Iron-deficiency anaemia in children
Iron-deficiency anaemia (IDA) is one of the most common nutritional disorders affecting children, particularly during periods of rapid growth and development. Inadequate dietary iron intake, increased physiological requirements, poor iron absorption, recurrent infections and chronic blood loss are important contributing factors. Iron is essential for haemoglobin synthesis, oxygen transport, cellular metabolism and neurological development. Its deficiency may result in pallor, fatigue, irritability, reduced appetite, impaired concentration and delayed cognitive development. Prolonged iron deficiency during early childhood may adversely affect neurodevelopment and learning abilities, highlighting the importance of early diagnosis and appropriate intervention.
Pandu Roga in Ayurveda
In Ayurveda, iron-deficiency anaemia is commonly correlated with Pandu Roga,1 a condition characterised by pallor or abnormal skin discolouration (Panduta), weakness (Daurbalya), fatigue (Shrama), reduced appetite (Aruchi) and impaired digestive capacity (Agnimandya). According to classical Ayurvedic principles, Pandu Roga primarily involves the vitiation of Pitta Dosha, along with disturbances in other Doshas and Rasa and Rakta Dhatus. Impaired digestive and metabolic processes (Agnimandya) may further affect tissue nourishment and the formation of healthy blood components. Ayurvedic management traditionally focuses on improving digestion, supporting Rakta Dhatu formation and restoring physiological balance.
Dhatri Lauha and its therapeutic significance
Dhatri Lauha is a classical Ayurvedic herbo-mineral formulation traditionally used in the management of Pandu Roga.2 It combines Dhatri (Emblica officinalis, commonly known as amla), Lauha Churna (processed iron), Yashtimadhu (Glycyrrhiza glabra) and Amrita (Tinospora cordifolia). The formulation brings together an iron-containing component and medicinal plants traditionally associated with digestive support and tissue nourishment.
Dhatri is recognised for its Rasayana properties and is a source of vitamin C and polyphenolic compounds. Vitamin C plays an important role in enhancing the absorption of non-haem iron. Lauha provides the iron-containing component required for haemoglobin synthesis, while Yashtimadhu and Amrita are traditionally used for their supportive therapeutic properties. The combined formulation has therefore attracted scientific interest as a potential intervention for iron-deficiency anaemia.
Exploring the potential mechanisms of action
The therapeutic rationale of Dhatri Lauha involves its iron-containing component and the complementary properties of its herbal ingredients. Iron is essential for haemoglobin production, erythrocyte formation and oxygen delivery to tissues. Amla contains ascorbic acid, which may enhance the absorption of dietary non-haem iron by improving its solubility and facilitating intestinal uptake. Its antioxidant constituents have also been investigated for their potential role in protecting cells against oxidative stress.
From an Ayurvedic perspective, Dhatri is considered Rasayana, while Lauha is traditionally used to support Rakta Dhatu formation.3 These properties provide a traditional basis for its use in Pandu Roga. However, the precise contribution of individual ingredients, their bioavailability and their combined pharmacological effects require further investigation.
Evidence from clinical studies
A prospective, open-label, single-arm, multicentre clinical trial evaluated the safety and efficacy of Dhatri Lauha in patients with iron-deficiency anaemia. The study was conducted across 12 centres and enrolled 458 participants aged 18–60 years, of whom 400 contributed to the final analysis. Participants received 500 mg of Dhatri Lauha twice daily after meals for 45 days. The formulation was evaluated using haemoglobin concentration, mean corpuscular volume (MCV), mean corpuscular haemoglobin concentration (MCHC), serum iron and serum ferritin as outcome measures.
The findings demonstrated statistically significant improvements in haemoglobin and other haematological parameters following treatment. Mean haemoglobin increased from 8.46 ± 1.14 g/dL at baseline to 9.18 ± 1.61 g/dL after 45 days. Improvements were also observed in serum iron and ferritin levels. Liver and kidney function parameters remained within normal limits during the study, and no participant discontinued treatment because of adverse events. These findings provide preliminary clinical evidence supporting the potential application of Dhatri Lauha in adult iron-deficiency anaemia. However, the study did not include children, and its findings cannot establish paediatric efficacy or safety.
Insights from paediatric Ayurvedic research
Although direct clinical evidence for Dhatri Lauha in childhood IDA remains limited, studies involving other Ayurvedic iron-containing formulations provide relevant research context. Kumar and Garai (2012) conducted a clinical study evaluating Trikatrayadi Lauha suspension in children with Pandu Roga and iron-deficiency anaemia. The study included children aged 1–15 years and investigated changes in clinical symptoms and haematological parameters following treatment. Improvements in haemoglobin and other blood indices were reported, suggesting the potential of further investigating Ayurvedic iron-based formulations in paediatric anaemia. However, these findings cannot be directly extrapolated to Dhatri Lauha because the formulations differ in composition.
A review (2023) also discussed the role of Ayurvedic interventions in childhood iron-deficiency anaemia, highlighting formulations such as Trikatrayadi Lauha and other traditional preparations. The authors emphasised the importance of a comprehensive approach involving dietary modification, digestive health and appropriate therapeutic interventions. Nevertheless, further formulation-specific paediatric trials are necessary to establish the clinical relevance of Dhatri Lauha.
Clinical assessment and safety considerations
The management of childhood IDA requires confirmation of iron deficiency and evaluation of its underlying causes. Clinical assessment should include dietary history, growth parameters, pallor, fatigue and other associated symptoms. Laboratory investigations such as complete blood count, peripheral blood smear and serum ferritin help establish the diagnosis. Inflammatory markers may also be useful when interpreting ferritin levels because inflammation can increase its concentration.
Since Dhatri Lauha contains processed iron, its use in children requires particular attention to age-appropriate dosing, pharmaceutical quality, elemental iron content and potential toxicity. Excess iron intake can cause gastrointestinal adverse effects and, in severe cases, iron toxicity. Standardisation, testing for heavy metal contamination and appropriate monitoring of liver and kidney function are important considerations. Its use should be supervised by qualified healthcare professionals, and it should not be administered without an established paediatric dosing protocol.
Integrating Ayurvedic care with standard paediatric management
The management of childhood IDA should prioritise correction of iron deficiency, adequate nutrition and treatment of underlying causes. Iron-rich foods such as green leafy vegetables, legumes, pulses, fortified cereals and appropriate animal-based foods can support dietary iron intake. Vitamin C-rich foods, including citrus fruits and amla, may improve non-haem iron absorption. Conventional oral iron supplementation remains the established first-line treatment for childhood IDA, with dosing determined by age, body weight and clinical severity. The Indian Academy of Pediatrics recommends oral elemental iron therapy at 2–3 mg/kg/day for most affected children, alongside nutritional interventions and follow-up assessment.
Dhatri Lauha may be considered a subject for further investigation within integrative paediatric healthcare. However, it should not replace prescribed iron supplementation, dietary correction or necessary medical treatment. Its potential role as an adjunctive intervention requires confirmation through well-designed paediatric clinical trials.
Conclusion
Dhatri Lauha is a traditional Ayurvedic herbo-mineral formulation with potential relevance to the management of Pandu Roga and iron-deficiency anaemia. Preliminary adult clinical findings indicate improvements in haemoglobin and iron-related parameters, while studies involving other Ayurvedic iron formulations offer additional research perspectives in paediatrics. However, direct clinical evidence supporting the use of Dhatri Lauha in children remains insufficient. Integrating traditional Ayurvedic principles with evidence-based paediatric management and rigorous clinical research is essential to establish its therapeutic applicability and safety.
References:
- Kumar A, Garai AK. A clinical study on Pandu Roga, iron deficiency anemia, with Trikatrayadi Lauha suspension in children. J Ayurveda Integr Med. 2012;3(4):215-222. doi:10.4103/0975-9476.104446. https://pmc.ncbi.nlm.nih.gov/articles/PMC3545243/
- Srikanth N, Rao BC, Yadav B, et al. Dhatri Lauha in the management of iron deficiency anemia: A prospective open-label single-arm multi-center trial. Ayu. 2021;42(2):69-75. doi:10.4103/ayu.ayu_379_21. https://pmc.ncbi.nlm.nih.gov/articles/PMC10158651/
- Khandelwal D, Donga SB, Harisha CR, Shukla VJ. Importance of Rasayana drugs in Dhatri Lauha w.s.r. to Garbhini Pandu (iron deficiency anaemia in pregnancy). J Pharm Biol. 2015;5(2):87-92. https://www.researchgate.net/publication/277559562_IMPORTANCE_OF_RASAYANA_DRUGS_IN_DHATRI_LAUHA_WSR_TO_GARBHINI_PANDU_IRON_DEFICIENCY_ANAEMIA_IN_PREGNANCY