Alternate day oral iron replacement versus daily intake in women with iron-deficiency anemia in Basrah

Muntadar Jafar Mawla, Internist, Basrah health directorate, Basrah, Iraq.Follow
Mohammed A. Al-Anssari, Clinical hematologist, Basrah hematology center, Basrah health directorate, Iraq.Follow
Qutaiba M. Dawood, Assistant Professor Internist-Clinical hematology, Alzahraa college of medicine, University of Basrah, Iraq.Follow
Murtadha A. Jeber, Consultant in internal medicine, Basrah health directorate, Iraq.Follow
Asaad A. Khalaf, Consultant in clinical hematology, Basrah hematology center, Basrah health directorate, Iraq.Follow

Article Type

Original Study

Abstract

Background: Iron-deficiency anemia (IDA) remains a major global health concern, disproportionately affecting women of reproductive age. Conventional daily iron supplementation, though effective, is often associated with poor adherence due to gastrointestinal side effects. Emerging evidence suggests that alternate-day dosing may enhance iron absorption and tolerability, but comparative efficacy data in clinical settings remain limited. Aim: This study aimed to compare the hematological and iron store responses of women with IDA in Basrah, Iraq, between alternate-day and daily oral iron supplementation regimens. Methods: A total of 97 women with confirmed IDA (hemoglobin [Hb] < 12 g/dL, serum ferritin < 15 ng/mL) were enrolled in a prospective follow-up cohort study. The participants were divided into two groups: Group B (n = 48) received 100 mg of elemental iron daily, while Group A (n = 49) received the same dose every other day. Serum ferritin and hematological parameters (Hb, red blood cell [RBC] count, hematocrit) were assessed at baseline, three weeks, six weeks, and three months. ANOVA and paired t-tests were used for statistical analysis, with a significance level of P < 0.05. Results: Compared to the daily group, the alternate-day group exhibited a significantly higher mean increase in serum ferritin (28.6 ± 4.2 ng/mL vs. 22.3 ± 3.8 ng/mL, P = 0.001) and hemoglobin (2.8 ± 0.5 g/dL vs. 2.1 ± 0.4 g/dL, P = 0.001) at three months. The alternate-day group demonstrated earlier and more sustained improvements in iron reserves (P < 0.01 at all follow-ups), but both regimens increased RBC counts. Conclusion: In women with IDA, alternate-day iron supplementation is more effective in restoring hemoglobin and iron stores than daily dosing, possibly due to improved absorption and reduced hepcidin inhibition. These findings suggest potential benefits for patient adherence and clinical outcomes, supporting the use of alternate-day regimens as a superior therapeutic approach. To validate these results, further randomized controlled trials are necessary.

Keywords

Iron-deficiency anemia, alternate-day dosing, daily iron supplementation, hemoglobin, serum ferritin, hepcidin

Recommended Citation

Mawla, Muntadar Jafar; Al-Anssari, Mohammed A.; Dawood, Qutaiba M.; Jeber, Murtadha A.; and Khalaf, Asaad A. (2025) "Alternate day oral iron replacement versus daily intake in women with iron-deficiency anemia in Basrah," Iraqi National Journal of Medicine: Vol. 7 : Iss. 2 , Article 15.
Available at: https://doi.org/10.37319/