Lactoferrin for Treatment of Iron Deficiency Anemia.
Condition: Anemia, Iron Deficiency
MeSH terms: Anemia; Anemia, Iron-Deficiency; Iron Deficiencies
Study type: Interventional
Phase: Phase 4

Summary: 
      Anemia is a great public health problem affecting both developing and developed countries.
      Iron deficiency anemia represents about 50% of causes of anemia worldwide.

      Lactoferrin fortified milk has a positive effect on Hb and iron status of infants.

      the hypothesis of this study is "lactoferrin may have comparable efficacy to ferrous sulfate
      therapy with more tolerability and fewer side effects".

      the research question of this study is whether oral lactoferrin is effective for treatment of
      iron deficiency anemia, compared to traditional ferrous sulfate therapy regarding hemoglobin
      rise and side effects and tolerability.
    

Detailed description: 
      Anemia is a great public health problem affecting both developing and developed countries. It
      is considered the most prevalent form of malnutrition in children and adolescents.

      Supplementation with standard iron therapy is the main treatment of iron deficiency anemia.

      There are two types of iron that are available: ferric and ferrous iron but ferrous iron
      better in absorption so it is more common in use.

      Three types of ferrous iron are present: ferrous sulfate, ferrous fumarate, and ferrous
      gluconate but all forms have annoying gastrointestinal side effects including diarrhea,
      anorexia, heartburn, vomiting, nausea, abdominal cramps, upset stomach, and constipation
      making continuation on it for many weeks unpleasant for all even adults.

      Studies have been performed to explore the effect of oral bovine lactoferrin on iron
      absorption on pregnant women. Many studies showed that oral bovine lactoferrin for pregnant
      women increased levels of hemoglobin, total serum iron, and ferritin and decreased the
      prevalence of iron deficiency anemia. although ferrous sulfate and lactoferrin both of them
      significantly improve the body's iron stores to the same extent, gastrointestinal side
      effects of lactoferrin were extremely lower than that of ferrous sulfate so oral bovine
      lactoferrin can replace iron forms in the treatment of iron deficiency anemia in pregnancy.

      Lactoferrin is a glycoprotein from the transferrin family consist of 691 amino acids. It is a
      component of exocrine secretions such as milk and saliva and is present in neutrophil
      granules. Lactoferrin was identified in 1939 in bovine milk and isolated in 1960 from both
      human and bovine milk. Human colostrum shows the highest levels of lactoferrin while mature
      milk and other secretions present lower.

      Lactoferrin was used in children as antimicrobial in cases of acute diarrhea.In vitro data
      document the growth inhibition of the diarrheal associated organisms: rotavirus, cholera,
      salmonella, and shigella by human lactoferrin.

      Studies about Milk formula fortified with bovine lactoferrin confirmed its positive effect on
      Hb and iron status of infants. Recombinant human lactoferrin was extracted from rice seed, is
      used by Ventria Bioscience as a dietary supplement for treatment of iron of deficiency
      anemia.

      Rationale:

      Iron deficiency anemia has a high prevalence rate in scholar age children with their big need
      to iron for anabolic processes of growth. Supplementation with standard iron therapy is the
      main treatment however its unpleasant side effects negatively affect patient compliance.

      Hypothesis:

      Lactoferrin may have a positive effect in the treatment of iron deficiency anemia in
      school-age children. Lactoferrin side effects less than standard iron therapy.

      Research question:

      Is lactoferrin usage in the treatment of iron deficiency anemia in scholar age children has a
      positive effect and little side effects in comparison with standard iron therapy (ferrous
      sulfate)?.

      1. Objectives

      This study aims to:

        1. Evaluation of the effect of oral lactoferrin in the treatment of iron deficiency anemia
           in school-age children in comparison with standard iron therapy (ferrous sulfate).

        2. Assessment of side effects occurs with the usage of lactoferrin.
    

Intervention name(s): Lactoferrin; Ferrous Sulfate
Intervention type(s): Drug; Drug
Intervention description(s): Bovine Lactoferrin 100mg sachets.; 6mg/kg of ferrous sulfate.
Intervention MeSH terms: Lactoferrin
Allocation: Randomized
Intervention model: Single Group Assignment
Intervention model description: the population for the study will be Scholar age Children attend family medicine clinic for treatment of iron deficiency anemia and their parents accept participation in the study.
For confirmation of the diagnosis of iron deficiency anemia the following investigations will be done:
CBC
Serum total iron
full medical history and examination will be performed. study participants will be assigned to either group A (lactoferrin group) or group B (ferrous sulfate group), and will receive the corresponding medication for 8 weeks.
4 weeks follow up for side effects and hemoglobin level and 8 weeks follow up for side effects, hemoglobin level and serum iron will be performed.
Masking: None (Open Label)
Primary purpose: Treatment