10 Professional Tips For The Treatment Of Iron-Deficiency Anemia!
Not all patients presenting with hematological findings of iron deficiency are iron deficient. The iron storage sites may show abundant iron which is unavailable for haemoglobinisation of the developing red cells. This is usually associated with chronic inflammatory or neoplastic disease in which there is an inhibition of mobilization of iron from the body stores. Here are ten useful professional tips for the treatment of iron-deficiency anemia.
1. It is self evident that the patient who is iron deficient requires iron. Almost all patients can be treated by the oral route and the cheapest preparation is ferrous sulphate given as a tablet containing 200 mg three times a day.
2. A small proportion of patients develop indigestion, constipation or diarrhea and then more expensive proprietary preparations may be tried. There are many of these and there is probably little to choose between them except that preparations employing a delayed release effect are to be avoided although they may give rise to less side-effects. This reflects the fact that they do not release the elemental iron at the best absorption site.
3. Some proprietary preparations can be given once daily. For the patient who cannot swallow tablets, proprietary liquid preparations may be used and are generally palatable.
4. Evidence of a response to oral medication usually appears in under two weeks. When there is concomitant inflammatory or neoplastic disease, response may be much slower and oral therapy should not be discarded until two to three months have passed. If no response is seen, it may be that the patient is not taking the tablets for a variety of reasons.
5. A check may be made by examining the stool which should he grey black if the patient is taking the tablets.
6. The rise in reticulocyte count associated with response to iron therapy is usually modest and seldom above 10%. After the hemoglobin level has returned to normal, iron should be continued for at least six months and in some cases a year in order to replenish iron stores. In cases of malabsorption, almost continuous therapy may be required or the parenteral route utilized.
7. Commercial preparations of iron for injection should not be used except when one or other of the oral preparations cannot be tolerated or is found to be ineffective. The parenteral route of administration is suitable for the few patients who are genuinely unable to take iron by mouth because of pain, vomiting or diarrhea, or who are unable to absorb iron because of some disorder of the gastrointestinal tract.
8. Iron given by injection has been used for the treatment of the anemia of rheumatoid arthritis, for the correction of severe anemia in the late stages of pregnancy and following major operations.
9. The recommended single dose of iron-sorbitol is 15 mg of iron per kg of body weight given daily. It is assumed that about 250 mg of iron are required to increase the hemoglobin level by 1 g/dl of blood but the total dosage of iron should not exceed 2.5 g. Iron-sorbitol should be given by intramuscular injection and should never be given intravenously.
10. Iron-dextran is seldom given intramuscularly because of local irritation and since it has been shown to cause sarcomatous change in certain animals. It can be given intravenously by what is known as the ‘total dose infusion method’ in a suitable diluents.