Iron Hydroxide Polymaltose complex:
latrogenic Cause of Persistent
Iron Deficiency Anaemia Despite Continuous Oral Iron use
BC Mehta
Lack of response to oral iron is an indication for review-
ing the diagnosis of iron deficiency anaemia (IDA),
searching for a source of chronic blood loss and searching
for a coexisting chronic disease. Lack of patient compli-
ance, coexisting vitamin Biz/folic acid deficiency and
inadequate dose of elemental iron or ineffective form of
iron preparation are other causes which may be responsible
for failure to respond lo oral iron' therapy. We report here a
case of IDA who did not respond to oral iron therapy as the
preparation used was ineffective.
Oral preparation of iron hydroxide polymaltose is not
mentioned in the latest editions of textbooks of medicine,
hematology, or pharmacology. Therefore only available
sources of information on this product are publications in
the journal and the promotional literature handed over to
practitioners by medical representatives of the Firms mar-
keting this preparation. Not many practitioners would have
access to the published literature, which is likely to be
scanty as negative results with ineffective preparation may
not be published. In 1987, we were requested to carry out a
trial of iron hydroxide polymaltose at the Dr. JC Patel De-
partment of Hematology, KEM Hospital, Mumbai. After
few weeks of initiating the trial, on reviewing the results, it
was seen that -none of the 21 patients who had completed 3-
4 weeks of treatment had any rise in hemoglobin level: all
the patients subsequently responded lo oral ferrous sul-
phate. In view of this, the trial was abandoned and the firm
which had sponsored the trial did not market the prepara-
tion. Negative results of incomplete trial were not
published. As against this literature from the manufacturers
is likely to be biased. Using Fe labelled iron hydroxide
polymaltose, bioavailability of iron was found to be 0.8% in
normal subjects and 2.4% in iron deficient subjects and
therefore iron hydroxide polymaltose was considered as
therapeutically ineffective. Neilsen et al~ observed no he-
moglobin rise at the end of four weeks of oral iron
hydroxide polymaltose therapy in nine patients with IDA.
There was no postabsorptive increase in serum iron hydrox-
ide polymaltose therapy in nine patients with IDA. There
was no postabsorptive increase in serum iron after admini-
stration of iron hydroxide polymaltose in seven patients
with IDA.' Low bioavailability of iron from iron hydroxide
polymaltose has also been reported in children. Kaltwasser
et al have shown poor iron absorption of iron from iron hy-
droxide polymaltose using 5 Fe labeled preparation made
by manufacturer of ironpolymaltose. Discrepancies be-
tween results of several reports on iron polymaltose and
reasons thereof have been well discussed by Neilsen et al.~
Taking into consideration all the published data and our
personal observations, it seems that iron hydroxide poly-
maltose preparations should not be used for oral therapy of
IDA.
Iron hydroxide polymaltose preparations available in
the Indian market : Chocofer, Ferium, Feroluv, Ferose,
Ferovit, Ferrum Fol, Globac-PM, Hemarange, Mumfer,
Orofer, Phosphomin-iron, Tofe, Trifer, Biofer, Cafe-kit,
Chari, Eleron, Fegem, Fered, Ferst, Fersuc, Fetan, Orofer-
kit, Polyfer, Zenglobin, Vitcofol. corn. This list may not be
complete.
Consultant Hematologist, Nanavati Hospital, Retired Head and
Honorary Professor, Dr. JC Patel Hematology Department, Seth
GS Medical College and KEM Hospital, Mumbai - 400 012.
Received : 24.2.2001; Accepted : 30.6.2001