TREATMENT-IDA(Iron Deficiency Anaemia)

APPROACHDepends on

• Severity and Cause

• Ability of the patient to tolerate

• Absorption capacity

TREATMENT OF CAUSE

Underlying cause for iron deficiency should be treated

Such as upper GI bleed , peptic ulcer , menorrahagia

R xRED CELL TRANSFUSION

ORAL IRON THERAPY

PARENTERAL IRON THERAPY

RED CELL TRANSFUSION

INDICATIONS

Blood loss Cardiac instability

• Mainly related to severity of anaemia than to iron deficiency

• Not only corrects anaemia acutely but also acts as a source of iron for reutilization

• Stabilizes the patient

Mainly done for the patients with Hb < 8 gm/dl

Iron content of packed red cells is around 1 mg of haeme iron per ml

Expected Hb level after transfusion of 1 unit is 1 gm/dl

Iron stores replenishes in 2-3 weeks

Oral iron therapy

• Asymptomatic patients with established IDA

• Simple salts to complex iron compounds

• Ascorbic acid combination to enhance absorption

Oral iron supplements

• Ferrous sulphate (52%)

• Ferrous succinate (35%)

• Ferrous fumarate (33%)

• Ferrous gluconate (12%)

IRON TOLERANCE TEST

2 Iron tabs given

Serum Iron at 2 hrs

At least 100 mcg/dl

Do’s Empty stomach

Dont’s

Monitoring• Increase in reticulocyte count

after 4-7 days

• Increase in Hb level after 3-4

weeks

Monitoring• Reconsider the diagnosis if no response

• Reveal the cause for poor response

(prolonged bleeding ,poor patient

compliance)

• Don’t continue the treatment beyond 3-4

weeks if there is no favourable response

SIDE EFFECTS

Nausea,vomiting

Heart burnAbdominal discomfort

Constipation

PARENTERAL THERAPY

INDICATIONS Iron malabsorption

Severe oral iron intolerance

Haemodialysis patient

Patients on erythropoietin Therapy

Non compliance patients

Iron Dextran

Ferumoxytol (510 mg / inj )

Sodium Ferric Gluconate (125mg

/inj )

Iron Sucrose (200mg/inj )

Ferric Carboxymaltose (750mg/inj )

Parenteral preparations

GOAL1.To correct Hb deficit and provide

atleast 500mg of iron stores

2.Repeated small doses in a

protracted period

Formula to Calculate Iron need

• Body weight(Kg) x 2.3 (15 – Patient’s

Hb,gm/dl) + 500 or 1000mg(Store)

Drug of Choice• IM (Z-track technique) Iron Dextran 2ml

daily on Alternate days

• IV (Test dose-0.5ml) of Iron dextran over

5-10 minutes,2ml can be injected/day

taking 10 mins for inj.

Newer Preparations Ferrous sucrose-100mg IV in 5mins(once

daily/weekly)

Ferric carboxymaltose(latest

formulation) 100mg IV or 1000mg

diluted with saline in 15 mins

IRON DEFICIENCY ANAEMIA IN PREGNANCY

Depends on degree of anaemia &period of gestation

Blood transfusion: severe anaemia, near term or if she is in labour

Oral treatment : Ferrous salts given 200 mg TDS

Intramuscular therapy : Iron dextran

complex ,Iron- sorbitol -citric acid complex

Oral iron is stopped 24 hrs priorly

Intravenous therapy: Iron dextron diluted in

500ml of 5% glucose as slow iv as needed

Closely observe during IV infusion

SIDE EFFECTS

STAINING

FEVER

Headache STERILE ABSCESS

PREVENTION

Initiative by TN govt

Treat the underlying cause

Treat the anaemia

Replenish the Iron stores