Iron deficiency anemia in dogs: Therapeutic management

Introduction

Dogs have been domesticated for millennia and currently serve various roles ranging from companionship to working and security duties (Wallace et al., 2017) [1] . Among the numerous health challenges affecting canines, anemia is a commonly encountered condition, often secondary to inflammatory, neoplastic, parasitic, nutritional, or toxicological causes (Fry, 2010; Dhuria et al., 2013) [2,3] . Anemia is defined as a reduction in red blood cell count, hemoglobin concentration, or packed cell volume below the species-specific reference interval (Ettinger et al., 2017) [4] . One notable subtype is iron deficiency anemia (IDA), typically characterized as a microcytic hypochromic anemia. It is often the result of chronic blood loss due to gastrointestinal bleeding, ectoparasite infestations, or dietary insufficiencies, especially in young or malnourished dogs (Schalm et al., 1975; Naigamwalla et al., 2012) [5,6] . Iron is a vital micronutrient for metabolic processes, including oxygen transport and energy production. It exists primarily in hemoglobin but also participates in enzymatic reactions through cytochromes and myoglobin (Crichton, 2009) [7] . Iron homeostasis is tightly regulated to prevent deficiency or overload, with dietary iron being absorbed predominantly in the duodenum and exported into circulation via ferroportin. This process is hormonally controlled by hepcidin, which modulates iron efflux based on systemic iron levels (Crichton, 2009; Harvey, 2008; Knovich et al., 2009) [7,8,9] . IDA manifests clinically with signs such as pallor, lethargy, reduced exercise tolerance, and in severe cases, pica-an unusual craving for non-nutritive substances (Harvey, 2008; Giger, 2005) [8,10] . Diagnosis is confirmed by evaluating serum ferritin, total iron binding capacity (TIBC), transferrin saturation, and red blood cell morphology (Weiss, 2010) [11] . Standard treatment involves cessation of blood loss, correction of the underlying cause, and and iron supplementation. Parenteral iron preparations like iron dextran allow rapid replenishment of iron stores, especially when oral absorption is compromised (Giger, 2005; Plumb, 2008) [10,12] . On the other hand, oral iron therapy must be tailored carefully to avoid gastrointestinal irritation and requires prolonged administration. Recently, interest has grown in alternative treatments such as homeopathy. Remedies like Ferrum metallicum are proposed to enhance iron utilization and absorption, with anecdotal evidence suggesting benefits in IDA management (Boericke et al., 2008; Dwivedi, 2019) [13,14] . However, scientific validation through controlled studies is lacking. Considering these aspects, the present study was undertaken to evaluate the hospital prevalence of IDA in dogs, analyze associated clinico-haematological parameters, and compare the therapeutic efficacy of allopathic and homeopathic interventions.

Materials and Methods

Selection of cases

Between September 2024 and February 2025, client-owned dogs presented with clinical signs indicative of anemia such as pallor of conjunctival mucous membranes, lethargy, weakness, and anorexia were screened. Diagnostic procedures included peripheral blood smear examination, faecal examination, complete blood count and serum biochemical assessments. Dogs exhibiting mild (PCV 30-36%) to moderate (PCV 20-29%) anemia were enrolled, resulting in a total of 20 IDA-positive subjects. Each of the 20 IDA-positive dogs underwent a thorough clinical evaluation. Parameters recorded included rectal temperature (°F), respiratory rate (breaths/min), heart rate (beats/min), mucous membrane color, and lymph node examination. Blood (4 mL) was collected aseptically from the cephalic or saphenous vein. Two milliliters were placed in EDTA vials for hematological analysis, and the remaining 2 mL was transferred to clot-activator vials for serum separation. Peripheral blood was obtained from the ear tip and smears were prepared, fixed in methanol, stained with 1:20 diluted Giemsa stain for 20 minutes, and examined under oil immersion (100×) for haemoparasites. Faecal samples were emulsified, filtered, and centrifuged at 3000 rpm for 5 minutes. Sediments were examined microscopically to identify ova of gastrointestinal parasites contributing to anemia.

Haematological Parameters

Hematological indices including hemoglobin concentration, packed cell volume (PCV), total erythrocyte count (TEC), total leukocyte count (TLC), platelet count, and differential leukocyte count (DLC) were assessed using an automated blood analyzer (Abacus ABJ Vet-5, Junior Vet 5). Evaluations were performed on day 0 (pre-treatment), and repeated on day 14 and 21 (post-treatment).

Serum Biochemical Parameters

Serum samples were analyzed using standard assay kits with a semi-auto biochemistry analyzer (Alta ADX-CHEM-220). The parameters included serum iron, total iron-binding capacity (TIBC), unsaturated iron-binding capacity (UIBC), percentage transferrin saturation (%TSAT), total protein, and glucose. Measurements were performed at the same intervals as hematological assessments.

Serum Iron and TIBC Estimation

Iron profile study parameters, including serum iron, serum TIBC, and%TSAT, were estimated using the Coral Clinical System IRON + TIBC kit via spectrophotometry at 570 nm. Serum iron was determined by the Ferrozine method, serum TIBC was calculated using a biochemical method, and transferrin saturation was computed using the formula: % TSAT = (Serum iron/TIBC) × 100

Treatment Protocol

The dogs were divided into two experimental groups (n=10 each), along with a control group (n=10) of healthy animals. Treatment protocols were as follows:

Results and Discussion

Of 1,951 dogs presented to the VCC, 117 were anemic and screened for IDA. Twenty of the 23 IDA-positive dogs were randomly assigned to two treatment groups: Group I (allopathic) and Group II (homeopathic), and their responses were documented.

Prevalence

In this study, 23 of 117 anemic dogs (19.66%) were diagnosed with IDA, representing a hospital prevalence of 1.18% among 1,951 dogs. IDA was most common in dogs under 1 year old (40%), followed by those over 6 years (25%), aged 1-3 years (20%), and 3-6 years (15%). Male dogs had a higher prevalence (60%) compared to females (40%). Among breeds, Labradors had the highest prevalence (25%), followed by non-descript dogs (15%). German Shepherds, Golden Retrievers, Pomeranians, and Rottweilers each showed a prevalence of 10%, while Pitbulls, Saint Bernards, Dachshunds, and Beagles each had a prevalence of 5%.

Clinical Signs

Among 20 IDA-positive dogs, the most common clinical signs were lethargy (90%), melena (60%), and weight loss (55%), followed by anorexia (45%), inappetence (40%), pica (35%), vomiting (40%), exercise intolerance (30%), epistaxis (20%), ascites (15%), and hematochezia (5%).

Rectal temperature was recorded in all IDA-positive dogs, with 50% showing hyperthermia. Tachycardia was observed in 60% of dogs, and tachypnea in 55%. On physical examination, 60% of dogs had enlarged lymph nodes, and 90% showed pale mucous membranes, the most prominent finding. The treatment of IDA in dogs was based on the underlying cause. Parasitic infections such as Ancylostoma caninum were managed with a single oral dose of Praziquantel (5 mg/kg BW), Pyrantel pamoate (14.4 mg/kg BW), and Fenbendazole (50 mg/kg), while Toxocara spp. was treated with Pyrantel pamoate (5 mg/kg) for three days, and Dipylidium spp. with Praziquantel (20 mg/kg) for two days. Protozoal infections like Babesia gibsoni were addressed using Clindamycin (25 mg/kg BW, BID), Doxycycline (10 mg/kg BW, OD), Metronidazole (15 mg/kg BW, BID), and Carica papaya extract (5 ml/dog) orally for 21 days. Dermatological conditions such as demodicosis were treated with a single oral dose of Fluralaner (10 mg/kg). Gastrointestinal issues, including gastritis, were managed with Sucralfate (500-1000 mg/dog) and Inj. Ondansetron (0.2 mg/kg) as needed, while NSAID toxicity was treated with Activated Charcoal (10 ml orally once), Liver tonic (5 ml orally twice for 10 days), Normal Saline, and Ranitidine

(2 mg/kg). Hematological disorders like haematuria required intravenous administration of Normal Saline and Haemocoagulase (0.5-1 ml/dog), and any abnormal mass was surgically removed. Dietary deficiencies were addressed by including egg yolk, chicken liver, and fish in the diet, providing a comprehensive approach to managing IDA by targeting both the primary causes and associated conditions. The comparative analysis of the two treatment groups (allopathic and homeopathic) for IDA in dogs revealed significant improvements in both clinical and haematobiochemical parameters. In Group I, which received allopathic treatment which included injection iron dextran @ 10 mg/kg B.wt IM OD every week for 2 weeks, syrup ferrous glycinate + copper glycinate + cobalt glycinate @ 5 ml/20Kg B.wt PO BID for 21 days, there was a highly significant increase in Hb levels from 7.46±0.29 g/dl on day 0 to 10.99±0.21 g/dl on day 21 (p<0.01). Similarly, PCV rose from 22.99±0.79% to 33.17±0.59% (p<0.01), and TEC increased from 3.74±0.14 × 10⁶/μl to 6.42±0.25 × 10⁶/μl (p<0.01). Similarly, Group II, which received homeopathic treatment which included Ferrum metallicum 6-10 drops 30C PO BID for 21 days, Cobaltum metallicum 6-10 drops 30C PO BID for 21 days, and Cuprum metallicum 6-10 drops 30C PO BID for 21 days, also showed significant improvements in haematological parameters, though with slightly different trends. Haemoglobin levels rose from 7.03±0.36 g/dl at baseline to 10.11±0.31 g/dl by day 21 (p<0.01), and PCV increased from 20.74±1.13% to 30.32±0.93% (p<0.01). The TEC levels followed a similar pattern, rising from 3.46±0.22 × 10⁶/μl to 6.18±0.34 × 10⁶/μl (p<0.01). While the pattern of improvement was comparable between both groups, the overall rise in Hb, PCV, and TEC was significantly higher in the allopathic group, suggesting improved iron utilization. Neutrophil and lymphocyte percentage variations in both groups indicated an improved immune response. Neutrophils significantly decreased in Group I (from 81.4±2.00% to 68±0.76%, p<0.01) and Group II (from 76.80±3.60% to 66.40±0.50%, p<0.01), while lymphocytes increased in both groups, indicating recovery. Although the changes in TLC and monocyte levels were not significant, eosinophils decreased in both groups. Serum biochemical analysis further reinforced the efficacy of both treatments. In Group I, iron levels increased significantly from 55.47±4.78 µg/dl to 114.49±6.18 µg/dl (p<0.01), while in Group II, iron levels improved from 52.21±4.31 µg/dl to 98.72±5.89 µg/dl (p<0.01). The%TSAT also showed a highly significant increase in both groups, with Group I reaching 33.73±1.75% and Group II reaching 30.11±1.92% by day 21 (p<0.01). Additionally, UIBC decreased significantly in both groups, confirming better iron absorption.

Conclusion

Overall, both treatment approaches were effective in managing IDA, with significant improvements in haematological and biochemical parameters. The allopathic treatment demonstrated a slightly faster restoration in haemoglobin, PCV, and iron levels, suggesting rapid iron replenishment. On the other hand, the homeopathic regimen also produced substantial improvements, indicating enhanced iron utilization and erythropoiesis. The results suggest that while allopathy offers a more immediate correction, homeopathy can serve as a viable alternative with sustained benefits, potentially reducing dependency on synthetic iron supplementation.

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