Iron deficiency anemia is the most common type of anemia seen in clinical practice. It is characterized by a decrease in hemoglobin and oxygen-carrying capacity due to low iron levels. Oral iron supplements are usually the first line treatment, with ferrous sulfate being a commonly used and inexpensive option. Parenteral iron is considered when oral iron is not tolerated or absorbed. The document provides details on causes of iron deficiency anemia, distribution and absorption of iron in the body, classification of anemias, oral and parenteral iron preparations and their administration, and indications and adverse effects of iron therapy.

1. DRUGS
FOR
IRON DEFICIENCY ANEMIA
PATKI
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2. 11/21/2019 PATKI 2

3. ANAEMIA
• Decrease in oxygen carrying capacity of blood is called
anaemia.
• Oxygen carrying capacity of blood is determined by
hemoglobin content of cells.
• Reduction in blood hemoglobin levels &
no of circulating erythrocytes are characteristic
features of anaemia.
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4.  The haematopoietic machinery – present in the bone
marrow.
 It is primarily involved in the formation of cellular
components of the blood – erythrocytes, leucocytes &
thrombocytes.
 For proper functioning – needs
 Exogenous nutrients – Iron, vitB12 & folic acid called
haematinics.
 Endogenously derived growth factors – (G-CSF), (GM-
CSF), Erythropoietin, thrombopoietins, IL-1,3,5,6,7,11
etc.
 Reduction in the supplies of any of these nutrients –
results in deficiency of normal blood cells.
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5. CLASSIFICATION OF ANAEMIAS
 ANAEMIAS due to dietary deficiency or
malabsorption of factors essential for normal blood
formation .
e.g: iron ,folic acid , vitamin B12,vit C ,pyridoxine
 DUE TO BLOOD LOSS - menorrhagia ,GI loss,
hookworm infestation.
 DUE TO EXCESSIVE BLOOD DESTRUCTION
thalassemia, sickle cell ,auto immune hemolytic
anaemia.
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6.  DUE TO APLASIA OR HYPOPLASIA OF BONE
MARROW
- Anti cancer drugs and chloramphenicol
 DUE TO DEFICIENCIES OF ERYTHROPOIETIN
- Chronic renal disease
 UNCERTAIN ORIGIN
- Infection, rheumatoid arthritis ,malignant disease
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7. HAEMATINICS
 These are the substances required in the
formation of blood, and are used for the
treatment of anemias.
- Iron, vitB12 & folic acid
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8.  Most common disorder in clinical practice.
 Charectarized by a decrease in the O2 carrying
capacity of the blood due to reduced
concentration of Hb or RBCS
Iron deficiency anemia
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9.  IRON DEF ANAEMIA CHARACTERISED BY-
 MICROCYTOSIS (presence of small erythrocytes).
 HYPO CHROMIA ( poorly filled with haemoglobin).
 POIKILOCYTOSIS (bizzare shaped cells).
 ANISOCYTIOSIS (different shapes).
 Iron def has adverse effects on brain function,
mental performance & ,behavioral abnormalities.
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10. Pink of your
health
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11. DISTRIBUTION OF IRON IN THE BODY
 Iron(Fe) is the essential body constituent .
 Total body iron in an adult –
2.5 – 5 g (average 3.5g).
 It is more in men - (50mg/kg)
Than in women (38mg/kg)
 It is distributed as follows :
 Hemoglobin (Hb) – 66%
 Iron stores ferritin and Haemosiderin – 25%
 Myoglobin ( in muscles) – 3%
 Parenchymal iron (in enzymes etc) – 6%
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12. Loss of 100ml of blood (containing 15g Hb) means loss of
50mg elemental iron.
To raise Hb level of blood by 1g/dl about 200mg of iron is
needed.
Daily requirement of iron
 Adult male – 0.5 – 1 mg (13mg/kg)
 Adult female – 1 – 2 mg (21mg/kg)
(Menstruating)
 Infants – 60mg/kg
 Children – 25 mg/kg
 Pregnancy – 3.5 mg (80mg/kg)
(Last 2 trimesters)
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13. DIETARY SOURCES OF IRON
 Rich → liver, egg yolk, oyster, drybeans, dry fruits, wheat germ,
yeast.
 Medium → meat, chicken, fish, spinach, banana, apple.
 Poor → milk and its products, root vegetables.
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14. Iron absorption
 Average daily diet contains- 10-20mg of iron.
 Absorption occurs all over the intestine, but more in the
upper part.
 There are two major forms of dietary iron.
 Heme iron, found primarily in red meats, is the most easily
absorbed form.
 Majority of dietary iron is in ferric form.
 It is reduced to ferrous form before absorption.
 Absorption occurs through 2 separate iron transporters in
the intestinal mucosal cells.
 Divalent metal transporter – 1 (DMT 1)
 Ferroportin
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16.  FACTORS FACILITATING FE ABSORPTION
 Acid: By favouring dissolution and reduction of ferric form.
 Reducing substances – Ascorbic acid.
 Meat – By increasing Hcl secretionand providing heme iron.
FACTORS IMPEDING FE ABS
 Alkalies – (Antacids) Renders iron insoluble, oppose its
reduction.
 Phosphates (rich in egg yolk)
 Phytates (maize, wheat) by complexing iron
 Tetracyclines
 Prescence of other foods in stomach.
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17. MUCOSAL BLOCK
 It is a mechanism to prevent entry of excess iron in the body
 Iron reaching inside mucosal cell is eigther transported to
plasma or oxidised to ferric form and complexed with
apoferritin to form ferritin.
 The ferritin stored on the mucosal cells is lost when they are
shed (life span 2-4 days).
 This is called ferritin curtain.
 Thus the amount of iron entering into the body is governed
by the iron status of the body and the erythropoietic activity.11/21/2019 PATKI 17

18. Transport, utilization, storage and excretion.
 Free iron is highly toxic.
 It is converted to ferric form and complexed with a
glycoprotein - transferrin (TF).
 Iron is transported in to erythropoietic and other cells by
attachment of transferrin to transferrin receptors (TFRS)
which is engulfed by endocytosis.
 Iron dissociates from complex and is utilised for Hb
synsthesis while TF and TFR return to cell surface to carry
fresh loads.11/21/2019 PATKI 18

19. Cont…
 Iron is stored in reticulo endothelial cells in liver, spleen
bone morrow, also in hepatocytes & myocytes as ferritin
and haemosiderin.
 Daily excretion – 0.5mg daily (adult male) mainly as
exfoliated G.I mucosal cells some RBC’s and in bile,
desquamated skin.
 In menstruating women – monthly menstrual loss may be
averaged to 0.5-1 mg/day.
 Excess iron is required during pregnancy for expansion of
RBC mass, transfer to foetus and loss during delivery
totaling about 700mg .
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21. PREPARATIONS AND DOSAGE
Oral iron
This is the preferred route of iron administration.
 Because
 Dissociable Ferrous salts are inexpensive.
 Have high iron content
 Better absorbed than ferric salts.
Some oral iron preparations
 Ferrous sulphate – cheapest LIVOGEN
 Ferrous citrate-commonly used.
 Ferrous gluconate
 Ferrous fumarate.
 Colloidal ferric hydroxide
 Ferric hydroxy poly maltose11/21/2019 PATKI 21

22.  Sustained release preperations – not rational.
 Most of iron absorbed in upper intestine – but these
preperations release iron lower down.
 Liquid formulations – may stain teeth.
 Hence should be put back on tongue.
DOSE
 A total of 200mg of elemental iron given daily in 3
divided doses – produce maximal haematopoietic
response.
 Absorption of iron is much better when it is taken on
empty stomach – side effects are also more on empty
stomach.
 Prophylactic dose – 30 mg iron daily.
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23. INDICATIONS OF IRON
THERAPY
PROPHYLATIC
pregnancy ,menstruation ,blood donors .
 THERAPEUTIC
- to treat existing iron deficiency.
 Nutritional deficiency.
 Anaemia of infancy and pregnancy.
 Anaemia due to acute or chronic blood loss.
menorrhagia ,peptic ulcer, hookworm infestation.
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24. ADVERSE EFFECTS OF ORAL IRON
 Adverse effects are related to elemental iron
content.
1. Epigastric pain
2. Heart burn
3. Nausea & vomiting
4. Staining of teeth
5. Metallic taste
6. Bloating, colic
7. Constipation
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25. PARENTERAL IRON
 INDICATIONS
1. Oral iron is not tolerated - bowel upset is more.
2. Failure to absorb iron – mal absorption,
Inflammatory bowel disease.
3. Non compliance to oral iron.
4. In prescence of severe deficiency with chronic
bleeding.
 Parenteral iron therapy needs calculation of the total
iron requirement of the pt.
 Iron requirement (mg) = 4.4 X body wt (kg) X Hb
deficit (g/dl)
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26. PARENTERAL IRON THERAPY
 PREPARATIONS:
Iron sucrose
 IRON DEXTRAN for IMIV use {imferon} contra
indicated in early pregnancy.
 IRON SORBITOL CITRIC ACID COMPLEX{JECTOFER} for
IM injection
(urine turns black –iron sulfide formation).
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27.  IRON CARBOHYDRATE COMPLEX {UNIFERON}
- iron ,dextran sorbitol citric acid .
- Given IM , each ml contains 50 mg of elemental
iron.
 Injection made by Z technique.
 Test dose of 25 mg is given followed by 100 mg .
 IV infusion is given at the rate of 10 drops per
minute.
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28. IV Route
 Iron dextran
 Ferrous –sucrose
 Sodium ferric gluconate
After a test dose with 0.5ml, 2ml to be given over
10min.
Alternatively dose diluted in 500ml glucose/saline –
to be infused over 6-8hrs.
 Should be stopped if pt complains of giddiness,
paraesthesias and tightness in the chest.
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29. ADVERSE EFFECTS OF PARENTERAL IRON
LOCAL –
pain at injection site
pigmentation of skin,
sterile abscess.
SYSTEMIC –
fever,
head ache,
joint pains,
flushing,
palpitation,
chest pain,
dyspnoea,
lymphnode enlargement.
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30. USES
IRON DEFICIENCY ANEMIA
 Most imp indication for medicinal iron.
CAUSES:
1. Nutritional deficiency
2. Chronic bleeding from G.I tract (common cause)
(ulcers, hook worm infestation)
3. Repeated attacks of malaria.
4. Chr. inflammatary diseases.
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31.  A rise in Hb level by 0.5 – 1g/dl per week is an
optimum response to iron therapy
 It takes 1-3 months – depending on severity to
correct anemia and 2-3 months to replenish stores-
because after correction of anemia iron absorption
is slow.
 MEGALOBLASTIC ANEMIA
AS AN ASTRINGENT – ferric chloride – used in throat
paint.
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32. ACUTE IRON POISONING
 It occurs mostly in infants and children.
 10-20 iron tablets or equivalent of the liquid
preperation (>60mg/kg iron) may cause serious
toxicity.
 Very rare in adults.
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33.  Manifestations
 Vomiting
 Abdominal pain
 Haemetemesis
 Diarrhoea
 Cyanosis
 Lethargy
 Dehydration
 Acidosis
 Convulsions & finally shock
 Cardio vascular collapse.
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34. Pareneteral iron dose
 4.4 x body weight x Hb deficit ( g/ dl)
 150 x Hb deficit (g/dl) + 600 mg
 Iv infusion in 500 ml of 5% dextrose over
6-8 hours.
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35.  Treatment – should be prompt
1) To prevent further absorption of iron from the gut.
 Induce vomiting / perform gastric lavage with sod.
Bicarbonate sol- To render iron insoluble.
 Give egg yolk and milk orally- To complex iron
 Activated charcoal does not absorb iron.
2) To bind and remove already absorbed iron.
 Desferroxamine (an iron chelating apent) – is the IM –
0.5-1g repeated 4-12 hrly.
 DTPA or calcium edetate – also used.
3) Supportive measures
 Fluid electrolyte balance maintained.
 Acidosis corrected by IV infusion
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36. ANAEMIA OF CHRONIC
DISEASE
 It occurs in pts with chronic infections (TB),
Inflammatory disease (rheumatoid arthritis), cancer,
trauma.
 Hypoferrimia, in presence of bone marrow iron
overload is a constant feature.
 There is deficient delivery of iron to developing RBC.
 Anaemia does not respond to iron therapy.
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37. ERYTHROPOIETIN
 Epoetin a&b has molecular weight 36,000.
 It is synthesized by kidney in response to hypoxemia.
 Given by IV route.
 Plasma half life is - 6-8 HRS.
 Adverse Effects:
- Hypertension, rise in hematocrit values..
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38. Therapeutic uses
 Anaemia of end stage renal failure.
 To permit autologous blood transfusion.
 Anemia due to anticancer drugs and HIV infection.
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39. THANK YOUdrpatki@gmail.com
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