Gönül TEZEL, Tiraje CELKAN, Alp ÖZKAN, Hilmi APAK, Lebriz YÜKSEL, İnci YILDIZ

Çocukluk çağı demir eksikliği anemisi tedavisinde günlük ve haftalık demir tedavilerinin karşılaştırılması

Amaç: Çocukluk çağı demir eksikliği anemisi tedavisinde 4 mg/kg haftada tek doz ve günlük aynı dozda demir tedavisinin etkinliğinin ve tedaviye uyumun belirlenmesidir. Yöntem: Çalışmaya yaşları 3 ay- 14 yaş arası olan, Dallman kriterlerine göre demir eksikliği anemisi tanısı alan 124 vaka dahil edildi. Birinci gruba (n=59) günde 4 mg/kg demir sülfat ve 15 mg C vitamini, ikinci gruba (n=65) haftada bir kez 4 mg/kg demir sülfat ve 15 mg C vitamini verildi. Bulgular: Günlük tedavi grubundan 39 hasta, haftalık tedavi grubundan 37 hasta çalışmayı tamamladı. Tedavi öncesi 1. grubun ortalama hemoglobin (Hb) 9.1±1.7 g/dL, retikülositi 0.92±0.8, 2. grubun ise 9.1±1.5 g/dL ve 0.88±0.7 olarak saptandı. Tedavinin 1. haftasında günlük tedavi grubunun MCV ve Hct değerleri haftalık tedavi grubundan anlamlı olarak yüksek bulunurken, ret değerleri arasında anlamlı fark saptanmadı. İki grupta da tedavi öncesi değerler ile 12 hafta tedavi sonrası değerleri arasındaki fark değerlendirildiğinde ise Hb, MCV, MCH ve MCHC'de artış ve RDW'da azalma anlamlıydı. İki grup birbiri ile kıyaslandığında günlük tedavi grubunun Hb, MCV, MCH, MCHC parametreleri haftalık gruba göre anlamlı yüksek, RDW ise anlamlı düşük bulundu. 12 hafta sonrasında 1. grubun ortalama Hb 12.07±0.96 g/dL, 2. grubun ise 10.77±1.1 g/dL olarak saptandı. Haftalık tedavi grubunda 12 hafta tedavi sonrası Hb değeri yaşa uygun normal değerlere ulaşamayan 11 vakanın tedavisi 16 haftaya uzatıldı. Bu vakaların hemogram ve demir durumları 1. grubun 12. hafta tedavi değerleri ile karşılaştırıldığında MCV ve ferritin haricindeki tüm parametreler arasında fark saptanmadı. Haftalık grubun 16 haftalık tedavi sonrasında hala MCV ve ferritin düzeyleri anlamlı olarak düşüktü. Günlük tedavi grubundaki vakaların % 69'u, haftalık tedavi grubundaki vakaların % 78'i ilacı düzenli olarak kullanmıştı. Sonuç: Aralıklı demir tedavisi günlük tedavi kadar olmasa da anemi tedavisinde etkilidir. Hastaların haftada bir günlük tedaviye uyumları daha kolay olmaktadır. Ancak hemoglobin yükselişi günlük tedaviye oranla daha yavaş olduğundan, tedavi süresi daha uzun olmalıdır. Önerimiz aralıklı tedavinin en az 4 ay uygulanmasıdır.

Anahtar Kelimeler:

Anemi, demir eksikliği, Çocuk, Demir

Comparison of daily and weekly iron therapy in childhood iron deficiency anemia

Aim: To compare efficiancy and compliance to 4 mg/kg elemental iron therapy one dose weekly with 4 mg/kg elemental iron therapy daily. Methods: 124 children, aged 3 month to 14 years, diagnosed as iron deficiency anemia according to Dallman criteria were included to study. The first group was given 4 mg/kg ferrous sulfate and 15 mg vitamin C daily (n=59) and the second group (n=65) 4 mg/kg ferrous sulfate with 15 mg vitamin C once a week. Results: 39 children from the daily therapy group and 37 children from weekly therapy group completed the study. Before treatment the Hb and reticulocyte values of group 1 and 2 were 9.1±1.7 g/dL, 9.1±1.5 g/dL, 0.92±0.8 and 0.88±0.7 respectively. At the end of the first week, mean corpuscular volume (MCV) and hematocrit (hct) values in daily group was significantly higher than the weekly therapy group. But there was no significant difference for reticulocyte counts, between two groups. When pretreatment and post treatment values of Hb, MCV, MCH, MCHC compared, there was an increment for Hb, MCV, MCHC were and decrement for RDW in both groups. At the end of treatment the Hb values of group 1 and 2 were 12.07±0.96 g/dL, 10.77±1.1 g/dL respectively. After 12 weeks of therapy in weekly group, Hb values of 11 patients did not rise to normal values for age and their treatment were prolonged to 16 weeks. Complete blood count and iron values are reevaluated in this group, and there was an increment in Hb, Hct, MCV, MCH values and a significant decrement in RDW values. Although an increase was detected in each parameter with the prolongation of therapy, there were still significant difference for MCV and ferritin values between 12th week values of first group and 16th week values of second group. Compliance was better in the weekly group with an appropriate intake in 78 % of patients versus 69 % in the daily group. As a result, weekly iron therapy is an effective therapy in iron deficiency anemia. Although it is not as effective as daily iron regimen, compliance to weekly iron regi-men is better than daily iron therapy. As increment in hemoglobin values is slower than daily regimen, therapy course should be longer than usual. Our recommendation is that weekly iron therapy should not be shorter than 4 months.

Keywords:

Anemia, Iron-Deficiency, Child, Iron,

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