The Indian Journal of Pediatrics

https://doi.org/10.1007/s12098-019-03068-2

ORIGINAL ARTICLE

Comparison of Therapeutic Efficacy of Ferrous Ascorbate and Iron

Polymaltose Complex in Iron Deficiency Anemia in Children:
A Randomized Controlled Trial
Prashant Patil 1 & Prajit Geevarghese 1 & Prabha Khaire 1 & Trupti Joshi 1 & Amol Suryawanshi 1 & Smita Mundada 1 &
Shilpa Pawar 1 & Aziz Farookh 1

Received: 16 April 2019 / Accepted: 21 August 2019

# Dr. K C Chaudhuri Foundation 2019

Abstract
Objective To compare the therapeutic efficacy of Ferrous ascorbate (FA) and Iron polymaltose complex (IPC) in Iron deficiency
anemia (IDA) in children.
Methods A randomized controlled trial (RCT) was conducted at a tertiary care hospital with 125 (1–12 y) children having
clinical symptoms and signs of IDA. Participants were randomized into FA group and IPC group. Both the groups received iron
salts (FA or IPC) randomly in a dose of 6 mg/kg elemental iron for 3 mo and followed up on day 3, day 7, at the end of 1 mo and 3
mo for Hemoglobin (Hb), Mean corpuscular volume (MCV), Red cell distribution width (RDW) and reticulocyte count.
Results Both groups had an improvement in hematological parameters at 3 mo of intervention. The difference in the rise of Hb
(g%) at the end of 1 mo in FA group (3.13 ± 1.01) vs. IPC group (2.0 ± 0.85); p = 0.017 and at 3 mo in FA group (4.88 ± 1.28) vs.
IPC group (3.33 ± 1.33); p = 0.001 was statistically significant. The difference in the rise of mean Hb was significantly better in
FA than the IPC group F [3392] =1.79; p = 0.00 (ANOVA). The difference in the mean increase in MCV (fL) at day 7 in FA group
(6.71 ± 8.32) vs. IPC group (2.91 ± 6.16); p = 0.011 and at 1 mo FA group (9.80 ± 8.56) vs. IPC group (5.35 ± 6.11); p = 0.004
was statistically significant. The mean decrease in RDW (%) at 1 mo in FA group (4.23 ± 3.27) vs. IPC group (2.67 ± 1.95); p =
0.005 and at 3 mo in FA group (5.74 ± 3.63) vs. IPC group (4.04 ± 2.17); p = 0.006 was statistically significant. The difference in
the rise in mean reticulocyte count at day 3 in FA group (0.88 ± 0.50) vs. IPC group (0.43 ± 1.20); p = 0.017 and at day 7 in FA
group (4.00 ± 1.69) vs. IPC group (2.19 ± 1.24); p = 0.001 was statistically significant. F [2294] = 29.2, p = 0.00 (ANOVA).
During the study period, the FA group had minor adverse reactions whereas the IPC group had none.
Conclusions Both the iron salts (FA and IPC) used in the treatment of IDA showed statistically significant improvement in the
hematological parameters during the 3 mo of intervention. The improvement in hematological parameters was better in FA
supplemented patients as compared to IPC.

Keywords Iron deficiency anemia . Ferrous ascorbate . Iron polymaltose complex . Comparison of ferrous ascorbate and iron
polymaltose complex

Introduction deficiency anemia (IDA) occurs in infants and young children

Anemia is typically defined as a hemoglobin concentration
that is 2 standard deviations (SD) or more below the mean
for a normal population of the same gender and age [1]. Iron
* Prajit Geevarghese
prajeeth200@gmail.com
1
Department of Pediatrics, GMCH Aurangabad, Panchakki Jubliee
Park, Aurangabad, Maharashtra 431001, India
mainly due to inadequate dietary iron [2].
Management of IDA depends upon the etiology of the dis-
order. The correction of IDA relies either upon the oral or
parenteral route. Different varieties of oral iron preparations
are available for the correction of iron deficiency. Oral prepa-
rations can be either in the form of Ferrous or Ferric salts. A
daily dose of 3–6 mg/kg of elemental iron in single or three
divided doses is well tolerated by the pediatric age group [3,
4]. Oral administration of ferrous salts provides inexpensive
and effective improvement in the correction of anemia due to
its high bioavailability. Due to this high bioavailability, it

promotes the development of free radicals when gastrointesti-
nal receptors get saturated resulting in numerous adverse
events. The long duration of treatment along with the issues
of compliance is the limitation of oral iron therapy. Since
generations, ferrous salts have been used for this purpose.
Intolerance to oral iron is uncommon in young children aside
from the unpleasant taste of iron. In contrast, older children
and adolescents sometimes have GI complaints like heartburn,
black stools, tooth staining, constipation and diarrhea [3].
To overcome these adverse effects and improve com-
pliance, therefore to improve efficacy, Iron Polymaltose
Complex (IPC) was developed. It is a highly water-solu-
ble, non-precipitating stable macromolecular complex of
polynuclear ferric ox hydroxide coupled with polysaccha-
ride groups. Due to its reduction potential of −332 mV, it
is not reduced in biological fluids and does not provoke
oxidative stress. IPC is absorbed and exchanged to trans-
port proteins very slowly, preventing rapid increases of
iron in serum and iron distribution to tissues. Since there
is no interference between IPC and feed components, the
bioavailability is not affected. The iron of IPC is
Assessed for eligibility (n= 730)
Enrollment
Randomized (n=125)
Allocation
Allocated to FA group (n=62)
Follow-up
Lost to follow-up (n=12)
Analysis
Analysed (n=50)
Fig. 1 CONSORT diagram of flow of patients. FA Ferrous ascorbate; IPC Iron polymaltose complex
Indian J Pediatr
absorbed in the intestine through a self-limiting active
and competitive interchange of ligands so that the intes-
tinal transport system is saturated in case of overdosage.
No intoxication with IPC has been observed till now.
Geisser et al. observed in his study that the LD50 of FS
is 350 mg/kg, while the LD50 of IPC could not be re-
corded even at doses of over 2000 mg/kg [5]. Although
having such advantages, the improvement of hematolog-
ical parameters with IPC is very slow requiring more
duration of treatment [6].
Ferrous ascorbate, L-(+)-Ascorbic acid iron (II) salt is pre-
pared from ferrous sulfate which is used as starting material
for the preparation of ferrous ascorbate. The advantage of
ferrous ascorbate is it being heat-stable, highly soluble in wa-
ter and combines with Ascorbic acid, improves the bioavail-
ability and reduces adverse effects. Iron is most readily
absorbed in the ferrous state. But most of the dietary iron is
in the ferric form. Not more than a trace amount of iron is
absorbed in the stomach. But the gastric secretion (HCl) dis-
solves the iron and permits it to form soluble complexes with
ascorbic acid. Vitamin C and other substances help in the
Excluded (n=605)
Not fulfilling inclusion criteria or
declined to participate (n=440)
Thalassemia Major (n=145)
Hematological malignancies (n=20)
Allocated to IPC group (n=63)
Lost to follow-up (n=13)
Analysed (n=50)
Indian J Pediatr

reduction of such ferric ions into ferrous form. Ascorbic acid Table 1 Baseline characteristics of FA and IPC groups at presentation
provides the movement of plasma iron to storage depots in FA group IPC group p value
tissues. There is also evidence that ascorbic acid improves iron
utilization, by its reducing action and it may have a direct Mean age in years 3.01 ± 2.16 2.31 ± 1.29 0.053*
effect on erythropoiesis [7]. Sex (M:F) 24:26 25:25 1*
These two salts are chosen for the study as there is a paucity Mean weight (Kg) 11.09 ± 3.69 10.96 ± 2.22 0.834#
of information on the comparison between these two iron salts. Mean Hb at Day 0 (g%) 6.85 ± 1.23 6.93 ± 1.38 0.766#
Mean MCV at Day 0 (fL) 59.38 ± 7.80 59.83 ± 7.31 0.766#
Mean RDW at Day 0 (%) 18.30 ± 3.23 18.73 ± 3.02 0.490#
Material and Methods
*Chi square test; # Unpaired Student t test; FA Ferrous ascorbate; Hb
Hemoglobin; IPC Iron polymaltose complex; MCV Mean corpuscular
The study was a single-center open-labeled randomized con- volume; RDW Red cell distribution width
trolled trial conducted at the Department of Pediatrics of a
tertiary care institute from January 2016 through August
measures obtained over time were analyzed using Two
2017. Approval from the Institutional ethical committee was
Way ANOVA with replication for between-group differ-
obtained. Informed written consent was taken from parents of
ences. The p value of ≤0.05 was considered statistically
the selected children for participation in the study.
significant. All statistical calculations were done using
Children between the age group of 1 to 12 y with anemia
computer programs, Microsoft excel 2010 (Microsoft
were eligible; defined as hemoglobin (Hb) less than 10 (g%).
Corporation, NY, USA) and SPSS (Statistical Package for
IDA diagnosis was based on the Guidelines by the British
the Social Science Inc. Chicago, IL, USA) version 19.
Society of Gastroenterology which included the combination
of at least two of the following criteria in addition to Hb <10
(g%) at baseline: lower than normal (80–100 fL) mean cor-
puscular volume (MCV), raised red cell volume distribution Results
(RDW) than the normal range (11–15%) or low serum ferritin
levels (<12 ng/ml but not >100 ng/ml) [8]. One hundred twenty five children of 1 to 12 y age, in the
The exclusion criteria was anemia causes other than Pediatric ward or OPD, who met the eligibility criteria, were
iron deficiency anemia, severe concurrent illness (cardio- included. They were randomized into two groups (FA and
vascular, renal, and hepatic), known hypersensitivity to IPC). Twenty-five patients were excluded from the study after
ferrous ascorbate or any other iron preparations, malig-
nancy of any type, children with Thalassemia Major or Mean Hb levels from Day 0 to 3 mo
Thalassemia Minor, Aplastic or hypoplastic anemia, 14
Mean Hb levels (GMS %)

Sickle cell anemia, hemolytic anemia or hemoglobinopa- 12

thy and any other condition that in the opinion of the 10
investigator did not justify the patient’s inclusion [8]. 8
6 FA
The sample size of the study was taken as 72 with
4 IPC
consideration of the prevalence of 50% [2]: 36 in 2
Group A (FA) and 36 in Group B (IPC). To increase 0
the creditability of the study total 100 patients were in- Day 0 Day 7 1 mo 3 mo
cluded and analyzed with 50 in the FA group and 50 in
the IPC group. Block randomization was done using a Mean Reticulocyte Count from Day 0 to 7
web-based random number generator using permuted
6
Mean Reculocyte Count

blocks of two. Allocation concealment was done using

5
sequentially numbered opaque sealed envelopes to pre-
4
vent selection bias. Blinding was not intended in this
3 FA
study. Patients were given iron salts (FA and IPC) in
the therapeutic dose of 6 mg/kg of an elemental iron 2 IPC

empty stomach for 3 mo and followed up on day 3, 1

day 7, at the end of 1 mo and 3 mo for Complete blood 0
count and reticulocyte count on visits. Day 0 Day 3 Day 7
Data were statistically analyzed using the Student un- Fig. 2 Marginal means self-plot showing comparison of mean Hb and
paired t-test for quantitive variables and Chi-square test for mean reticulocyte count between FA group and IPC group. FA Ferrous
qualitative variables. Continuous variables with multiple ascorbate; Hb Hemoglobin; IPC Iron polymaltose complex
 Indian J Pediatr

Table 2 Hb, MCV and RDW in FA and IPC group on Day 0, Day 7, 1 mo and 3 mo

Mean Hb (g%) Mean MCV (fL) Mean RDW (%)

FA IPC p value FA IPC p value FA IPC p value

Day 0 6.85 ± 1.23 6.93 ± 1.38 0.766 59.38 ± 7.80 59.83 ± 7.31 0.766 18.30 ± 3.23 18.73 ± 3.02 0.490
Day 7 8.41 ± 1.38 7.88 ± 1.30 0.04 66.09 ± 8.32 62.75 ± 8.88 0.04 16.06 ± 2.90 17.42 ± 3.47 0.03
1 mo 9.98 ± 1.36 8.95 ± 1.47 0.00 69.19 ± 8.62 65.19 ± 8.88 0.02 14.07 ± 2.60 16.07 ± 3.44 0.00
3 mo 11.7 ± 1.44 10.25 ± 1.52 0.00 80.67 ± 6.49 80.94 ± 5.70 0.77 12.56 ± 2.80 14.69 ± 3.16 0.00
Mean Increase in Hb Mean Increase in MCV Mean Decrease in RDW
Day 7 1.56 ± 0.63 0.95 ± 0.58 0.00 6.71 ± 8.32 2.91 ± 6.16 0.011 2.24 ± 3.43 1.31 ± 1.92 0.098
1 mo 3.13 ± 1.01 2.0 ± 0.85 0.017 9.80 ± 8.56 5.35 ± 6.11 0.004 4.23 ± 3.27 2.67 ± 1.95 0.005
3 mo 4.88 ± 1.28 3.33 ± 1.33 0.001 21.29 ± 12.03 21.11 ± 11.12 0.078 5.74 ± 3.63 4.04 ± 2.17 0.006

FA Ferrous ascorbate; Hb Hemoglobin; IPC Iron polymaltose complex; MCV Mean corpuscular volume; RDW Red cell distribution width

randomization due to the inability to complete follow-up. A
total of 100 patients, 50 in each group, completed 3 mo of the
study period and were analyzed (Fig. 1). The baseline param-
eters in the two groups were similar (Table 1).
Both groups had an improvement in hematological param-
eters at 3 mo of intervention. The difference in the rise of Hb
(g%) at the end of 1 mo in FA group (3.13 ± 1.01) vs. IPC
group (2.0 ± 0.85); p = 0.017 and at 3 mo in FA group (4.88 ±
1.28) vs. IPC group (3.33 ± 1.33); p = 0.001 was statistically
significant. The difference in the rise of mean Hb was signif-
icantly better in FA than the IPC group {F [3392] =1.79; p =
0.00 (ANOVA)} (Fig. 2). The difference in the mean increase
in MCV (fL) at day 7 in FA group (6.71 ± 8.32) vs. IPC group
(2.91 ± 6.16); p = 0.011 and at 1 mo in FA group (9.80 ± 8.56)
vs. IPC group (5.35 ± 6.11); p = 0.004 was statistically signif-
icant. The mean decrease in RDW (%) at 1 mo in FA group
(4.23 ± 3.27) vs. IPC group (2.67 ± 1.95); p = 0.005 and at 3
mo in FA group (5.74 ± 3.63) vs. IPC group (4.04 ± 2.17); p =
0.006 was statistically significant (Table 2). The difference in
the rise in mean reticulocyte count at day 3 in FA group (0.88
± 0.50) vs. IPC group (0.43 ± 1.20); p = 0.017 and at day 7 in
FA group (4.00 ± 1.69) vs. IPC group (2.19 ± 1.24); p = 0.001
Table 3 Reticulocyte count in FA and IPC group on Day 0, Day 3 and
Day 7
FA IPC
Mean reticulocyte count (%)
Day 0 0.85 ± 0.65 1.22 ± 1.09
Day 3 1.74 ± 0.55 1.65 ± 0.48
Day 7 4.85 ± 1.41 3.4 ± 0.51
Mean increase in reticulocyte count
Day 3 0.88 ± 0.50 0.43 ± 1.20
Day 7 4.00 ± 1.69 2.19 ± 1.24
FA Ferrous ascorbate; IPC Iron polymaltose complex
was statistically significant {F [2294] =29.2, p = 0.00
(ANOVA)} (Table 3 and Fig. 2).
During the study period, the FA group had minor adverse
reactions whereas the IPC group had none.
Discussion
Several studies have demonstrated that IPC has a significant
effect on the endpoint of iron therapy, i.e., Hb formation and/
or restoration of iron stores, in infants, children, and adoles-
cents [6, 9, 10]. Marwat et al. [11] conducted an RCT in
children using IPC (3 mg/kg/d) vs. Ferrous sulfate (FS)
(6 mg/kg/d) and concluded both drugs to be efficacious in
the treatment of IDA (p = 0.065). Similarly, Yasa et al. [12]
conducted an RCT between FS (6 mg/kg/d) and IPC
(5 mg/kg/d) and found IPC to be equally efficacious on the
basis of change in Hb parameter after 4 mo of intervention
(p = 0.349). IPC appears to have a somewhat slower onset of
action than classical ferrous salts as described by Afzal et al.
[13] who conducted an RCT using Sodium iron edetate (SIE),
IPC (3 mg/kg/d) and intramuscular iron sorbitol for 12 wk and
found that the target Hb was achieved at 8 wk in SIE com-
pared to 12 wk in IPC. Vetter et al. [14] conducted a random-
ized controlled trial of 63 adults with IPC in IDA and found
that the mean time to achieve target Hb level was 6.6, 8.3, and
11.3 wk for patients receiving 600 mg, 400 mg and 200 mg of
p value
iron respectively. Therefore he postulated that the rate of the
erythropoietic response to IPC appears to be dose-dependent
0.03 [14] (Table 4).
0.25 The study by Guinea et al. demonstrates the efficacy of
0.00 ferrous ascorbate in the treatment of IDA but has been done
mainly in the adult population [16]. In a study by Ganguly
0.017
et al. [15], FA was used at 3 mg/kg/d which showed better
0.001
efficacy with negligible side-effects compared to Colloidal
iron in the treatment of IDA and found no difference in retic-
ulocyte count at 1 mo, 2 mo and 3 mo of intervention. In the
Indian J Pediatr

Table 4 Comparison of hemoglobin levels in different studies

Hemoglobin (g%) Marwat et al. 2013 Afzal et al. 2009 Yasa et al. 2011 Bopche et al. 2007 Ganguly et al. 2011 Present Present
(IPC) [11] (IPC) [13] (IPC) [12] (IPC) [9] (FA) [15] study (IPC) study (FA)

Dose 3 mg/kg 3 mg/kg 5 mg/kg 6 mg/kg 3 mg/kg 6 mg/kg 6 mg/kg

Day 0 6.69 ± 1.04 7.60 ± 0.38 9.5 ± 1.10 8.46 ± 0.73 7.53 ± 1.68 6.93 ± 1.38 6.85 ± 1.23
1 mo – 8.80 ± 1.2 10.6 ± 1.0 8.67 ± 0.73 10.20 ± 1.01 8.95 ± 1.47 9.98 ± 1.36
2 mo – 9.7 ± 1.3 – – 10.65 ± 1.16 – –
3 mo 9.11 ± 1.25 10.5 ± 0.74 – – 11.38 ± 0.83 10.25 ± 1.52 11.73 ± 1.44
4 mo – – 11.7 ± 0.8 – – – –
Mean rise in Hb – 1.20 ± 0.1 1.2 ± 0.9 – 2.67 ± 0.67 2.0 ± 0.85 3.13 ± 1.01
after 1 mo
Mean rise in Hb 2.42 ± 0.71 2.90 ± 0.64 – – 3.24 ± 1.66 3.33 ± 1.33 4.88 ± 1.28
after 3 mo
Mean rise in Hb – – 2.3 ± 1.3 – – – –
after 4 mo

FA Ferrous ascorbate; Hb Hemoglobin; IPC Iron polymaltose complex

present study, the reticulocyte count showed a statistically
significant increase at day 3 and day 7 which is an ideal time
for evaluation of reticulocyte response [3] (Table 4).
There is a paucity of information on the comparison be-
tween IPC vs. FA. In the present study, the rise in Hb levels in
FA supplemented group was statistically better than the IPC
group at all stages of the study. The improvement in reticulo-
cyte count and MCV increase at the end of 7 d was better in FA
supplemented patients than that of IPC suggesting early initi-
ation of hematological recovery with FA supplementation.
This could be attributed to the better absorption of FA. It is
resistant to oxidation at alkaline pH, delivers the maximum
amount of ferrous iron to the duodenal brush border and at the
same time produces minimum gastrointestinal (GI) adverse
effects [16].
Considering Indian literacy scenario, compliance is a major
factor affecting the completion of therapy. Prolonged therapy
invites dropouts. The early improvement in hematological pa-
rameters in FA supplemented patients will help in early initi-
ation of replenishment of iron stores.
IPC is generally well tolerated and appears to cause
significantly less gastrointestinal disturbance than ferrous
salts [5]. Both the incidence and severity of adverse events
in most clinical trials have been lower with IPC than with
ferrous sulfate [11–13]. IPC is also safer in cases of acci-
dental overdose, and no fatalities have been reported [5].
However, the absence of adverse reactions in the IPC
group in the present study warrants further research for
improving the efficacy of the molecule so that an ideal oral
iron supplement will be developed.
In the present study the Hb increase at 1 mo and 3 mo,
MCV increase at day 7 and 1 mo, RDW decrease at 1 and 3
mo and reticulocyte count at day 3 and day 7 were found to be
statistically better in FA than IPC. Hence FA has got better
therapeutic efficacy than IPC. Although some minor side-
effects were observed in the FA group and none in IPC, the
significantly better response of FA would put FA as an agent of
choice for the correction of iron deficiency anemia.
The present study has certain limitations. Iron studies and
Hb electrophoresis were not done in all patients due to financial
constraints. Categorization of participants according to the se-
verity of anemia could have affected the results in both groups.
Conclusions
The iron salts (Ferrous ascorbate and Iron polymaltose com-
plex) used in the treatment of iron deficiency anemia showed a
significant statistical improvement in the hematological pa-
rameters during the 3 mo of intervention. The improvement
in hematological parameters was better in FA supplemented
patients as compared to IPC.
Authors’ Contribution PP and PG: Conceptualized and designed the
study, designed data collection instruments, collected data, carried out
initial analyses, drafted the initial manuscript, and approved the final
manuscript as submitted. PK, TJ, AS, SM, SP and AF carried out the
further analyses, reviewed and revised the manuscript, and approved the
final manuscript as submitted. PP is the guarantor for this paper.
Compliance with Ethical Standards
Conflict of Interest None.
References
1. Lanzkowsky P. Iron deficiency anemia. In: Lanzkowsky P, Lipton
JM, Fish JD, editors. Lanzkowsky Manual of Pediatric Hematology
and Oncology, 6th ed. London: Elsevier; 2016. p. 32–41.
2. Verma N, Naseem S. Hypochromic anemia: iron deficiency anemia
and sideroblastic anemia. In: Saxena R, editor. Gruchy’s Clinical

Haemotology in Medical Practice, 6th adapted ed. New Delhi:
Wiley; 2014. p. 33–57.
3. Sills R. Iron deficiency anemia. In: Behrman RE, editor. Nelson
Textbook of Paediatrics, Vol. II, First South Asia Edition (Reprint
20th ed). New Delhi: Elsevier; 2016. p. 2323–6.
4. Niranjan S. Nutritional anemias in infancy and childhood. In:
Parthasarathy A, editor. IAP Textbook of Pediatrics, 6th ed. New
Delhi: Jaypee Brother’s Medical Publishers; 2016. p. 749–834.
5. Geisser P, Müller A. Iron pharmacokinetics after administration of
ferric-hydroxide polymaltose complex in rats. Arzneimittelforschung.
1984;34:1560–9.
6. Svoboda M, Ficek R, Drábek J. Evaluation of the efficacy of iron
polymaltose complex in the prevention of anaemia in piglets. Bull
Vet Inst Pulawy. 2008;52:119–23.
7. Jaiswar DR, Amin PD. Solid-state characterization of ferrous ascor-
bate. Int J Pharm Pharm Sci. 2012;4:282–7.
8. Goddard AF, James MW, McIntyre AS, Scott BB. Guidelines for the
management of iron deficiency anaemia. Gut. 2011;60:1309–16.
9. Bopche AV, Dwivedi R, Mishra R, Patel GS. Ferrous sulphate ver-
sus iron polymaltose complex for treatment of iron deficiency ane-
mia in children. Indian Pediatr. 2009;46:883–5.
10. Devaki PB, Chandra RK, Geisser P. Effect of oral supplementation
with iron (III)-hydroxide polymaltose complex on the immunolog-
ical profile of adolescents with varying iron status. Arzneimittel-
Forschung. 2007;57:417–25.
11. Marwat IU, Hassan KA, Javed T, Chishti AL. Comparison of
the efficacy of ferrous and iron polymaltose salts in the
Indian J Pediatr
treatment of childhood iron deficiency anemia. Annals Kemu.
2013;19:322–6.
12. Yasa B, Agaoglu L, Unuvar E. Efficacy, tolerability, and acceptabil-
ity of iron hydroxide polymaltose complex versus ferrous sulfate: a
randomized trial in pediatric patients with iron deficiency anemia.
Int J Pediatr. 2011;2011:1–6 Article ID: 524520.
13. Afzal M, Qureshi SM, Lutafullah M, Iqbal M, Sultan M, Khan SA.
Comparative study of efficacy, tolerability and compliance of oral
iron preparations (iron edetate, iron polymaltose complex) and in-
tramuscular iron sorbitol in iron deficiency anaemia in children. J
Pak Med Assoc. 2009;59:764–8.
14. Vetter W, Steurer J. Single-centre, open, randomised, parallel-group
study comparing the efficacy and tolerability of oral ferric
polymaltose complex in doses of 200 mg, 400 mg and 600 mg
per day. Clinical Report [internal report]. St. Gallen, Switzerland:
Vifor (International) Inc; 2000.
15. Ganguly S, Dewan B, Philipose N, Samanta T, Paul DK, Purkait R.
Comparison between ferrous ascorbate and colloidal iron in the
treatment of iron deficiency anemia in children from Kolkata,
India. Br J Med Med Res. 2012;2:195–205.
16. Guinea JM. Results of preoperative autotransfusion with ferrous
ascorbate prophylaxis in orthopedic surgery patients. Sangre
(Barc). 1996;41:25–8.
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