Comparative Study of Oral versus Intravenous Iron Therapy in the Management of Iron Deficiency Anemia
DOI:
https://doi.org/10.62497/3zt6g879Keywords:
Iron deficiency anemia, intravenous iron, oral iron, hemoglobin, ferritin, treatment comparison.Abstract
Introduction: Iron deficiency anemia (IDA) is a common hematological disorder with significant health implications, especially in low-resource settings. It affects physical performance, cognition, and overall quality of life.
Objective: To compare the hematologic response, iron store repletion, symptom improvement, and adverse effects of oral versus intravenous iron therapy in patients with IDA.
Methodology: From 10 March 2023 to 10 March 2024, a 12-month comparative A cross-sectional study was conducted at the Lady Reading Hospital's Department of Medicine in Peshawar. Two groups of 136 patients with proven IDA were randomly assigned to receive oral ferrous sulfate (Group A) and intravenous iron sucrose (Group B). Over the course of eight weeks, hematologic and biochemical markers, symptom improvement, and side effects were evaluated. SPSS version 25 was employed to examine the information using chi-square and t-tests.
Results: At 8 weeks, Group B showed a significantly higher increase in hemoglobin(12.4 ± 1.2 g/dL) than Group A (10.7 ± 1.3 g/dL) (p < 0.001). Ferritin and transferrin saturation were also higher in Group B (110.6 ± 18.4 ng/mL, 34.5 ± 6.2%) than in Group A (29.8 ± 9.2 ng/mL, 18.7 ± 4.5%) (p < 0.001). Fatigue improved in 86.8% vs. 57.4%, pallor in 80.9% vs. 48.5%, and dyspnea in 77.9% vs. 44.1%. GI side effects like nausea (30.9% vs. 5.9%) were more common in the oral group.
Conclusion: Intravenous iron therapy is more effective and better tolerated than oral iron for the treatment of IDA, offering faster hematologic recovery and greater symptom improvement.
Downloads
References
De Souza LV, Hoffmann A, Fischer C, Petzer V, Asshoff M, Theurl I, Tymoszuk P, Seifert M, Brigo N, Hilbe R, Demetz E. Comparative analysis of oral and intravenous iron therapy in rat models of inflammatory anemia and iron deficiency. Haematologica. 2022 Jul 7;108(1):135. doi: 10.3324/haematol.2022.281149
Das SN, Devi A, Mohanta BB, Choudhury A, Swain A, Thatoi PK. Oral versus intravenous iron therapy in iron deficiency anemia: an observational study. Journal of family medicine and primary care. 2020 Jul 1;9(7):3619-22. DOI: 10.4103/jfmpc.jfmpc_559_20
Govindappagari S, Burwick RM. Treatment of iron deficiency anemia in pregnancy with intravenous versus oral iron: systematic review and meta-analysis. American journal of perinatology. 2019 Mar;36(04):366-76.DOI: 10.1055/s-0038-1668555
Lewkowitz, A.K., Gupta, A., Simon, L., Sabol, B.A., Stoll, C., Cooke, E., Rampersad, R.A. and Tuuli, M.G., 2019. Intravenous compared with oral iron for the treatment of iron-deficiency anemia in pregnancy: a systematic review and meta-analysis. Journal of Perinatology, 39(4), pp.519-532.
Mei Z, Chen J, Luo S, Jin L, Liu Q, Chen Y. Comparative efficacy of intravenous and oral iron supplements for the treatment of iron deficiency in patients with heart failure: a network meta-analysis of randomized controlled trials. Pharmacological Research. 2022 Aug 1;182:106345.doi.org/10.1016/j.phrs.2022.106345
Vernekar SR, Agarwal S. Comparative study between intravenous iron sucrose vs oral iron therapy. International Journal of Academic Medicine and Pharmacy. 2023;5(3):1894-8. DOI: 10.47009/jamp.2023.5.3.375
Sultan P, Bampoe S, Shah R, Guo N, Estes J, Stave C, Goodnough LT, Halpern S, Butwick AJ. Oral vs intravenous iron therapy for postpartum anemia: a systematic review and meta-analysis. American journal of obstetrics and gynecology. 2019 Jul 1;221(1):19-29.doi.org/10.1016/j.ajog.2018.12.016
Tigga MP, Debbarma AP. A comparative study to evaluate oral iron and intravenous iron sucrose for treatment of anemia in pregnancy in a poor socioeconomic region of Northeast India. Tzu Chi Medical Journal. 2020 Jul 1;32(3):258-61.DOI: 10.4103/tcmj.tcmj_99_19
Lewkowitz AK, Stout MJ, Cooke E, Deoni SC, D'Sa V, Rouse DJ, Carter EB, Tuuli MG. Intravenous versus oral iron for iron-deficiency anemia in pregnancy (IVIDA): A randomized controlled trial. American journal of perinatology. 2022 Jun;39(08):808-15.DOI: 10.1055/s-0041-1740003
Gamad N, Saha PK, Sharma P, Suri V, Chakrabarti A, Saha L. A randomized controlled trial comparing the efficacy, tolerability, and cost of oral iron preparations in iron‐deficiency anemia in pregnancy. Journal of Obstetrics and Gynaecology Research. 2021 Nov;47(11):3828-41.doi.org/10.1111/jog.14999
Martin‐Malo A, Borchard G, Flühmann B, Mori C, Silverberg D, Jankowska EA. Differences between intravenous iron products: focus on treatment of iron deficiency in chronic heart failure patients. ESC heart failure. 2019 Apr;6(2):241-53.doi.org/10.1002/ehf2.12400
Howaldt S, Domènech E, Martinez N, Schmidt C, Bokemeyer B. Long-term effectiveness of oral ferric maltol vs intravenous ferric carboxymaltose for the treatment of iron-deficiency anemia in patients with inflammatory bowel disease: a randomized controlled noninferiority trial. Inflammatory Bowel Diseases. 2022 Mar 1;28(3):373-84. doi.org/10.1093/ibd/izab224
Ferrer‐Barceló L, Sanchis Artero L, Sempere García‐Argüelles J, Canelles Gamir P, P. Gisbert J, Ferrer‐Arranz LM, Monzó Gallego A, Plana Campos L, Huguet Malavés JM, Luján Sanchis M, Ruiz Sánchez L. Randomised clinical trial: intravenous vs oral iron for the treatment of anaemia after acute gastrointestinal bleeding. Alimentary Pharmacology & Therapeutics. 2019 Aug;50(3):258-68.doi.org/10.1111/apt.15327
DeLoughery TG. Safety of oral and intravenous iron. Acta haematologica. 2019 May 15;142(1):8-12.doi.org/10.1159/000496966
Saxena D, Rathore D. Comparison of intravenous iron sucrose versus oral iron for the treatment of iron deficiency anaemia in pregnancy. International Journal of Clinical Obstetrics and Gynaecology. 2021;5(4):221-4.doi.org/10.33545/gynae.2021.v5.i4d.988
Miles LF, Litton E, Imberger G, Story D. Intravenous iron therapy for non‐anaemic, iron‐deficient adults. Cochrane Database of Systematic Reviews. 2019(12).doi.org/10.1002/14651858.CD013084.pub2
Shin HW, Go DY, Lee SW, Choi YJ, Ko EJ, You HS, Jang YK. Comparative efficacy and safety of intravenous ferric carboxymaltose and iron sucrose for iron deficiency anemia in obstetric and gynecologic patients: A systematic review and meta-analysis. Medicine. 2021 May 21;100(20):e24571.DOI: 10.1097/MD.0000000000024571
Drexler C, Macher S, Lindenau I, Holter M, Moritz M, Stojakovic T, Pieber TR, Schlenke P, Amrein K. High-dose intravenous versus oral iron in blood donors with iron deficiency: the IronWoMan randomized, controlled clinical trial. Clinical Nutrition. 2020 Mar 1;39(3):737-45.doi.org/10.1016/j.clnu.2019.03.025
Kumar A, Sharma E, Marley A, Samaan MA, Brookes MJ. Iron deficiency anaemia: pathophysiology, assessment, practical management. BMJ open gastroenterology. 2022 Jan 1;9(1):e000759.doi: 10.1136/bmjgast-2021-000759
Ning S, Zeller MP. Management of iron deficiency. Hematology 2014, the American Society of Hematology Education Program Book. 2019 Dec 6;2019(1):315-22.doi.org/10.1182/hematology.2019000034
Numan S, Kaluza K. Systematic review of guidelines for the diagnosis and treatment of iron deficiency anemia using intravenous iron across multiple indications. Current Medical Research and Opinion. 2020 Nov 1;36(11):1769-82.doi.org/10.1080/03007995.2020.1824898
Pollock RF, Muduma G. A systematic literature review and indirect comparison of iron isomaltoside and ferric carboxymaltose in iron deficiency anemia after failure or intolerance of oral iron treatment. Expert Review of Hematology. 2019 Feb 1;12(2):129-36.doi.org/10.1080/17474086.2019.1575202
Kassianides X, Gordon A, Sturmey R, Bhandari S. The comparative effects of intravenous iron on oxidative stress and inflammation in patients with chronic kidney disease and iron deficiency: a randomized controlled pilot study. Kidney Research and Clinical Practice. 2021 Mar 22;40(1):89.doi.org/10.23876/j.krcp.20.120
Omda A, Abd El Aal F, Nar A, Abd El Raaof AE, Naggar A, El Sayed W. Comparative study of total dose infusion of iron and intramuscular iron administration in treatment of severe iron deficiency anemia during pregnancy. The Egyptian Journal of Hospital Medicine. 2019 Jan 1;74(4):905-13.doi.org/10.21608/ejhm.2019.25558
Bertani L, Tricò D, Zanzi F, Baiano Svizzero G, Coppini F, de Bortoli N, Bellini M, Antonioli L, Blandizzi C, Marchi S. Oral sucrosomial iron is as effective as intravenous ferric carboxy-maltose in treating anemia in patients with ulcerative colitis. Nutrients. 2021 Feb 12;13(2):608.doi.org/10.3390/nu13020608
Uçan A, Kaya ZI, Yilmaz EÖ, Vasi İ, Özgeyik MO. Comparing therapeutic effects of alternate day versus daily oral iron in women with iron deficiency anemia: a retrospective cohort study. Medicine. 2023 Jul 28;102(30):e34421.DOI: 10.1097/MD.0000000000034421
Published
Issue
Section
Categories
License
Copyright (c) 2025 Dr. Saifullah Chan, Dr. Usman Khalil, Hamdan Khan, Dr. Fakhar Zaman, Sheharyar Khalid Rahim, Dr. Abdul Samad (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Authors retain copyright to their work published in the IRABCS journal under the Creative Commons Attribution Non-Commercial No Derivatives License (CC BY-NC-ND 4.0).
![](<img src="https://assets.crossref.org/logo/crossref-logo-landscape-200.svg" width="200" height="68" alt="Crossref logo">){kind=logo}
