IRON DEFICIENCY ANEMTA Presenting by: Shoneza Kingston and Fizal Alilron Deficiency Anemia "anemia" usually refers to a condition in A which your blood has a lower than normal number of red blood cells. Iron is an essential mineral that is needed 4 to form hemoglobin, an oxygen carrying protein inside red blood cells. Iron deficiency anemia is a condition in which the body lack enough red blood ce! to transport oxygen-rich blood to body oiler)Pathophysiology Figure 3 Erythropoietin tron ~ 1 @ -@= -@ — BFU-E CFU-E Pro- Erythroblast * Iron deficiency anemia is the most common form of anemia and it develops over time if the body does not have enough iron to manufacture red blood fe) Eo * Without enough iron, the body uses up all the iron it has stored in the liver, bone marrow and other organs.* Once the stored iron is depleted, the body is able to make very few red blood cells. + If erythropoietin is present without sufficient iron, there is insufficient fuel for red blood cell production * The red blood cells that the body is able to make are abnormal and do not have a normal hemoglobin-carrying capacity, as do normal red blood cells.Figure 3 Iron Deficiency Anemia BS 5e3 si Es se OF a3, normal bloodN %, ‘ Etiology + lron-deficiency anemia is usually due to: QO) blood loss Q) poor diet Q) an inability to absorb enough iron from food. 4 a «4* Blood Loss QO) Blood lost causes iron depletion QOIn women, long or heavy menstrual periods or bleeding fibroids in the uterus. OChildbirth Olnternal bleeding * Poor Diet ULow iron intake. 1 TU Tal ateme=celantewe) tle [=m ey (mele erg =) pregnancy and childhood. ne EJ oo os od* Inability To Absorb Enough Iron ) \ QOiEven if you have enough iron in your — ) diet, your body may not be able to it absorb it. This can happen if you have — intestinal surgery or a disease of the \ intestine. I OPrescription medicines that reduce acid in the stomach also can interfere with iron absorption.Clinical Presentation Obrittle nails ‘ - lron-deficiency anemia can cause: ) Q cy )| Ocracks in the sides of the mouth ;O Extreme fatigue (tiredness)OMe ef-l (M141)Ce aro] =t= eel) * HeadacheQian enlarged spleen OCold hands and feet mice WIM iceolase Olrritability Oshortness of breath Oswelling or soreness of the tongue 2, i we ce* An unusual craving for non-nutritive substances such as: Olce * Bia mere nels t= a t This craving is called pica. f y )’ * Some people who have iron-deficiency | : anemia develop restless legs syndrome (RLS). RLS is a disorder that causes a ee urge to move the legs.* Some signs and symptoms of iron-deficiency anemia are related to the condition's causes QO Assign of intestinal bleeding is bright red *; blood in the stools or black, tarry-looking | stools. rN QO Very heavy menstrual bleeding, long period: — or other vaginal bleeding may suggest that a / : woman is at risk for iron-deficiency anemia. — l* Severe iron-deficiency anemia can ad to: Oproblems with growth and aid alias ; in children Oangina (chest pain) Oleg pains (intermittent claudication) / od <—TREATMENT IRON SUPPLEMENT errous Sulphate i (iIMPORTANT POINTS ABOUT IRON LY SUPPLEMENT. v Before using iron medication, check if you Elec) enti ‘0 any drugs or food dyes, or if you have: iron overload syndrome ‘ hemolytic anemia (a lack of red blood cells) porphyria (a lip enzyme disorder that causes gle ioms affecting the skin or Talla elt See betes eel G) — disorder of red blood cells) liver or kidney disease if you are an alcoholic; or if you receive regular blood transfusion. . . re) . me, <—IMPORTANT POINTS ABOU’ ) IRON SUPPLEMENT. i empty stomach, at least 1 hour before — « Most iron medication are taken on my. r or 2 hours after meal. \ 7 7DEFICIENCY ANEMIA. TREATMENT OF IRON ‘i * Iron deficiency anemia is treated with oral or ’ parenteral iron preparation. Oral iron corrects , the anemia just as rapidly and completely as \ parenteral iron in most cases if iron absorption f from the GIT is normal. = Different iron salt provide different amount of \ elemental iron. r In iron deficient individual, about 50-80mg of i F iron can be incorporated in hemoglobin daily and about 25% of oral ferrous salt can be absorbed.ORAL IRON THERAPY \Y f * Oral iron treatment may require 3-6 i) | months to replenish body stores. J \ | TABLE SHOWING SOME COMMON ORAL IRON MEDICATION. Preparation Tablet size |Elemental iron per tablet |Usual Adult Dosage(per tab) | Femnoussufate- hydrated | 325mg | fame | tod eroussutate-desicated| 200mg | esmg_— | stad Ferousgconate | zomg | tomg =| ato rerousturarate | 00mg | img | tos pi img | tog | ttsFerrous sulfate is the DOC for iron deficiency anemia. Dosage: 325 mg tid, which provides 180 mg of iron daily of which 10mg is 1 usually absorbed. fr oraie Patients who cannot Suite Sulfate tolerate iron on an empty = stomach should take it with food. Administration: PO © 125 TABLETSGENERAL MECHANISM OF ACTION OF IRON AY SU aaa NF P) During the process of absorption, ) oxygen combines with iron and is i transported into the plasma portion of ay blood by binding to transferrin. P From there, iron and transferrin are \ 4 : used in the production of hemoglobin _ (the molecule that transports oxygen Dy the blood) and myoglobin( helps your muscle cells store oxygen.)COMMON ADVERSE EFFECTS i OF ORAL IRON THERAPY ¢ + Nausea ¢ Epigastric discomfort A ty .- + Abdominal cramps * Constipation and diarrhea. * Black stool * These effects are usually dose- ale A elCONTRAINDICATIONS \ + Avoid taking any other multivitamin or ’, mineral product within 2 hours before or _ after taking your iron supplement. Avoid antibiotic such as ciprofloxacin , \ demeclocycline , doxycycline , levofloxacin, lomefloxacin , minocycline , norfloxacin , ofloxacin , or erence Avoid antacids within 2 hours before or after meals when taking your iron medication* If you have a bleeding disorder, you \ should avoid non-steroidal anti- bi inflammatory (NSAID) drugs, as well } as aspirin, because these drugs may » / interfere with blood platelets, prolong r bleeding, and irritate your stomach. \ A ,PARENTERAL IRON \ THERAPY ve * Iron Dextran- is a stable complex of ferric hydroxide and low-molecular- ] weight dextran containing 50mg of elemental iron per milliliter of Bee "i Fa\ It can be given deep IM injection or IV iy infusion. P | PN Mole -m 1a -le light-headedness, fever, arthralgias, back pain, urticaria, bronchospasm and Vee s reaction.2)- Iron sucrose complex & iron sodium gluconate complex. \ These are indicated for patient with A hypersensitivity reactions to oral iron Rice n ; They are only given by IV route For patient who are treated chronically with iron, it is important to monitor the iron level to avoid serious toxicity associated with iron overload. Adverse effect same as iron dextran. A Se ali Non- pharmacological treatment << * lron-rich diet * Good sources of iron includes = meats - beef, pork, lamb, liver, and other organ aoe — poultry - chicken, duck, turkey, liver (especially dark %y meat) / = fish - shellfish, including clams, mussels, and oysters, )’ sardines, anchovies — leafy greens of the cabbage family, such as broccoli, kale, turnip greens, and collards — legumes, such as lima beans and green peas; dry beans and peas, such as pinto beans, black-eyed peas, and canned baked beans eeeREFERENCES A The HealthCentralNetwork, Inc.Copyright © 2001-2011. Treatment of \ Breil ie Us Rel PO MO Saco im ate ae for the rears renee © Pane 2011. Iron Fs Eel Uhre noe EOS OMS Stila oh ice lua) 4 ttp://www.drugs.com/ppa/ A-Z Drug Facts for the Professional, Copyright © 2000-2011. What =~ j avoid while taking iron supplement, retrieved on 2011-10-03. Retrieve http://www.drugs .com/ferrous_sulfate.htm| Bs National Center for Biotechnology Information, LORS PAN-lfela Beles MOM elle -m ole) RS Cole a7 eda sclera USA Iron supplements: a common cause of drug interactions, retrieve PA Rate lula en cei) 4 aaen Basic and clinical pharmacology 10" edition, Beram.G. Katzung,MD. Professor Emertus, Department of cellular & Molecular Pharmacolog) University of California San Francisco.