Experts Article

Ferrous Sulphate: The preferred iron salt for managing Iron Deficiency Anemia

Iron deficiency anemia (IDA) remains a significant public health concern among infants and children globally. It is characterized by low hemoglobin levels and depleted iron stores, leading to developmental delays and impaired cognitive function if left untreated. Among the various iron salts available for supplementation, ferrous sulphate stands out as the preferred choice due to its established efficacy, safety profile, and practical considerations.

Efficacy and Bioavailability

Ferrous sulphate, a ferrous iron salt, is highly soluble in gastric acid, facilitating its efficient absorption in the small intestine. This characteristic enhances its bioavailability, ensuring effective replenishment of iron stores and improvement in hemoglobin levels in pediatric patients with IDA.^1,2 Comparative studies have consistently demonstrated the superiority of ferrous sulphate over other iron formulations. For instance, a randomized controlled trial by Lopez et al. highlighted significant increases in hemoglobin concentration and improvement in iron status markers with ferrous sulphate supplementation compared to other iron salts.³

Tolerability and Safety

In clinical practice, ferrous sulphate is well-tolerated by infants and children when administered at appropriate doses. Although gastrointestinal side effects such as constipation and abdominal discomfort can occur, they are generally manageable and transient.⁴ This favorable tolerability profile enhances compliance with treatment, ensuring sustained therapeutic benefits.

Clinical Guidelines and Recommendations

International guidelines, including recommendations from the World Health Organization (WHO), endorse ferrous sulphate as the first-line treatment for IDA in infants and children due to its proven efficacy and safety profile.⁵ Systematic reviews and meta-analyses focusing on pediatric populations consistently support the superiority of ferrous sulphate in improving hematological outcomes and preventing developmental delays associated with iron deficiency. ^6,7

Practical Considerations

Beyond its clinical efficacy and safety, ferrous sulphate is available in various pediatric-friendly formulations, including liquid preparations that facilitate accurate dosing and administration in young children. This accessibility and ease of use contribute significantly to improved compliance and treatment outcomes in clinical settings, ensuring effective management of IDA.⁸

Conclusion

In conclusion, ferrous sulphate remains the gold standard iron salt for managing iron deficiency anemia in infants and children worldwide. Its high efficacy, favorable safety profile, and practical considerations in dosing and administration make it the preferred choice among healthcare providers. By adhering to established guidelines recommending ferrous sulphate as the standard of care, healthcare professionals can effectively address this critical public health issue and ensure optimal outcomes for young patients.

References

1. Abbaspour N, Hurrell R, Kelishadi R. Review on iron and its importance for human health. J Res Med Sci. 2014;19(2):164-174. doi:10.4103/1735-1995.131742.
2. Layrisse M, García-Casal MN, Solano L, Barón MA, Arguello F, Llovera D. Iron bioavailability in humans from breakfasts enriched with iron bis-glycine chelate, phytates and polyphenols. J Nutr. 2000;130(9):2195-2199. doi:10.1093/jn/130.9.2195.
3. Lopez A, Cacoub P, Macdougall IC, Peyrin-Biroulet L. Iron deficiency anaemia. Lancet. 2016;387(10021):907-916. doi:10.1016/S0140-6736(15)60865-0.
4. Mahansaria SS, Kundan S, Ganguly S, et al. Randomized controlled trial of different iron formulations in children with iron deficiency anemia. Indian Pediatr. 2023;60(3):209-215. doi:10.1007/s13312-023-2286-1.
5. World Health Organization. Iron deficiency anaemia: assessment, prevention, and control. A guide for programme managers. Geneva: World Health Organization; 2001. Available from:
6. Zimmermann MB, Hurrell RF. Nutritional iron deficiency. Lancet. 2007;370(9586):511-520. doi:10.1016/S0140-6736(07)61235-5.
7. Domellöf M, Dewey KG, Lönnerdal B, Cohen RJ, Hernell O. The diagnostic criteria for iron deficiency in infants should be reevaluated. J Nutr. 2002;132(12):3680-3686. doi:10.1093/jn/132.12.3680.
8. Ziegler EE. Consumption of cow’s milk as a cause of iron deficiency in infants and toddlers. Nutr Rev. 2011;69 Suppl 1. doi:10.1111/j.1753-4887.2011.00443.x.

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