The effect of oral ferrous sulfate use in different posology on laboratory values and clinical findings related to iron metabolism in anemia due to iron deficiency

Iron deficiency anemia (IDA) is a common general health problem in daily clinical practice. A large amount of iron in the body is used for hemoglobin (Hb) synthesis and iron is critical for many biological functions such as cell proliferation, energy production, DNA synthesis and respiration. In recent years, with a better understanding of iron metabolism; it has led to the need to review treatment regimens in the treatment of IDA. Based on these data, we aimed to evaluate the efficacy of oral ferrous sulfate treatment with different doses and posology, its relationship with hepcidin, treatment compliance and gastrointestinal side effects in premenopausal women diagnosed with IDA. Our study was a prospective observational study and included premenopausal female patients aged 18 to 50 years diagnosed with IDA. The patients, who were started on oral ferrous sulfate treatment with different posology and dose, were divided into 3 groups as 2*1 day in the first group, 1*1 day in the second group and 1*1 every other day in the third group and their treatment was completed for 3 months. Changes in Hb and hepcidin were evaluated before treatment and in the second week, and changes in ferritin, transferrin saturation %, total iron binding capacity, and Hb were evaluated in the 3rd month. Significant Hb increase was observed at the end of the second week ( P < .01) and the mean Hb increase was 1.38 ± 1.04 and 1.03 ± 0.48 and ≥1 g/dL in the first and second groups, respectively, while it was 0.69 ± 0.36 and < 1 g/dL in the group given every other day ( P = .020, P = .019, respectively). At the end of the 3rd month, there was a significant increase in Hb level in all 3 groups ( P < .001) and Hb increase was similar between the groups ( P > .05). When the change in ferritin was analyzed, it was observed that ferritin was statistically significantly higher in the first group (2*1) compared to the second and third groups ( P < .05). There was no difference between group 2 and group 3 in terms of ferritin change values ( P > .05). The increase in transferrin saturation % and decrease in total iron binding capacity were similar in all 3 groups at the end of treatment ( P > .05). The change between the second week and baseline hepcidin was observed most in the second group ( P = .024) and the change in hepcidin was similar between the 3 groups ( P = .708). Gastrointestinal side effects were observed more in the first group receiving 2*1 than in the second and third groups ( P < .05). Patients in groups 1 and 2 showed a similar increase in appetite and weight at the end of treatment ( P > .05), whereas no increase in appetite and weight was observed in group 3. In our study, Hb increase of ≥ 1 g/dL in the first and second treatment groups and < 1 g/dL in the third treatment group was observed at the end of the second week; at the end of treatment, anemia improved significantly and Hb increase was similar in all 3 groups. However, due to the gastrointestinal side effects that were significant in the first group, we think that 1*1 daily or 1*1 every other day instead of 2*1 would be more appropriate. In addition, we think that serial hepcidin measurements would give a better idea about the kinetics. Larger studies may emphasize the importance of alternative iron treatment regimens.