The most common causes of anemia are poor nutrition, iron deficiencies, micronutrients deficiencies including folic acid, vitamin A and vitamin B12, diseases like malaria, hookworm infestation and schistosomiasis.

1. IRON THERAPY-
WHAT OPTIONS DO WE
HAVE?
DR. NIRANJAN CHAVAN

3. IRON DEFICIENCY ANAEMIA
• Most common micronutrient deficiency in the world affecting ~
24% of the world population.
• Iron deficiency can range from sub-clinical state to severe iron
deficiency anemia.

5. DIETARY FACTORS THAT
AFFECTS ABSORPTION

6. IRON
REQUIREMENTS
2.5 mg/day in early pregnancy
5.5 mg/day from 20-32 weeks
6 to 8 mg/day from 32 weeks onwards
Average : 4mg/day
• Ideally women should enter pregnancy with adequate iron
stores
• As a public health approach, prolonged oral iron
supplementation even before pregnancy is a better strategy
(PRECONCEPTION COUNSELING)

7. • WHO recommends 60 mg elemental iron with 250 mg folic
acid for 6 months in pregnancy and additional 3 months
postpartum

8. GOI & MOH RECOMMENDATION
• 100 mg elemental iron with 500 mg of folic acid for 100
days in second half of pregnancy

9. ROUTES OF IRON
THERAPY
1. Oral route
2. Parenteral route

11. ORAL IRON
Iron is best absorbed in ferrous form within the body.
Preparations available are
• Ferrous gluconate
• Ferrous fumarate
• Ferrous succinate

12. • Treatment should be continued till the blood picture becomes
normal. There after a maintenance dose of 1 tab./day is to be
continued for atleast 100 days following delivery to replenish the
iron stores.

13. • Drawbacks of oral iron therapy :
• Intolerance : It is evidenced by –
• Pain
• Nausea
• Vomiting
• Diarrhea
• Constipation
• To avoid intolerance, therapy should be started with a smaller dose
(1 tab./day) and then to increase the dose to a maximum of 3
tab./day

14. • With the therapeutic dose, the serum iron may be restored but there is
difficulty in replenishing the iron stores.
• Response : It is evidenced by –
• Sense of well being
• Increased appetite
• Improved outlook of the patient
• Rise in Hb levels about 0.7 gm/100 ml/week.
• Contraindications : -
• Intolerance to oral iron
• Severe anaemia in advance pregnancy

15. PARENTERAL IRON THERAPY
• Indications : -
• Intolerance to oral iron
• Cases seen for the first time during the last 8-10 weeks with severe
anemia.
• Routes
• 1. Intravenous route - a. Total dose infusion (TDI)
b. Repeated injections
• 2. Intramuscular route

16. INTRAVENOUS ROUTE:
• Total dose infusion (TDI) : - Iron dextran or Iron
sucrose are used to correct the deficit in a single
sitting. –
• Estimation of dose :
• For Iron sucrose : 2.3 x W x D + 500
(W= weight in kg before pregnancy) D= Hb ( target-
actual )

17. • Pre-requisites: -
• Correct diagnosis of iron deficiency anaemia
• Adequate supervision
• Facilities for management of anaphylactic reaction
• Advantages : -
• It eliminates repeated and painful I.M inj.
• Early discharge of the patients
• Less costly as compared to I.M therapy

18. INTRAMUSCULAR ROUTE
• Compounds are used:
• Iron dextran (Imferon) .
• Iron sorbitol complex – (Jectofer)
• Both preparation contains 50 mg of elemental iron in 1 ml.
• Precautions : -
• Oral iron should be suspended atleast 24 hrs prior to therapy to avoid reaction.
• Drawbacks : -
• Painful procedure
• Chance of abscess formation at the site of infection
• Discoloration of the skin over the injection site

19. NEWER IRON PREPARATIONS
• Ferric carboxy maltose
• Structure: Macromolecular ferric hydroxide carbohydrate
complex, with ferric hydroxide core stabilized by a
carbohydrate shell (controlled delivery of iron, leading to
decreased oxidative stress)
• Around 60 – 100% of iron is used for RBC production, within
16 – 24 days.
• Peak of Serum ferritin levels occur within 48 – 120hrs after
administration
• Increases transferrin saturation rapidly, but didn’t change s.
transferrin levels or transferrin receptor levels
• Reticulocyte count increases at around 8 days

20. • Dose:
maximum single dose of 1000mg of iron, not exceeding 15mg/kg or
calculated cumulative dose, over a minimum infusion time of up to 15
min. Infusions shouldn’t be administered more than once per week

21. • Side effects & tolerability:
• Most adverse events noticed with FCM are mild to moderate in
intensity
• Rash (pruritis & urticaria are uncommon) & local skin reactions
(generally after first dose, not recur)
• Transient & asymptomatic decrease in serum phosphorous levels
• Tolerance is very good
• Mild adverse effects
• No multiple doses
• No long infusion times as with other IV iron preparations
• No gastrointestinal side effects as with oral iron
• No serious hypersensitivity reactions as with Iron dextran

22. THANK YOU