Iron deficiency anemia is the most advanced stage of iron deficiency which is characterized not only by low hemoglobin and Hematocrit levels but also by a reduction or depletion of iron stores, by low serum iron levels and decreased transferrin saturation.

1. Iron Deficiency Anaemia
Prepared By:- Ajay kumar sah
16BPH080
VIII SEM
B PHARMACY

2. Contents
•Introduction
•Types of iron deficiency anaemia
•Etiology
•Pathophysiology
•Pharmacological treatment
•Non-pharmacological treatment
•Conclusions
•References

3. Introduction
• Anemia is considered the most common nutritional deficiency worldwide and in
95% of cases it is associated with an iron-poor diet, despite the fact that iron is the
second most abundant metal in the earth’s crust. Anemia is more common in
infants, in children of 3 to 6 years of age and in adolescents of 11 to 17 years of age
particularly those living in developing countries, constituting a serious public health
issues. The World Health Organization estimates that around two billion individuals
worldwide, i.e. over 30% of the world’s population, are anemic, highlighting the
importance of anemia as a public health issue in both developing and developed
nations. In developed countries, 4.3 to 20% of the population, depending on age and
gender, are affected by iron deficiency anemia, while in developing countries these
figures range from 30 to 48%. Notwithstanding, few data are currently available on
the prevalence of iron deficiency anemia in adolescents. Statistics of United States
show iron deficiency prevalence rates of 9% in girls of 12 to 15 years of age and
16% in girls aged 16-19 years. In boys, these rates are lower. In India, WHO has
found 1% moderate and 4.4% severe anaemia among the Indian populations and
for15-19 year’s age group prevalence is 47%, out of which 43.6% have mild, 1%
moderate and 2.4% severe anaemia.

4. • Anaemia is a term given to a pathological process in which erythrocyte
hemoglobin (Hb), Hematocrit (Ht) and the concentration of red blood cells
per unit of volume are abnormally low compared to the peripheral blood
parameters of a reference population. In normal individuals, Hematocrit
and hemoglobin levels vary in accordance with the phase of development
of the individual, and as a function of hormonal stimulation,
environmental oxygen pressure, age and gender. Iron deficiency is defined
by a reduction in Ferritin levels that generally results from a diet in which
the bioavailability of iron is inadequate or from an increased need for iron
during a period of intense growth (pregnancy, adolescence and infancy).
Decreased ferritin levels may also be the consequence of extensive blood
loss, either in hemorrhagic conditions or in cases of occult bleeding or
following inflammatory processes caused by various chronic diseases. The
amount of iron in the body varies according to weight, gender, hemoglobin
level and the size of body iron stores. Iron is known to play an important
role in the formation of hemoglobin, myoglobin and other heme proteins.
In the diet, iron is present in red meat, eggs, vegetables and grains. Its
absorption depends largely on its balance in the body. Commonly, around
10% of iron intake is only absorbed in our body.

5. • Iron deficiency anemia is the most advanced
stage of iron deficiency which is characterized not
only by low hemoglobin and Hematocrit levels
but also by a reduction or depletion of iron
stores, by low serum iron levels and decreased
transferrin saturation. In general, serum iron
levels decrease in the presence of acute and
chronic infections, extensive inflammatory
processes, malignant neoplasm, during
menstruation and, principally, when there is a
prolonged deficit of iron in the diet. Evidence that
iron deficiency hampers psychomotor
development and cognitive function is attracting
more and more interest.

6. • These alterations are particularly concerning, since they occur
even in the presence of relatively mild anemia (Hb levels less
than 1 g/dl) and their reversibility remains uncertain.
Otherwise in case of High levels may be a consequence of
iron poisoning or may present during some types of hemolytic
anemia, hemochromatosis and sideroblastic anemia.
• The cut-off hemoglobin limits established by the World Health
Organization (WHO) to define iron deficiency anemia are
shown in table I.

7. Age Group and Gender Hemoglobin (g/dl)
Children of 6 to 59 months (both sexes) 11.0
Children of 5 to 11 years (both sexes) 11.5
Children of 12 to 14 years (both sexes) 12.0
Non-pregnant women (> 15 years) 12.0
Pregnant women 11.0
Men (> 15 years) 13.0

8. Types of iron deficiency anaemia
Generally there are three categories of iron deficiency anaemia on the
basis of hemoglobin content which are shown in tabular form in table
II.
TYPES OF IRON DEFICIENY ANAEMIAS DESCRIPTION
MILD Hemoglobin of 100-109 g/l in
pregnant women, 110-119 g/l in
children and adult women and 120-
129 g/l in adult men.
MODERATE Hemoglobin of 70-99 g/l in pregnant
women, 80-109 g/l in children and
adult women and 90-119 g/l in adult
men
SEVERE Hemoglobin of ˂70 g/l in pregnant
women, ˂80 g/l in children and adult
women and ˂90 g/l in adult men.

9. note:
Severe iron deficiency anaemia may gets develop into another advanced stage i.e.
cognitive impairment which is characterized by Delayed psychomotor development,
impaired performance on language skills, motor skills and co-ordination that is
equivalent to a 5-10 point deficit in IQ.
Etiology
There are several causes of iron deficiency anaemia and the most
common cause is the poor diet and nutritional insufficiency. Some of
the major contributing factors are as follows:
•Low iron diet: An inadequate diet, with poor iron, micronutrient and vitamin
content, leading to an insufficient intake of nutrients such as iron, folic acid, vitamin
A, vitamin B12 and vitamin D29. Multiple micronutrient deficiencies are still
common worldwide and may be present at any age, hampering both physical and
cognitive development.
•Use of medication: The use of medication and food that inhibit iron absorption,
including antacids, aspirin, non-steroidal anti-inflammatory drugs, and excessive
phytate, phosphate, oxalate and tannin intake.

10. •Overweight and obesity: The prevalence of overweight and obesity has
increased significantly in children and adolescents and, in these individuals,
iron deficiency may be related to a micronutrient-poor, calorie-rich diet, to a
greater need for iron that is associated with body weight, to genetic factors
and/or to sedentariness. Furthermore, overweight and obesity lead to a
continuous inflammatory process, intensifying anemia and hampering
treatment.
•Malnutrition: In addition to an inadequate diet, there are other possible
associated conditions such as malabsorption syndrome and/or excessive iron
loss. In this context, these patients also have flattening or atrophy of the
intestinal villi, hampering micronutrient absorption.
•Sports anaemia: Another group that merits particular attention consists of
adolescent athletes in whom the prevalence of iron deficiency ranges from 5 to
7.5%. In addition, they are predisposed to developing “sports anemia”. This
type of anemia appears to be associated with various factors including
dilutional pseudo anemia, mechanical intravascular hemolysis and iron loss.
•Blood loss: Iron deficiency caused by blood loss resulting from injury,
accidents or blood donation (every 500 ml of blood donated per year results in
the loss of another 0.5 mg of iron/day).

11. •GI disorders: Iron loss due to parasitosis of the gastrointestinal tract (Entamoeba
histolytica, Necator americanus, Ascaris lumbricoides, Schistosoma mansoni,
Trichuris trichiura), esophagitis, angiodysplasia, telangiectasia, atrophic gastritis,
colitis, Helicobacter pylori infection, coeliac disease39,40, inflammatory bowel
disease, diverticulosis, hemorrhoids, gastrectomy or gastroplasty (bariatric surgery),
etc.
•Genitourinary losses: Genitourinary iron loss of various etiologies46, including
paroxysmal nocturnal hemoglobinuria and glomerulonephritis.
•Pregnancy, childbirth and use of an intrauterine device: This also causes
alternations i.e. decrease in the level of iron.
•Menarche and menstrual abnormalities: Menarche and menstrual abnormalities
in adolescents, in combination with an inadequate diet. Heavy menstrual bleeding is
also a common cause of iron deficiency and iron deficiency anemia in women of
reproductive age. In these cases, menstrual bleeding is moderate, but chronically
heavier than normal, causing a negative iron balance. Iron deficiency anemia is less
common in adolescent boys than in girls and this is explained by the physiological
increase in hemoglobin levels caused by sexual maturation. Nonetheless, iron
deficiency may be higher in this age group due to blood volume expansion and the
increase in muscle mass. On the other hand, any increase in hemoglobin levels that
might be expected in girls is offset by menstrual blood loss.

12. •Infections during chronic and acute diseases: The association between infection
and anemia remains controversial; however, the reduction in hemoglobin levels during
an infectious process is presumed to be the result of impaired iron release from the
reticuloendothelial system and a consequent reduction in the amount of iron available
for erythropoietin.
•Hormonal imbalances in adolescents: In adolescence, hemoglobin levels are
admittedly higher in males than in females because prostaglandins (PGE) facilitate
erythropoietic activity, both directly (PGE 1) and via cyclic AMP (PGE 2). Androgens
stimulate erythropoietin action by increasing or facilitating its production in the
erythroid stem cells. Conversely, estrogens inhibit the effects of erythropoietin. Due to
changes in the nutritional requirements of adolescents –at menarche in girls and as a
result of the hormonal changes at puberty in boys– hemoglobin levels differ as a
function of gender, age or stage of sexual maturity. In women of reproductive age,
menstrual bleeding defines anemia, sometimes requiring daily oral iron
supplementation. Women, in whom menstrual bleeding is excessive, either with
respect to the number of bleeding days or to the amount of flow and the occurrence of
menstrual clots, need to be monitored continuously for as long as dysfunctional
uterine bleeding is present, a period in which iron supplementation may indeed be
required.

13. Summary of some important factors responsible for iron deficiency anaemia are listed in table 3.
S.N. CAUSES PECULARITIES
1. Iron-poor diet Inappropriate dietary habits
2. Medication/food Use of medication and foods that
inhibit iron absorption
3. Overweight and obesity Iron requirements are higher as a
function of weight and iron-poor
food
4. Malnutrition Mucosal lesions of the duodenum
prevent iron absorption
5. Iron deficiency associated
with sporting activities
“Sports anemia”
6. Acute or chronic blood loss,
injury, blood donation
Depletion caused by blood loss
7. Gastrointestinal tract
disorders
Parasitosis, peptic disease, H.
pylori infection, inflammatory
bowel disease, coeliac disease,
hemorrhoids, diverticulitis
8. Genitourinary losses Paroxysmal nocturnal
hemoglobinuria

14. 9. Menarche and menstrual
abnormalities
Metrorrhagia
10. Pregnancy, childbirth and
use of an intrauterine
device
11. Chronic and acute diseases
Pathophysiology:
The most important protein as far as iron reserves are concerned is
ferritin, which is found in almost all the cells of the body, iron reserves
being situated principally in organs such as the spleen, liver and bone
marrow. Serum ferritin level is the most accurate indicator of body iron
stores. Plasma ferritin levels decrease when there is a deficiency of iron
that is not complicated by another concomitant disease. This reduction
in ferritin occurs early, well before the abnormalities in hemoglobin
levels, serum iron levels or in erythrocyte size become apparent.

15. On the other hand, increased ferritin levels may occur in the presence of
infections, neoplasm in general, and in cases of leukemia, lymphoma, breast
cancer, renal disease, rheumatoid arthritis, hemochromatosis or
hemosiderosis, as well as following alcohol consumption. Serum ferritin,
when used alone as a single parameter, is not considered a good indicator of
the nutritional iron status of a population, since this measurement does not
provide all the information necessary on the prevalence of anemia. To reach
a definitive diagnosis of iron deficiency anemia, in addition to performing a
full blood count (hemoglobin, Hematocrit, red blood cell count), ferritin and
serum iron levels should be measured. Iron is essential for most living
creatures, since it plays a role in numerous vital processes ranging from cell
oxidative mechanisms to oxygen transport to the tissues. Iron homeostasis
is regulated principally by iron absorption rather than excretion; therefore,
serum iron level reflects the balance between the amount of iron absorbed
and the amount used by the body. Iron deficiency develops gradually and
progressively until anemia is established.

16. The first stage of anemia consists of iron depletion or a negative iron
balance. It is characterized by a period of greater vulnerability (affecting iron
stores) and may progress slowly to a more severe deficiency, with functional
consequences. As iron stores deplete, ferritin levels fall, with iron values < 12
ng/ml corresponding to depleted iron stores.
The second stage, also referred to as “iron deficiency”, is characterized by a
phase of erythropoiesis. Iron is depleted, but anemia is not yet present,
although biochemical abnormalities reflect its inability to produce hemoglobin
normally. The transferrin saturation index is < 16% and there is an increase in
red cell distribution width (RDW) of more than 16% and a reduction in mean
corpuscular volume (MCV) < 80 fl, in the pre - sence of populations of
microcytic and hypochromic erythrocytes.
The third stage (iron deficiency anemia itself) is characterized by a reduction
in iron delivery to the bone marrow, reducing both hemoglobin synthesis and
content in erythrocyte precursor cells. The damage inflicted on the body
increases as the concentration of available iron diminishes.

18. Diagnosis :
To diagnose iron deficiency anemia, the doctor may run tests to look for:
•Red blood cell size and color. With iron deficiency anemia, red blood cells are
smaller and paler in color than normal.
•Hematocrit. This is the percentage of your blood volume made up by red blood
cells. Normal levels are generally between 35.5 and 44.9 percent for adult women
and 38.3 to 48.6 percent for adult men. These values may change depending on your
age.
•Hemoglobin. Lower than normal hemoglobin levels indicate anemia. The normal
hemoglobin range is generally defined as 13.2 to 16.6 grams (g) of hemoglobin per
deciliter (dL) of blood for men and 11.6 to 15. g/dL for women.
•Ferritin. This protein helps store iron in your body, and a low level of ferritin
usually indicates a low level of stored iron.
So, main diagnostic tests includes a full blood count must be performed and serum
ferritin levels must be measured and If your bloodwork indicates iron deficiency
anemia, your doctor may order additional tests to identify an underlying cause, such
as:
Evaluation of the gastrointestinal tract in patients with
iron deficiency anemia

19. Evaluation of the gastrointestinal tract forms an integral and obligatory part of the
investigation of any patient of any age with iron deficiency anemia. The principal
tests used to investigate the digestive tract are a fecal occult blood test, upper
gastrointestinal endoscopy, ultrasound and colonoscopy.
•Endoscopy. Doctors often check for bleeding from a hiatal hernia, an ulcer or the
stomach with the aid of endoscopy. In this procedure, a thin, lighted tube equipped with
a video camera is passed down your throat to your stomach. This allows your doctor to
view the tube that runs from your mouth to your stomach (esophagus) and your stomach
to look for sources of bleeding.
•Colonoscopy. To rule out lower intestinal sources of bleeding, your doctor may
recommend a procedure called a colonoscopy. A thin, flexible tube equipped with a
video camera is inserted into the rectum and guided to your colon. You're usually
sedated during this test. A colonoscopy allows your doctor to view inside some or all of
your colon and rectum to look for internal bleeding.
•Ultrasound. Women may also have a pelvic ultrasound to look for the cause of excess
menstrual bleeding, such as uterine fibroids.
Your doctor may order these or other tests after a trial period of treatment with iron
supplementation.

20. Differential diagnosis of microcytic anemia
The most important differential diagnosis in patients with iron deficiency anemia is
beta-Thelassemia minor. In beta-Thelassemia minor, red blood cell count is either
normal or elevated, RDW is < 18% and there is an increase in hemoglobin A2
(HbA2)70. When Thelassemia minor is associated with iron deficiency anemia,
HbA2 measurement is affected and levels are lower. Therefore, if this association is
suspected, total body iron stores should be corrected prior to measuring HbA2.
Serum ferritin < 12 ng/ml practically confirms iron deficiency anemia, whereas
values > 100 ng/ml essentially exclude this diagnosis even in the presence of an
inflammatory condition or liver disease.
Another differential diagnosis for iron deficiency anemia is anemia of chronic
disease. In this situation, hemoglobin values normally fluctuate between 9 and 11
g/dl. In general, this type of anemia is asymptomatic or oligosymptomatic and is
associated with the pre - sence of an inflammatory or infectious disease or with
neoplasia. Usually, it is a normochromic and normocytic form of anemia; however,
it may be microcytic and hypochromic. Serum iron levels and transferrin saturation
are low; nevertheless, ferritin is normal or elevated, with normal or high levels of
iron in bone marrow

21. Fig: Diagnostic approach for iron deficiency

22. Pharmacological treatment
Once the patient is diagnosed with iron deficiency anaemia, the main of the treatment is
to restore the Hb levels and RBCs levels to normal and to restore the iron stores.
Dietary Supplementation with iron is required which generally has given through oral
and parenteral route. If needed blood transfusion is done in some cases which is a non-
pharmacological one.
1. Oral iron therapy: The dosage of elemental iron required to treat iron deficiency
anemia in adults is 120 mg per day for three months; the dosage for children is 3 mg per
kg per day, up to 60 mg per day. An increase in hemoglobin of 1 g per dL after one
month of treatment shows an adequate response to treatment and confirms the
diagnosis. In adults, therapy should be continued for three months after the anemia is
corrected to allow iron stores to become replenished.
Adherence to oral iron therapy can be a barrier to treatment because of GI adverse
effects such as epigastric discomfort, nausea, diarrhea, and constipation. These effects
may be reduced when iron is taken with meals, but absorption may decrease by 40
percent. Medications such as proton pump inhibitors and factors that induce gastric acid
hyposecretion (e.g., chronic atrophic gastritis, recent gastrectomy or vagotomy) are
associated with reduced absorption of dietary iron and iron tablets.

23. If iron deficiency anaemia is diagnosed
Treat its cause and start
with oral iron therapy
If intolerance,
start intravenous
iron therapy
Monthly CBC test indicating normal
hematocrit and RBC level or not?
Continue therapy for three months until normal
ferritin and hematocrit values
CBC performed monthly until values get normal
No monitoring needed
until symptoms arises
Reevaluation needed; go for parenteral iron
therapy if symptomatic and transfuse if needed.
Fig: Treatment of iron deficiency anaemia
NO
YES
YES NO

24. 2. Parenteral iron therapy: Parenteral therapy may be used in patients who cannot
tolerate or absorb oral preparations, such as those who have undergone gastrectomy,
gastrojejunostomy, bariatric surgery, or other small bowel surgeries. The most common
indications for intravenous therapy include GI effects, worsening symptoms of
inflammatory bowel disease, unresolved bleeding, renal failure–induced anemia treated
with erythropoietin, and insufficient absorption in patients with celiac disease.
Parenteral treatment options are outlined in Table below. Serious adverse effects have
occurred in up to 0.7 percent of patients receiving iron dextran, with 31 recorded
fatalities reported between 1976 and 1996. Iron sucrose and sodium ferric gluconate
(Ferrlecit) have greater bio-availability and a lower incidence of life-threatening
anaphylaxis compared with iron dextran. Approximately 35 percent of patients
receiving iron sucrose have mild adverse effects (e.g., headache, nausea, and diarrhea).
One small study cited similar adverse effect profiles between intravenous iron dextran
and sodium ferric gluconate, with only one serious adverse effect reported in the iron
dextran group. If this finding is duplicated in larger studies, it could support the use of
iron dextran over sodium ferric gluconate, because the total dose can be given in one
sitting.
A newer formulation, Ferumoxytol, can be given over five minutes and supplies 510 mg
of elemental iron per infusion, allowing for greater amounts of iron in fewer infusions
compared with iron sucrose.

25. Tables summarizing iron formulations in case of oral as well as parenteral therapy
Drugs formulations Elemental iron Adult dosage
Intravenous
Sodium ferric
gluconate (Ferrlecit)
Solution for injection 12.5 mg per mL Based on weight and
amount of desired
change in
hemoglobin
Iron dextran Solution for injection 50 mg per mL
Iron sucrose Solution for injection 20 mg per mL
Ferumoxytol Solution for injection 30 mg per mL
Oral
Ferrous fumarate 324-mg tablet 106 mg One tablet twice per
day
Ferrous gluconate 300-mg tablet 38 mg One to three tablets
two or three times
per day
Ferrous sulfate 325-mg tablet 65 mg One tablet three
times per day
Note: Elemental iron (mg) = 50 × (0.442 [desired hemoglobin level in g per L – observed
hemoglobin level in g per L] × lean body weight + 0.26 × lean body weight).

26. MONITORING
There are no standard recommendations for follow-up after initiating therapy for iron
deficiency anemia; however, one suggested course is to recheck complete blood counts
every three months for one year. If hemoglobin and red blood cell indices remain
normal, one additional complete blood count should be obtained 12 months later. A
more practical approach is to recheck the patient periodically; no further follow-up is
necessary if the patient is asymptomatic and the Hematocrit level remains normal.
Non-pharmacological treatment
This generally includes the nutrients and food rich with iron, blood transfusion,
change in certain life style and some major preventive measures to treat the iron
deficient anaemia.
BLOOD TRANSFUSION: There is no universally accepted threshold for
transfusing packed red blood cells in patients with iron deficiency anemia.
Guidelines often specify certain hemoglobin values as indications to transfuse, but
the patient's clinical condition and symptoms are an essential part of deciding
whether to transfuse. Transfusion is recommended in pregnant women with
hemoglobin levels of less than 6 g per dL because of potentially abnormal fetal
oxygenation resulting in non-reassuring fetal heart tracings, low amniotic fluid
volumes, fetal cerebral vasodilatation, and fetal death. If transfusion is performed,
two units of packed red blood cells should be given, and then the clinical situation
should be reassessed to guide further treatment.

27. Prevention of iron deficiency anemia should be based on four approaches:
•Nutritional counseling: Providing dietary counseling is fundamental and it is
important to explain that the bioavailability of iron obtained from meat (red or white
meat) is greater. In addition to meat, individuals should be encouraged to consume citric
fruits, vegetables and legumes and be warned to avoid sodas, tea, and coffee, excessive
amounts of milk, and cereals that reduce iron absorption. Some nutrition which can be
easily available at home are as follows:
•Increase Vitamin C intake: Anemia tends to weaken your immune system and thus,
you may be more prone to infections and inflammatory diseases. Adequate doses
of vitamin C can help fortify you from within and at the same time it also helps in the
absorption of iron.
•Yogurt with Turmeric: helps in balancing iron content in blood.
•Eat more green vegetables: green vegetables like spinach, celery, mustard
greens and broccoli is a good source of iron.
•Drink up: Fresh beetroot or pomegranate juice acts as great blood builders and also
blood purifiers.
• Sesame seeds: Eating sesame seeds is another great way of increasing your iron
intake, especially black sesame seeds.
•Raisins and dates: These dried fruits offer a combination of iron and Vitamin C. This
enables the body to quickly and effectively absorb the iron from them.

28. • Breastfeeding should be encouraged in case of women and for new born babies
during delivery: Delayed Clamping of the Umbilical Cord should be promoted.
•Fortification of food: Enrichment of normal diet with small amount of iron metals
helps us to prevent us from iron deficient anaemia. As for example: wheat and corn
flour produced should be supplemented with iron.
•Infection control: Controlling infections is important, since iron is also reduced in
chronic diseases and this may result in an erroneous diagnosis of iron deficiency
anemia. Gastrointestinal and respiratory tract infections are known to predispose to a
depletion of iron stores in the body due to diminished hemoglobin production and iron
absorption
Lifestyle modifications: These lifestyle changes can help to defend anaemia:
•Do not smoke
•Do not use illegal drugs.
•Do not drink alcohol or only drink in moderation. This means two drinks or less a day
for men and one drink or less a day for women.

29. Conclusions
Unlike other prevalent anemia's and hemoglobinopathies, the diagnosis and treatment of
iron deficiency anemia is achievable in most, if not all individuals. The iron deficiency
anaemia is mostly prevalent in infants, children and adolescents of developing countries
over the globe. The main cause for the iron deficiency anaemia is the under nutrition
and malnutrition where they lack the iron content in the sorts of food they are taking. As
we know that RBC’s one of the most important content is iron which forms the heme
part of hemoglobin and lack of it arrives the condition of anaemia. One of the causes
for this anaemia is the hormonal changes during the adolescents phase and phase of
menstrual cycle and pregnancy. All the causes mostly imply that there is lack of iron
content which on deficient condition brings anaemia. The people must know about it
and get aware about the diet containing iron element. The government should bring the
idea of fortification of food products wherever they gone produced. This disease is
treated normally by taking iron pills when they seem to appear in patients and food
containing iron element. For its better prevention, life style and diet must be
maintained. One of the methods used to treat non-pharmacologically during emergency
phase is blood transfusion. Researched should be done regarding the potential
eradication of anaemia by Delayed Clamping of the Umbilical Cord .Ultimately, it is
predicted that increased research and understanding of fundamental iron biology will
assist in devising new strategies aimed toward the global elimination of this disease.

30. References
•Kumari, R. (2017). Prevalence of Iron Deficiency and Iron Deficiency Anaemia in Adolescent Girls in a
Tertiary Care Hospital. JOURNAL OF CLINICAL AND DIAGNOSTIC
RESEARCH. doi:10.7860/jcdr/2017/26163.10325 from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5620749/ (accessed on 16th may)
•K. D. Tripathi, “Essentials of Medical Pharmacology,” 5th Edition, Jaypee Brothers Medical Publishers (P)
LTD, New Delhi, 2003.pg.no.-599-613
• Rastogi T., Mathers T., Global burden of iron deficiency; Geneva: WHO, 2002 - who.int From:
https://www.who.int/healthinfo/statistics/bod_irondeficiencyanaemia.pdf ( accessed on 16th may)
• SHORT MATTHEW W. , LTC, MC, USA and DOMAGALSKI JASON E. , MAJ, MC, USA, Madigan
Healthcare System, Tacoma, Washington; Iron Deficiency Anemia: Evaluation and Management; Am Fam
Physician. 2013 Jan 15;87(2):98-104. From: https://www.aafp.org/afp/2013/0115/p98.html#sec-6 (accessed
on 16th may)
• Diagnosis and treatment of Iron deficiency anaemia, from: https://www.mayoclinic.org/diseases-
conditions/iron-deficiency-anemia/diagnosis-treatment/drc-20355040(accessed on 18th may)
•Cairo Romilda Castro de Andrade, MD, MSc; Silva R. Luciana , MD, MSc, PhD; Bustani C. Nadya, MSc
and Marques Cibele Dantas Ferreira , MSc ; Revision on Iron deficiency anemia in adolescents; a literature
review ; ( Nutr Hosp. 2014;29:1240-1249) ; DOI:10.3305/nh.2014.29.6.7245 From:
https://www.redalyc.org/pdf/3092/309231671004.pdf(accessed on 18th may)
• Miller L. Jeffery, Iron Deficiency Anemia: A Common and Curable Disease, cold spring harbor perspectives
in medicines; Molecular Medicine Branch, National Institute of Diabetes and Digestive and Kidney Diseases,
National Institutes of Health, Bethesda, Maryland 20892;from:
http://www.sah.org.ar/pdf/eritropatias/cadae1306.pdf(accessed on 19th may)