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•IRON DEFICIENCYIRON DEFICIENCY
Case scenario : Trigger 3
Parameters Obeserved value
RBC 4.8 million cells/mcL
WBC 6000 cells/mcL
Platelets 300 thousands/mcL
Haemoglobin 8.4 g/dl
Provisional diagnosis: Iron deficiency anemia
Iron Deficiency Anemia
"anemia" usually refers to a condition in which your
blood has a lower than normal number of red blood
Iron is an essential mineral that is needed to form
hemoglobin, an oxygen carrying protein inside red
Iron deficiency anemia(IDA) is a condition in
which the body lack enough red blood cell to
transport oxygen-rich blood to body tissues
• IDA is the most common form of anemia and it
develops over time
Without enough iron, the body uses up all the iron it
has stored in the liver, bone marrow and other organs.
According to WHO, iron deficiency anemia is the most
common nutrient deficiency in world.
Iron-deficiency anemia is usually due to :
an inability to absorb enough iron from food.
Blood lost causes iron depletion
In women, long or heavy menstrual periods or bleeding
fibroids in the uterus.
Internal bleeding (angiodyspalsia)
Gastrointestinal blood loss(GI cancer, peptic ulcer)
Non steroidal anti-inflammatory drugs (NSAIDs)
Low iron intake.
During some stages of life, such as pregnancy and
Some studies suggest vegetarians or vegans are more at risk
of IDA, due to the lack of meat in their diet
Inability To Absorb Enough Iron
Even if you have enough iron in your diet, your body may not
be able to absorb it. This can happen if you have intestinal
surgery or a disease of the intestine.
Prescription medicines that reduce acid in the stomach also can
interfere with iron absorption.
• Chronic kidney disease
Other conditions or actions that cause blood loss and may lead to iron
deficiency anaemia include:
• inflammatory bowel disease – a condition that causes inflammation
(redness and swelling) in the digestive system, such as Crohn’s disease
and ulcerative colitis
• oesophagitis – inflammation of the gullet (oesophagus) caused by stomach
acid leaking through it
• schistosomiasis – an infection caused by parasites and mainly found in Sub-
• blood donation – donating a large amount of blood may lead to anaemia
• trauma – a serious accident, such as a car crash, may cause you to lose a
lot of blood
• nosebleeds – if you have a lot of nosebleeds, this may lead to anaemia,
although this is rare
• haematuria (blood in your urine) – although this rarely causes anaemia and
may be a symptom of another condition
IMPORTANT POINTS ABOUT IRON
Before using iron medication, check if you are
allergic to any drugs or food dyes, or if you
iron overload syndrome
hemolytic anemia (a lack of red blood cells)
porphyria (a genetic enzyme disorder that
causes symptoms affecting the skin or
thalassemia (a genetic disorder of red blood
liver or kidney disease
if you are an alcoholic; or
if you receive regular blood transfusion.
Most iron medication are taken on an empty
stomach, at least 1 hour before or 2 hours
TREATMENT OF IRON DEFICIENCY
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
from the GIT is normal.
Different iron salt provide different amount of
In iron deficient individual, about 50-80mg of iron
can be incorporated in hemoglobin daily and
about 25% of oral ferrous salt can be absorbed.
Oral iron treatment may require 3-6 months to
replenish body stores.
Ferrous sulfate is the treatment
for iron deficiency anemia.
Dosage: 325 mg tid, which
provides 180 mg of iron daily of
which 10mg is usually
Patients who cannot tolerate
iron on an empty stomach
should take it with food.
COMMON ADVERSE EFFECTS OF ORAL
Constipation and diarrhea.
These effects are usually dose-related.
PARENTERAL IRON THERAPY
1) Iron Dextran- is a stable complex of
ferric hydroxide and low-molecular-weight
dextran containing 50mg of elemental
iron per milliliter of solution.
It can be given deep IM injection or IV
light-headedness, fever, arthralgias, back
pain, urticaria, bronchospasm and
2)- Iron sucrose complex &
iron sodium gluconate
These are indicated for patient with
hypersensitivity reactions to oral iron salts.
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.
Treating Anemia with
common in patients who have experienced major blood loss from
physical trauma, those who are chronically ill, or those who have
recently undergone major surgery
Recent clinical research investigations done to study preoperative
anemia suggest , a blood transfusion can damage the immune
system (the system that protects us from disease) which can lead
to infection, organ dysfunction (especially of the heart,
kidney, brain), prolonged hospital stays, as well as
increased supplies, resources and cost in surgical
Another treatment for anemia includes erythropoiesis-
stimulating agents (ESAs), a man-made hormone which
boosts the body’s processes for making red blood cells.
These medications are approved for treating anemia in patients
with cancer, chronic kidney disease or HIV/AIDS
some studies have shown the benefits of their use in other types
of patients as well.
Non- pharmacological treatment
Good sources of iron includes:
meats - beef, pork, lamb, liver, and other organ meats
poultry - chicken, duck, turkey, liver (especially dark
fish - shellfish, including clams, mussels, and oysters,
leafy greens of the cabbage family, such as broccoli,
kale, turnip greens, and collards
legumes, such as beans and green peas; dry beans and
peas, such as pinto beans, black-eyed peas, and canned
Oral iron replacement to correct IDA is a time
Daily iron absorption is about 2 mg. This value can
increase to as much as 10 mg with
An oral iron replacement regimen would require
nearly 6 months to completely correct the iron deficit
in this patient. Such a time frame is unacceptable for
most patients who require surgery.
Two to three weeks provides a minimum window in
which to correct even severe IDA Parenteral iron
replacement should be used in this setting since oral
iron replacement will not have time to work.