Long-term Effect of Intravenous Iron Carboxymaltose Treatment on Oxidative Stress in Women with Iron Deficiency Anemia


oxidative stress

How to Cite

Pektaş, G., & Kırlı, İsmail. (2021). Long-term Effect of Intravenous Iron Carboxymaltose Treatment on Oxidative Stress in Women with Iron Deficiency Anemia. HEALTH SCIENCES QUARTERLY, 1(1), 3-10. https://doi.org/10.26900/hsq.1.1.02


Objective: This study aims to clarify the effects of intravenous iron supplementation on biomarkers for oxidative stress in women with iron deficiency anemia.

Methods: This is a cross-sectional review of 40 healthy women and 40 women who underwent intravenous iron treatment due to anemia. Biochemical markers for oxidative stress were determined for both healthy controls and anemic patients. These markers were also evaluated at hour 1 and day 30 of intravenous iron treatment.

Results: The patients with anemia had significantly higher catalase activity and total oxidant status (TOS) but significantly lower nitrate and total anti-oxidant status (TAS) than the healthy controls (p=0.0245, p<0.0001, p=0.0437 and p<0.0001 respectively). At hour 1 of intravenous iron treatment, nitrate, nitrite, nitric oxide, total thiol and TAS values were significantly lower and TOS values were significantly higher than those before the administration of treatment (p=0.0322, p=0.0003, p=0.0005, p<0.0001, p<0.0001 and p=0.004). At day 30 of intravenous iron treatment, catalase activity, nitrate, total thiol and TOS values were significantly lower than those before the administration of treatment (p=0.0332, p=0.0015, p=0.0391 and p<0.0001 respectively) and at hour 1 of treatment (p=0.0498, p<0.0001, p=0.0004 and p<0.0001 respectively). At day 30 of intravenous iron treatment, nitric oxide and TAS values were significantly higher than those before the administration of treatment (p=0.0480 and p=0.001 respectively) and at hour 1 of treatment (p<0.0001 for both).

Conclusion: Intravenous iron replacement prompts oxidative stress at hour 1 of infusion in adults with anemia but this increase resolves partially in the following 30 days.



AUERBACH, M., ADAMSON, J.W. 2016. How we diagnose and treat iron deficiency anemia. American Journal of Hematology 91(1):31–38.

AUERBACH, M., DELOUGHERY, T. 2016. Single-dose intravenous iron for iron deficiency: a new paradigm. Hematology 2016(1):57–66.

AUERBACH, M., MACDOUGALL, I. 2017. The available intravenous iron formulations: History, efficacy, and toxicology. Hemodialysis International 21(1):S83–S92.

AVNI, T., BIEBER, A., GROSSMAN, A., GREEN, H., LEIBOVICI, L., GAFTER-GVILI, A. 2015. The safety of intravenous iron preparations. Mayo Clinic Proceedings 90(1):12–23.

BAILIE, G.R., SCHULER, C., LEGGETT, R.E., LI, H., LI, H.D., PATADIA, H., LEVIN, R. 2013. Oxidative effect of several intravenous iron complexes in the rat. BioMetals 26(3):473–478.

BRAMAN, R.S., HENDRIX, S.A. 1989. Nanogram nitrite and nitrate determination in environmental and biological materials by vanadium(III) reduction with chemiluminescence detection. Analytical Chemistry 61(24):2715–2718.

BURATTI, P., GAMMELLA, E. RYBINSKA, I. CAIRO, G., RECALCATI, S. 2015. Recent advances in iron metabolism. Medicine & Science in Sports & Exercise 47(8):1596–1604.

CAMASCHELLA, C. 2015. Iron deficiency: new insights into diagnosis and treatment. Hematology 2015(1):8–13.

CAPPELLINI, M.D., MUSALLAM, K.M., TAHER, A.T. 2020. Iron deficiency anaemia revisited. Journal of Internal Medicine 287(2):153–170.

CHAPARRO, C.M., SUCHDEV, P.S. 2019. Anemia epidemiology, pathophysiology, and etiology in low‐ and middle‐income countries. Annals of the New York Academy of Sciences 1450(1):15–31.

DAN DUNN, J., ALVAREZ, L.A., ZHANG, X., SOLDATI, T. 2015. Reactive oxygen species and mitochondria: A nexus of cellular homeostasis. Redox Biology 6:472–485.

DELOUGHERY, T.G. 2019. Safety of oral and intravenous iron. Acta Haematologica 142(1):8–12.

EDUARDO-TOBLLI, J., CAO, G., OLIVERI, L., ANGEROSA, M. 2012. Comparison of oxidative stress and inflammation induced by different intravenous iron sucrose similar preparations in a rat model. Inflammation & Allergy - Drug Targets 11(1):66–78.

EREL, O. 2005. A new automated colorimetric method for measuring total oxidant status. Clinical Biochemistry 38(12):1103–1111.

EREL, O. 2004. A novel automated direct measurement method for total antioxidant capacity using a new generation, more stable ABTS radical cation. Clinical Biochemistry 37(4):277–285.

EREL, O. 1998. Automated measurement of serum ferroxidase activity. Clinical Chemistry 44(11):2313–2319.

EREL, O., NESELIOGLU, S. 2014. A novel and automated assay for thiol/disulphide homeostasis. Clinical Biochemistry 47(18):326–332.

ERENLER, A., YARDAN, T. 2017. Clinical utility of thiol/disulfide homeostasis. Clinical Laboratory 63(5):867–870.

FIBACH, E., DANA, M. 2019. Oxidative stress in β-thalassemia. Molecular Diagnosis & Therapy 23(2):245–261.

GUPTA, A., ZHUO, J., ZHA, J., REDDY, S., OLP, J., PAI, A. 2010. Effect of different intravenous iron preparations on lymphocyte intracellular reactive oxygen species generation and subpopulation survival. BMC Nephrology 11(1):16.

JEONG, D.W., CHO, H., LEE, H., LI, C., GARZA, J., FRIED, M., BAE, T. 2011. Identification of the P3 promoter and distinct roles of the two promoters of the SaeRS two-component system in Staphylococcus aureus. Journal of Bacteriology 193(18):4672–4684.

KOSKENKORVA-FRANK, T.S., WEISS, G., KOPPENOL, W.H., BURCKHARDT, S. 2013. The complex interplay of iron metabolism, reactive oxygen species, and reactive nitrogen species: Insights into the potential of various iron therapies to induce oxidative and nitrosative stress. Free Radical Biology and Medicine 65:1174–1194.

LEE, F.S., PERCY, M.J. 2011. The HIF pathway and erythrocytosis. Annual Review of Pathology: Mechanisms of Disease 6(1):165–192.

DE LIMA PORTELLA, R., LYNN BICKTA, J., SHIVA, S. 2015. Nitrite confers preconditioning and cytoprotection after ischemia/reperfusion injury through the modulation of mitochondrial function. Antioxidants & Redox Signaling 23(4):307–327.

LOPEZ, A., CACOUB, P., MACDOUGALL, I.C., PEYRIN-BIROULET, L. 2016. Iron deficiency anaemia. The Lancet 387(10021):907–916.

MEROÑO, T., DAUTEUILLE C., TETZLAFF, W., MARTÍN, M., BOTTA, E., LHOMME, M., SAEZ, M.S., SORROCHE, P., BOERO, L., ARBELBIDE, J., CHAPMAN, M.J., KONTUSH, A., BRITES, F. 2017. Oxidative stress, HDL functionality and effects of intravenous iron administration in women with iron deficiency anemia. Clinical Nutrition 36(2):552–558.

OYEWOLE, A.O., BIRCH‐MACHIN, M.A. 2015. Mitochondria‐targeted antioxidants. The FASEB Journal 29(12):4766–4771.

PERCY, L., MANSOUR, D., FRASER, I. 2017. Iron deficiency and iron deficiency anaemia in women. Best Practice & Research Clinical Obstetrics & Gynaecology 40:55–67.

RAHAL, A., KUMAR, A., SINGH, V., YADAV, B., TIWARI, R., CHAKRABORTY, S., DHAMA, K. 2014. Oxidative stress, prooxidants, and antioxidants: The interplay. BioMed Research International 2014(761264):1–19.

SIES, H. 2015. Oxidative stress: a concept in redox biology and medicine. Redox Biology 4:180–183.

STURM, B., H. STEINKELLNER, N. TERNES, H. GOLDENBERG, AND B. SCHEIBER-MOJDEHKAR. 2011. In vitro study on the effects of iron sucrose, ferric gluconate and iron dextran on redox-active iron and oxidative stress. Arzneimittelforschung 60(7):459–465.

TOBLLI, J., CAO, G., GIANI, J., DOMINICI, F., ANGEROSA, M. 2014. Nitrosative stress and apoptosis by intravenous ferumoxytol, iron isomaltoside 1000, iron dextran, iron sucrose, and ferric carboxymaltose in a nonclinical model. Drug Research 65(07):354–360.

TOBLLI, J.E., CAO, G., GIANI, J., DOMINICI, F., ANGEROSA, M. 2017. Markers of oxidative/nitrosative stress and inflammation in lung tissue of rats exposed to different intravenous iron compounds. Drug Design, Development and Therapy 11:2251–2263.

URSINI, F., MAIORINO, M., FORMAN, H.J. 2016. Redox homeostasis: The Golden Mean of healthy living. Redox Biology 8:205–215.

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