Cobalt‐iron Therapy for Iron‐deficiency Anemia

Abstract

Iron-deficiency anemia is treated by the administration of iron in adequate quantity, and in a form that can be well tolerated and utilized by the patient. The oral route is preferred in all but an extremely small percentage of patients. The administration of iron, however, is not without risk of untoward reactions (1) , and acute iron intoxication has been described. Therefore iron preparations should be used more judiciously than in the past (2-5).The large doses of ferrous sulfate required to produce a therapeutic effect are poorly tolerated in about one-third of the patients treated. We should be searching constantly for preparations of iron that are absorbed more readily, thereby permitting the use of smaller doses. We (6-9) have reported experiences with 3 such preparations which, although better than most, did not fulfill the specifications of (a) excellent absorption, and (b) small dosage of iron.I n a previous study (6), excellent results were obtained with a cobalt-iron preparation containing 15 mg of cobalt chloride and 200 mg of exsiccated ferrous sulfate (corresponding to approximately 5 grains of ordinary ferrous sulfate) per tablet. When a modification of the tablet1 (15 mg of cobalt chloride equivalent to 3.7 mg of elemental cobalt, and 100 mg of exsiccated ferrous sulfate equivalent to 36.8 mg of elemental iron) was marketed, we became interested in a comparative study of this new smaller-iron-dose combination in a series of iron-deficiency anemia patients. METHODS AND MATERIALAll hematologic technics were carried out in the office laboratory except in the few instances in which the patients were in the hospital. The counting chambers, coverslips, and pipettes were all government certified. Hemoglobin estimations were made on a photoelectric colorimeter that had been checked at the beginning and at frequent intervals during the study by means of calibration against a standard iron solution, according to the method of Wong (10). All patients were studied with respect to hemoglobin level, red blood cell count, hematocrit, mean corpuscular volume (MCV) , mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC) . The appearance of the red blood cells in the differential smear was always used as a rough check on the calculated corpuscular constants. The technics and methods for obviating avoidable sources of errors have been summarized in another report (11). The degree of utilization of iron was calculated in the manner outlined previously (7).The 44 patients studied were white adults with iron-deficiency anemia; 5 were men and 39 were women. Their ages ranged from 16 to 84 years (average 52.5 years). They were from the middle-income group and all were private patients. The medication was