Iron Supplementation in Anemic Patients with Cystic Fibrosis: Effects on Hematologic, Clinical, and Pulmonary Outcomes

Hokmabadi, Soheila; Hassanzad, Maryam; Ghaffaripour, Hosseinali; Malek, Fatemeh; Pourabdollah, Mihan; Farnia, Poopak; Mohammadpour-Belvirdy, Leila; Velayati, Ali Akbar

Iron Supplementation in Anemic Patients with Cystic Fibrosis: Effects on Hematologic, Clinical, and Pulmonary Outcomes

Document Type : Original Article

Authors

Soheila Hokmabadi ¹

Maryam Hassanzad ¹^{, 2}

Hosseinali Ghaffaripour ¹

Fatemeh Malek ³

Mihan Pourabdollah ¹

Poopak Farnia ⁴

Leila Mohammadpour-Belvirdy ¹

Ali Akbar Velayati ⁴

¹ Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran

² Telemedicine Research Center (TMRC), NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran

³ Pediatric Congenital Hematologic Disorders Research Center, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

⁴ Mycobacteriology Research Centre (MRC), NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Abstract

Background: Cystic fibrosis (CF) is an autosomal recessive multisystem disorder frequently complicated by anemia. This study aimed to evaluate the clinical, laboratory, radiological, and functional outcomes of oral iron therapy in anemic patients with CF.
Materials and Methods: In this interventional before–after study, 340 patients with confirmed CF were screened for anemia. Twenty-two patients met the diagnostic criteria for anemia, and 15 completed the study and were included in the final analysis. Participants received oral ferrous sulfate at a dose of 4–6 mg/kg/day (maximum 150 mg/day) for 6–8 weeks. Demographic characteristics, CBC, iron profile, inflammatory markers, pulmonary function tests, sputum culture, high-resolution computed tomography (HRCT) findings, and Shwachman–Kulczycki scores were evaluated before and after treatment.
Results: The prevalence of anemia among patients with CF was 6.47% (22/340). The mean age of participants was 18.8±1.24 years, and 53.3% were male. Hemoglobin and hematocrit levels increased significantly following treatment, with the greatest improvement observed among patients with combined iron deficiency anemia (IDA) and anemia of chronic inflammation (ACI) (p=0.007 and p=0.014, respectively). Serum iron levels also increased significantly after treatment (p=0.040). No significant changes were observed in pulmonary function indices, sputum culture results, or HRCT findings. Physical examination scores within the Shwachman–Kulczycki assessment improved significantly in the IDA+ACI group (p=0.039). Hemoglobin and ferritin levels showed significant direct and inverse correlations with the total Shwachman–Kulczycki score, respectively (p=0.003 and p=0.015).
Conclusion: Short-term oral ferrous sulfate therapy improved hematologic and selected clinical outcomes in anemic CF patients without evidence of worsening pulmonary infection or respiratory status. Accurate identification of anemia etiology and appropriate management may improve patient outcomes, although longer-term follow-up studies are warranted.

Keywords

Cystic Fibrosis

Anemia

Iron Deficiency Anemia

Ferrous Sulfate

Iron Supplementation