adult Gambian men. Oral iron therapy for anaemia after orthopaedic surgery: randomized clinical trial Intravenous versus oral iron therapy for postpartum anaemia. The FIND-CKD study—a randomized controlled trial of intravenous iron versus oral iron in non-dialysis chronic kidney disease patients: background and rationale The effects on malaria of treatment of iron-deficiency anaemia with oral iron in Gambian children. A comparative study between intramuscular iron dextran and oral ferrous sulphate in the treatment of iron deficiency anaemia in pregnancy Iron plus folate is more effective than iron alone in the treatment of iron deficiency anaemia in pregnancy: a randomised, double blind clinical trial The efficacy of micronutrient supplementation in reducing the prevalence of anaemia and deficiencies of zinc and iron among adolescents in Sri Lanka
Objective Iron supplementation in iron-deficiency anaemia is st and ard practice , but the benefits of iron supplementation in iron-deficient non-anaemic ( IDNA ) individuals remains controversial . Our objective is to identify the effects of iron therapy on fatigue and physical capacity in IDNA adults . Design Systematic review and meta- analysis of r and omised controlled trials ( RCTs ) . Setting Primary care . Participants Adults ( ≥18 years ) who were iron deficient but non-anaemic . Interventions Oral , intramuscular or intravenous iron supplementation ; all therapy doses , frequencies and duration s were included . Comparators Placebo or active therapy . Results We identified RCTs in Medline , Embase , Cochrane Central Register of Controlled Trials , Cumulative Index of Nursing and Allied Health , SportD iscus and CAB Abstract s from inception to 31 October 2016 . We search ed the WHO ’s International Clinical Trials Registry Platform for relevant ongoing trials and performed forward search es of included trials and relevant review s in Web of Science . We assessed internal validity of included trials using the Cochrane Risk of Bias tool and the external validity using the Grading of Recommendations Assessment , Development and Evaluation methodology . From 11 580 citations , we included 18 unique trials and 2 companion papers enrolling 1170 patients . Using a Mantel-Haenszel r and om-effects model , iron supplementation was associated with reduced self-reported fatigue ( st and ardised mean difference ( SMD ) −0.38 ; 95 % CI −0.52 to −0.23 ; I2 0 % ; 4 trials ; 714 participants ) but was not associated with differences in objective measures of physical capacity , including maximal oxygen consumption ( SMD 0.11 ; 95 % CI −0.15 to 0.37 ; I2 0 % ; 9 trials ; 235 participants ) and timed methods of exercise testing  . Iron supplementation significantly increased serum haemoglobin concentration ( MD 4.01 g/L ; 95 % CI 1.22 to 6.81 ; I2 48 % ; 12 trials ; 298 participants ) and serum ferritin ( MD 9.23 µmol/L ; 95 % CI 6.48 to 11.97 ; I2 58 % ; 14 trials ; 616 participants ) . Conclusion In IDNA adults , iron supplementation is associated with reduced subjective measures of fatigue but not with objective improvements in physical capacity . Given the global prevalence of both iron deficiency and fatigue , patients and practitioners could consider consumption of iron-rich foods or iron supplementation to improve symptoms of fatigue in the absence of documented anaemia . PROSPERO registration number CRD42014007085 Background & objectives : Despite routine iron supplementation and promotion of diet modification , iron deficiency anaemia ( IDA ) remains widely prevalent in our antenatal population . Recent studies in pediatric population have highlighted the role of Helicobacter pylori infection in IDA . This study was undertaken to study the effect of eradication therapy in H. pylori infected pregnant women with IDA . Methods : R and omized placebo-controlled double blind clinical trial was done on 40 antenatal women between 14 - 30 wk gestation , with mild to moderate IDA and having H. pylori infection , as detected by stool antigen test . These women were r and omly divided into group I ( n=20 ) : H. pylori treatment group ( amoxicillin , clarithromycin , omeprazole for 2 wk ) and group II ( n=20 ) : placebo group . Both groups received therapeutic doses of iron and folic acid . Outcome measures were improvement in haematological parameters and serum iron profile after 6 wk of oral iron therapy . Results : The prevalence of iron deficiency in pregnant women with mild to moderate anaemia  was 39.8 per cent ( 95 % CI 35.7 , 44.3 ) ; and 62.5 per cent ( 95 % CI 52 , 73 ) of these pregnant women with IDA were infected with H. pylori . After 6 wk of therapeutic oral iron and folic acid supplementation , the rise in haemoglobin , packed cell volume , serum iron and percentage transferrin saturation was significantly ( P<0.05 ) higher in the group given H. pylori eradication therapy as compared to the placebo group . Interpretation & conclusions : Our results showed a high occurrence of H. pylori infection in pregnant women with IDA . Eradication therapy result ed in significantly better response to oral iron supplementation among H. pylori infected pregnant women with IDA Abstract : Anaemia is the most common medical disorder in pregnancy with iron deficiency anaemia accounting for the majority of cases . Over 90 % of the iron deficiency anaemia is due to red cell iron deficiency associated with depleted iron stores and deficient intake . The two main modalities of treating iron deficiency anaemia are oral or parenteral iron . Ferrous Hausmann ® ( iron dextrin ) is the latest iron preparation which can be used for intravenous parenteral administration as a total dose infusion . This study compares the efficacy of Ferrum Hausmann ® with oral ferrous fumarate therapy in the treatment of iron deficiency anaemia in pregnancy . Our study shows that treatment with intravenous Ferrum Hausmann ® ( iron dextrin ) result ed in a significantly better level and rate of increase of haemoglobin ( p<0.001 ) . Serum ferritin , which is the best indicator of iron stores , was significantly higher ( p<0.001 ) in the intravenous group . Other indices of iron status such as serum iron , serum transferrin and zinc protoporphyrin also showed a significant improvement in the intravenous group compared to those given oral iron . The results suggest that intravenous iron as a total dose infusion is able to replenish iron stores more efficiently , completely and at a faster rate than oral iron therapy , thus providing the fuel for stimulation of full erythopoiesis compared to oral iron . There were also no reports of any adverse reactions with intravenous iron dextrin , whereas there were a considerable proportion of women on oral iron therapy who reported side effects . In conclusion , intravenous iron therapy with Ferrous Hausmann ® ( iron dextrin ) is a suitable , effective and safe alternative to oral iron therapy in the treatment of iron deficiency anaemia in pregnancy RATIONALE It has been suggested that in pregnant women weekly iron supplements are as effective as daily supplements in preventing iron deficiency anaemia ( IDA ) . OBJECTIVE To compare the effectiveness of prophylactic antenatal oral iron supplements given weekly , thrice weekly and daily in preventing IDA in pregnancy . DESIGN A r and omised control trial . SETTING University antenatal clinic , ( UANC ) Galle . SUBJECTS AND METHOD An oral iron supplement containing 100 mg of elemental iron was r and omly given weekly ( n = 26 ) thrice weekly ( n = 35 ) and daily ( n = 31 ) to 92 women who were 14 to 24 weeks pregnant .  Haemoglobin ( Hb ) , serum ferritin ( SF ) and haematocrit ( Hct ) were assessed before and after 12 to 20 weeks of supplementation and a logistic regression analysis carried out . RESULTS The risk of developing anaemia was significantly higher in the weekly ( odds ratio 15 , 95 % CI 1.4 - 165.6 , p < 0.03 ) and possibly higher in the thrice weekly ( odds ratio 3 , 95 % CI 0.3 - 30.3 , p = 0.3 ) groups . The risk of developing iron deficiency ( SF < 12 micrograms/l ) was also significantly higher in the weekly ( odds ratio 18 , 95 % CI 2.8 - 115.5 , p < 0.003 ) and thrice weekly ( odds ratio 10 , 95 % CI 1.6 - 64.8 , p < 0.02 ) groups . CONCLUSION Prophylactic oral iron supplements when given intermittently were not effective in preventing iron deficiency anaemia in pregnancy BACKGROUND Iron deficiency anaemia is the most common deficiency disorder in the world , affecting more than one billion people , with pregnant women at particular risk . OBJECTIVES AND DESIGN We conducted a single site , prospect i ve , nonblinded r and omized-controlled trial to compare the efficacy , safety , tolerability and compliance of st and ard oral daily iron versus intravenous iron . SUBJECTS We prospect ively screened 2654 pregnant women between March 2007 and January 2009 with a full blood count and iron studies , of which 461 ( 18 % ) had moderate IDA . Two hundred women matched for haemoglobin concentration and serum ferritin level were recruited . INTERVENTIONS Patients were r and omized to daily oral ferrous sulphate 250 mg ( elemental iron 80 mg ) with or without a single intravenous iron polymaltose infusion . RESULTS Prior to delivery , the intravenous plus oral iron arm was superior to the oral iron only arm as measured by the increase in haemoglobin level ( mean of 19.5 g/L vs. 12 g/L ; P < 0.001 ) ; the increase in mean serum ferritin level ( 222 microg/L vs. 18 ug/L ; P < 0.001 ) ; and the percentage of mothers with ferritin levels below 30 microg/L ( 4.5 % vs. 79 % ; P < 0.001 ) . A single dose of intravenous iron polymaltose was well tolerated without significant side effects . CONCLUSIONS Our data indicate that intravenous iron polymaltose is safe and leads to improved efficacy and iron stores compared to oral iron alone in pregnancy-related IDA BACKGROUND Preliminary clinical evidence suggests that heme iron polypeptide ( HIP ) might represent a promising , novel oral iron supplementation strategy in chronic kidney disease . The aim of this multi-centre r and omized controlled trial was to determine the ability of HIP administration to augment iron stores in darbepoetin (DPO)-treated patients compared with conventional oral iron supplementation . METHODS Adult peritoneal dialysis ( PD ) patients treated with DPO were r and omized 1:1 to receive two capsules daily of either HIP or ferrous sulphate per os for 6 months . The primary outcome measure was transferrin saturation ( TSAT ) . Secondary outcomes comprised serum ferritin , haemoglobin , DPO dose and responsiveness , and adverse events . RESULTS Sixty-two patients were r and omized to HIP ( n = 32 ) or ferrous sulphate ( n = 30 ) . On intention-to-treat analysis , the median ( inter-quartile range ) TSAT was 22 % ( 16 - 29 ) in the HIP group compared with 20 % ( 17 - 26 ) in controls ( P = 0.65 ) . HIP treatment was not significantly associated with TSAT at 6 months on multivariable analysis ( P = 0.95 ) . Similar results were found on per- protocol analysis and subgroup analysis in iron-deficient patients . Serum ferritin levels at 6 months were significantly lower in the HIP group ( P = 0.003 ) , while the cost of HIP was 7-fold higher than that of ferrous sulphate . No other differences in secondary outcomes were observed . CONCLUSIONS HIP showed no clear safety or efficacy benefit in PD patients compared with conventional oral iron supplements . The reduction in serum ferritin levels and high costs associated with HIP therapy suggest that this agent is unlikely to have a significant role in iron supplementation in PD patients Background Anaemia is a known risk factor for cardiovascular disease and treating anaemia in chronic kidney disease ( CKD ) may improve outcomes . However , little is known about the scope to improve primary care management of anaemia in CKD . Methods An observational study ( N = 1,099,292 ) with a nationally representative sample using anonymised routine primary care data from 127 Quality Improvement in CKD trial practice s ( IS RCT N5631023731 ) . We explored variables associated with anaemia in CKD : eGFR , haemoglobin ( Hb ) , mean corpuscular volume ( MCV ) , iron status , cardiovascular comorbidities , and use of therapy which associated with gastrointestinal bleeding , oral iron and deprivation score . We developed a linear regression model to identify variables amenable to improved primary care management . Results The prevalence of Stage 3–5 CKD was 6.76 % . Hb was lower in CKD ( 13.2 g/dl ) than without ( 13.7 g/dl ) . 22.2 % of people with CKD had World Health Organization defined anaemia ; 8.6 % had Hb ≤ 11 g/dl ; 3 % Hb ≤ 10 g/dl ; and 1 % Hb ≤ 9 g/dl . Normocytic anaemia was present in 80.5 % with Hb ≤ 11 ; 72.7 % with Hb ≤ 10 g/dl ; and 67.6 % with Hb ≤ 9 g/dl ; microcytic anaemia in 13.4 % with Hb ≤ 11 g/dl ; 20.8 % with Hb ≤ 10 g/dl ; and 24.9 % where Hb ≤ 9 g/dl . 82.7 % of people with microcytic and 58.8 % with normocytic anaemia ( Hb ≤ 11 g/dl ) had a low ferritin ( < 100ug/mL ) . Hypertension ( 67.2 % vs. 54 % ) and diabetes ( 30.7 % vs. 15.4 % ) were more prevalent in CKD and anaemia ; 61 % had been prescribed aspirin ; 73 % non-steroidal anti-inflammatory drugs ( NSAIDs ) ; 14.1 % warfarin 12.4 % clopidogrel ; and 53.1 % aspirin and NSAID . 56.3 % of people with CKD and anaemia had been prescribed oral iron . The main limitations of the study are that routine data are inevitably incomplete and definitions of anaemia have not been st and ardised . Conclusions Medication review is needed in people with CKD and anaemia prior to considering erythropoietin or parenteral iron . Iron stores may be depleted in over > 60 % of people with normocytic anaemia . Prescribing oral iron has not corrected anaemia This study was planned to determine whether iron deficiency in pregnancy predisposed to the development of folate deficiency and also the smallest daily iron supplement that maintained haemoglobin levels in pregnancy . Three groups of women were given oral ferrous fumarate supplying 30 , 60 , and 120 mg of iron ;  a fourth group was given 1 g of parenteral iron in early pregnancy followed by oral iron ( 60 mg ) ; a fifth group received a placebo . Tablets were taken once daily . Oral iron 30 mg once daily maintained haemoglobin levels throughout pregnancy . Women whose marrows lacked demonstrable iron at the 37th week had a significantly higher incidence of megaloblastic haemopoiesis ( 28·7 % ) than those with demonstrable iron stores ( 15·3 % ) ; women taking oral iron did not have a lower frequency of megaloblastosis than those given a placebo . We concluded that iron does not have a direct effect on folate status in pregnancy , that the association of iron deficiency and megaloblastic anaemia in pregnancy is the result of poor nutrition , and that there is no cause- and -effect relation between them The effects of  iron-deficiency anaemia on  workers productivity  were studied in a tea plantation in Sri Lanka . The quantity of tea picked per day was studied before and after iron supplementation or placebo treatment . After one month 's treatment significantly more tea was picked when the haemoglobin ( Hb ) concentration was increased by iron supplementation than when it was not . The degree of improvement was greater in more-anaemic subjects ( those with concentrations of 6.0 - 9.0 g Hb/dl ) . The level of physical activity of anaemic subjects in their everyday environment was also recorded for four or 24 hours continuously both before and after treatment . After three weeks these levels was significantly greater in the iron-treated than matched placebo-treated subjects . The economic implication s of increased work productively with iron treatment are evident , particularly in developing countries . These results also provide strong evidence for the clinical impression that people with iron-deficiency anaemia suffer from tiredness and weakness OBJECTIVES Anaemia is a frequent complication after cardiopulmonary bypass surgery .  Iron therapy has been variably employed by medical centres over the years . In our study we test the clinical effectiveness of intravenous and oral iron supplementation in correcting anaemia , and its impact on blood transfusion requirements , in patients undergoing cardiopulmonary bypass surgery . METHODS A double-blind , r and omized , placebo-controlled clinical trial with three parallel groups of patients . Group I ( n = 54 ) : intravenous iron(III)-hydroxide sucrose complex , three doses of 100 mg/24 h during pre- and postoperative hospitalization and 1 pill/24 h of oral placebo in the same period and during 1 month after discharge . Group II ( n = 53 ) : oral ferrous fumarate iron 1 pill/24 h pre- and postoperatively and during 1 month after discharge , and intravenous placebo while hospitalized . Group III ( n = 52 ) : oral and intravenous placebo pre- and postoperatively , following the same protocol . Data were collected preoperatively , at theatre , at intensive care unit admission , before hospital discharge and 1 month later . RESULTS ( 1 ) Baseline clinical and demographic characteristics and surgical procedures were similar in the three groups ; ( 2 ) no inter-group differences were found in haemoglobin and haematocrit during the postoperative period ; ( 3 ) the intravenous iron group showed higher serum ferritin levels at hospital discharge ( 1321 ± 495 ng/ml ; P < 0.001 ) and 1 month later ( 610 ± 387 ; P < 0.001 ) compared with the other groups and ( 4 ) we did not observe statistical differences in blood transfusion requirements between the three groups . CONCLUSIONS The use of intravenous or oral iron supplementation proved ineffective in correcting anaemia after cardiopulmonary bypass and did not reduce blood transfusion requirements . [ Current Controlled Trials number : NCT01078818 ( oral and intravenous iron in patients postoperative cardiovascular surgery under EC ) ] BACKGROUND In developing countries , many children are at high risk of goiter and iron deficiency anemia . Because iron deficiency can have adverse effects on thyroid metabolism , iron deficiency may influence the response to supplemental iodine in areas of endemic goiter . OBJECTIVE The aim of this study was to determine whether goitrous children with iron deficiency anemia would respond to oral iodine supplementation . DESIGN A trial of oral iodine supplementation was carried out in an area of endemic goiter in western Côte d'Ivoire in goitrous children ( n = 109 ) aged 6 - 12 y. Group 1 ( n = 53 ) consisted of goitrous children who were not anemic . Group 2 ( n = 56 ) consisted of goitrous children who had iron deficiency anemia . At baseline , thyroid gl and volume and urinary iodine , thyrotropin , and thyroxine were measured by using ultrasound . Each child received 200 mg I orally and was observed for 30 wk , during which urinary iodine , thyrotropin , thyroxine , hemoglobin , and thyroid gl and volume were measured . RESULTS The prevalence of goiter at 30 wk was 12 % in group 1 and 64 % in group 2 . The mean percentage change from baseline in thyroid volume 30 wk after administration of oral iodine was -45.1 % in group 1 and -21.8 % in group 2 ( P < 0.001 ) . Among the anemic children , there was a strong correlation between the percentage decrease in thyroid volume and hemoglobin concentration ( r(2 ) = 0.65 ) . CONCLUSION The therapeutic response to oral iodine was impaired in goitrous children with iron deficiency anemia , suggesting that the presence of iron deficiency anemia in children limits the effectiveness of iodine intervention programs Iron deficiency anaemia is a common disorder among paediatric population . Traditionally , oral iron is given for treatment on daily basis . We undertook this study to compare the results of intermittent with continuous oral iron therapy in children . The study was conducted at Combined Military Hospital ( CMH ) , Lahore . Children ( aged 1 to 6 ) with iron deficiency anaemia ( Hb 11 g/dl ) were allocated at r and om into two groups , A ( n = 27 ) and B ( n = 28 ) . The mean Hb of group A , before treatment , was 8.56 ( + /- 1.51 ) g/dl and that of group B was 8.32 ( + /- 1.68 ) g/dl . Group A was given daily oral dosage of 6 mg/kg of elementAL iron whereas group B was given the same dosage of iron but only 3 days a week . After 2 months of treatment the Hb of group A rose to a mean of 11.06 ( + /- 0.72 ) g/dl and that of group B was increased to 11.3 ( + /- 0.90 ) g/dl , respectively . The difference , in the rise of Hb of two groups , was not statistically significant . It was concluded that in our sample of population , the results of intermittent and continuous oral iron therapy , for iron deficiency anaemia in children aged 1 to 6 years , were identical A r and omized , double-blind , placebo-controlled community-based trial of oral iron supplementation ( 200 mg ferrous sulphate daily ) administered to multigravid pregnant women by traditional birth attendants ( TBAs ) was carried out in a rural area of The Gambia .  Iron supplementation led to a significant reduction in the prevalence of anaemia and of iron deficiency .  Iron supplementation was not accompanied by increased susceptibility to malaria infection ; there was no difference in the prevalence and severity of peripheral blood or placental malaria infection between the 2 groups of women . The birth weight of children born to women who received iron prophylaxis was increased by an average of 56 g. It is concluded that oral iron prophylaxis can be successfully delivered through TBAs integrated into a primary health care programme . This simple intervention can produce significant beneficial effects on the health of the mother without inducing increased susceptibility to malaria and has the potential for reducing perinatal mortality by increasing birth weight BACKGROUND Malaria and anaemia , especially that due to iron deficiency , are two leading causes of morbidity worldwide . Little is known about the relative contribution of Plasmodium falciparum infection and iron deficiency to the aetiology of anaemia in malaria-endemic areas . We undertook a r and omised comparison of different strategies for control of anaemia and malaria in infants , including an assessment of the effect of iron supplementation on malaria susceptibility . METHODS 832 infants born at one hospital in a malaria-hyperendemic area of Tanzania between January and October , 1995 , were r and omly assigned to group DI , receiving daily oral iron ( 2 mg/kg daily ) plus weekly Deltaprim ( 3.125 mg pyrimethamine plus 25 mg dapsone ) ; group IP , receiving iron plus weekly placebo ; group DP , receiving daily placebo plus weekly Deltaprim ; or group PP . supplementation was given from 8 to 24 weeks of age , and the weekly chemoprophylaxis from 8 to 48 weeks . The frequency of severe anaemia ( packed-cell volume < 25 % ) and malaria episodes was assessed through a combination of passive case detection and cross-sectional surveys . FINDINGS The groups that received iron supplementation had a lower frequency of severe anaemia than those that did not receive iron ( 0.62 vs 0.87 cases per person-year ; protective efficacy 28.8 % [ 95 % CI 6.3 - 45.8 ) . Iron supplementation had no effect on the frequency of malaria ( 0.87 vs 1.00 cases per person-year ; protective efficacy 12.8 % [ -12.8 to 32.5 ] ) . The groups that received malaria prophylaxis had lower frequencies of both severe anaemia ( 0.45 vs 1.04 episodes per person-year ; protective efficacy 57.3 % [ 43.0 - 67.9 ] ) and malaria ( 0.53 vs 1.34 episodes per person-year ; protective efficacy 60.5 % [ 48.2 - 69.9 ] ) than the groups that did not receive prophylaxis . After the end of the intervention period , children who had received malaria chemoprophylaxis had higher rates of severe anaemia and malaria than non-chemoprophylaxis groups ( relative risks 2.2 [ 1.3 - 3.7 ] and 1.8 [ 1.3 - 2.6 ] ) . INTERPRETATION Malaria chemoprophylaxis during the first year of life was effective in prevention of malaria and anaemia but apparently impaired the development of natural immunity . Iron supplementation was effective in preventing severe anaemia without increasing susceptibility to malaria . Our findings support iron supplementation of infants to prevent iron-deficiency anaemia , even in malaria-endemic areas In a coastal population in whom anaemia was common , two r and omised controlled trials were undertaken to investigate the effectiveness of treating iron deficiency anaemia at a dispensary and at primary schools . For anaemic adult villagers treated at a dispensary , one dose of tetrachlorethylene for hookworm infection and a once per week visit to collect medicines were found to be satisfactory . A small but significant increase in haemoglobin level was produced by four weeks oral iron therapy , but this was only maintained after seven months by the group that had initially also received tetrachlorethylene . In children ( 5 - 14 years ) no significant rise in haemoglobin level was obtained by using oral iron and /or TCE , either at the dispensary or at the primary schools . This suggests that malaria was a more potent cause of anaemia in these children Iron absorption from 3.38 mg 58Fe was measured in  riboflavin-deficient Gambian men with haemoglobin ( Hb ) less than 11.5 g/dl before and after oral riboflavin therapy  , and the results compared with a group not receiving riboflavin .  Riboflavin status ( as determined by erythrocyte glutathione reductase activation coefficient ) and Hb increased in teh riboflavin-supplemented but not placebo group . Plasma ferritin levels were low and did not change in either group . There was very wide variation in percentage iron absorption between individuals and also within single individuals on two separate occasions but no measurable change with riboflavin supplementation . The results of the study indicate that the efficiency of iron utilization is impaired in riboflavin deficiency , but that iron absorption is unaffected Background : Oral iron therapy is often used after orthopaedic surgery to improve haemoglobin levels . The aim of the present trial was to determine if administration of oral iron  after orthopaedic surgery results in a better improvement of haemoglobin levels than a control treatment OBJECTIVE Postpartum iron deficiency anaemia ( IDA ) is common in women . Most women are treated with either oral iron supplementation or blood transfusion . Hence , the aim of our study was to compare the effect of treatment with either oral ferrous sulphate or intravenous ferrous sucrose on postpartum IDA . DESIGN A single centre , prospect i ve r and omised controlled trial . SETTING Women 's Centre , John Radcliffe Hospital , Oxford , UK . POPULATION Forty-four women with haemoglobin ( Hb ) of < 9 g/dl and ferritin of < 15 microgram/l at 24 - 48 hours postdelivery . METHODS Women were r and omised to receive either oral ferrous sulphate 200 mg twice daily for 6 weeks ( group O ) or intravenous ferrous sucrose 200 mg ( Venofer ; Vifor International Ltd , St Gallen , Switzerl and ) , two doses given on days 2 and 4 following recruitment ( group I ) . RESULTS were analysed by the Students t-test , chi-square test and analysis of variance . MAIN OUTCOME MEASURES Hb , haematocrit , red cell indices , ferritin and serum iron levels were measured on days 0 , 5 , 14 and 40 . Results By day 5 , the Hb level in women treated with intravenous iron had risen from 7.3 + /- 0.9 to 9.9 + /- 0.7 g/dl , while there was no change in those treated with oral iron . Women treated with intravenous iron had significantly higher Hb levels on days 5 and 14 ( P < 0.01 ) than those treated with oral iron ; although by day 40 , there was no significant difference between the two groups . Throughout the study , ferritin levels rose rapidly in those treated with intravenous iron and remained significantly higher than in those treated with oral iron ( P < 0.01 ) . CONCLUSIONS Intravenous iron sucrose increases the Hb level more rapidly than oral ferrous sulphate in women with postpartum IDA . It also appears to replenish iron stores more rapidly . However , this study was not large enough to address the safety of this strategy Background Rigorous data are sparse concerning the optimal route of administration and dosing strategy for iron therapy with or without concomitant erythropoiesis-stimulating agent ( ESA ) therapy for the management of iron deficiency anaemia in patients with non-dialysis dependent chronic kidney disease ( ND-CKD ) . Methods FIND-CKD was a 56-week , open-label , multicentre , prospect i ve , r and omized three-arm study ( NCT00994318 ) of 626 patients with ND-CKD and iron deficiency anaemia r and omized to ( i ) intravenous ( IV ) ferric carboxymaltose ( FCM ) at an initial dose of 1000 mg iron with subsequent dosing as necessary to target a serum ferritin level of 400–600 µg/L ( ii ) IV FCM at an initial dose of 200 mg with subsequent dosing as necessary to target serum ferritin 100–200 µg/L or ( iii ) oral ferrous sulphate 200 mg iron/day . The primary end point was time to initiation of other anaemia management ( ESA therapy , iron therapy other than study drug or blood transfusion ) or a haemoglobin ( Hb ) trigger ( two consecutive Hb values < 10 g/dL without an increase of ≥0.5 g/dL ) . Results The background , rationale and study design of the trial are presented here . The study has been completed and results are expected in late 2013 . Discussion FIND-CKD was the longest r and omized trial of IV iron therapy to date . Its findings will address several unanswered questions regarding iron therapy to treat iron deficiency anaemia in patients with ND-CKD . It was also the first r and omized trial to utilize both a high and low serum ferritin target range to adjust IV iron dosing , and the first not to employ Hb response as its primary end point In order to determine whether giving iron to iron-deficient children increases their susceptibility to malaria , 213 Gambian children aged between 6 months and 5 years with iron-deficiency anaemia were r and omized to receive either oral iron or placebo during the rainy season when malaria transmission is maximal . Haematological and iron measurements improved significantly in the group given iron . Regular morbidity surveys showed that fever associated with parasitaemia occurred more frequently in the iron-treated group than in the placebo group . This difference was not significant for all parasitaemias grouped together , but became significant and progressively larger for parasitaemias of ten or more positive fields per 100 high power fields ( P less than 0.025 ) , and for parasitaemias of 50 or more positive fields per 100 high power fields ( P less than 0.01 ) . Three children in the iron-treated group but none in the placebo group had more than one episode of fever and parasitaemia . Splenomegaly rates rose appreciably during the study in both groups , but in children at age 2 years the splenomegaly rate at the end of the study was significantly greater in the iron-treated group . We concluded that there is a significantly increased risk of fever associated with severe malarial parasitaemia for children with iron-deficiency anaemia given iron during the season of maximal malaria transmission in this part of The Gambia A comparative study was conducted to demonstrate the difference , if any , in effectiveness of treatment of iron deficiency anaemia in pregnancy with either iron dextran or ferrous sulphate .  Sixty pregnant women with iron deficiency anaemia were assigned r and omly to either group and treated for 6 weeks . The age and parity distributions with mean packed cell volumes ( PCVs ) and gestational age at onset of treatment in the two groups were comparable . Comparing the mean PCVs at week 2 , week 4 and week 6 of treatment the iron dextran group recorded higher and statistically significant mean PCVs ( P < 0.001 ) . Thirty-six per cent of patients in the iron dextran group compared to 3.3 % in the oral iron group ( P = 0.004 ) had their anaemia corrected by the sixth week . No significant side effects accompanied the use of intramuscular iron dextran . It was concluded that iron dextran corrects iron deficiency anaemia faster than ferrous sulphate . Parenteral iron should be considered in pregnant woman with moderate and asymptomatic severe anaemia between gestation ages of 28 weeks and 34 weeks ; this may reduce the frequency of blood transfusion both in the antenatal and postnatal periods in these patients Objective To evaluate whether folate supplementation to iron is able to accelerate solving of iron deficiency anaemia in pregnancy Objective : To determine the effectiveness of combined iron and zinc over the iron or zinc-only supplementation in correcting deficiency and possible interactive effects in a group of adolescent school children . Subjects and methods : Schoolchildren ( n=821 ) of 12–16 years of age were r and omized into four groups and supplemented with iron ( 50 mg/day ) , zinc ( 14 mg/day ) , iron+zinc or placebo capsules 5 days per week for 24 weeks . Anthropometry , and haemoglobin ( Hb ) , serum zinc ( SZn ) and serum ferritin ( SF ) concentrations were determined before and after the intervention . Results : There were no significant effects between-groups in their weight , height and Hb concentrations with the intervention when compared with the placebo group . Iron-only and combination-supplemented groups had reached mean SF concentrations of 55.1 μg/l with no difference between them ( P=0.99 ) . The zinc-only group had a mean change of 4.3 μmol//l whereas the combine-supplemented group had a mean change of 4.0 μmol/l ( P=0.82 ) . The prevalence of anaemia was found to be 70.3 % in the iron group at baseline ; this was reduced to 14.5 % after the supplementation . In the combine-supplemented group anaemia , prevalence was reduced from 64.8 to 19.3 % . Conclusions : Zinc alone or in combination with iron has not shown a significant improvement in growth in adolescence . Severe and moderate forms of anaemia were successfully treated in children who received iron supplementation . Initial high prevalence of low SZn and iron stores was significantly improved with micronutrient supplementation
There were no statistically significant differences in adverse effects , length of hospitalisation or mortality .
Conclusion Oral iron raises haemoglobin levels in elderly people with iron deficiency anaemia by 0.35 g/dL after 4–6 weeks , but it is unclear if this results in tangible health benefits
Background Oral iron supplementation is used widely in older people despite observational studies suggesting it is ineffective .
Objective The aim of this systematic review was to determine if oral iron therapy is effective in elderly people with iron deficiency anaemia .