Advantages of «iron + copper + manganese» combination in treatment of iron deficiency conditions in children

Rapid growth is the main cause of a negative iron balance that is why children are especially subject to development of iron deficiency anaemia. In a human body, 22 manganese proteins and 9 copper enzymes take part in iron metabolism. Iron monotherapy does not take into account interactions between trace elements and therefore might be accompanied by an increased number of side effects, and in case of copper deficiency (prematurity, active growth period, celiac disease, intestinal amyloidosis, intake of zinc preparations, Menkes syndrome) might result in either body overload with iron, or refractory to such treatment. The use of «Fe + Cu + Mn» combination permits to avoid such results. Analysis of 38 studies has shown that a combination of «Fe II + Cu + Mn gluconates» (Tot'hema) has a 2-3-fold better tolerance as compared with iron II sulfate and the same good tolerance as iron III preparations (level of evidence 1À). Side effects of Tot'hema intake, as a rule, were of transient character, in the group of children and adolescents (n = 690) they were 9.3%, refusals - only 0.4%. The synergistic action of three elements in the drug Tot'hema and its liquid form promote a rapid increase of haemoglobin: by 31% within 7-8 days in children and adolescents with mild iron deficiency anaemia and by 63% within 14-15 days in moderate anaemia.