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TREATMENT OF IRON DEFICIENCY ANEMIA WITH
FERRIC CARBOXYMALTOSE
Dr. Kunal Chhattani
MBBS MD DrNB [Clinical Hematology]
Hematologist and Hemato-Oncologist,
Chhattani Hematology Clinic, Nagpur
ANAEMIA
 WHO Cut Offs:
 M<13g/dl
 F<12gm/dl
 Anemia in pregnancy:
 1st Trimester Hb< 11
 2nd trimester Hb <10.5
 3rd trimester Hb<11
 Post partum Hb <10
Iron
Homeostasis
IRON HOMEOSTASIS
 1-2mg of iron –absorbed and lost every day
 Most absorption- Duodenum
 2 forms- Ferrous and ferric
 Ferric iron Ferrous iron at brush border
 Iron Blood transferrinBone marrow2/3rd in
Hb
 Storage:
1. Reticulo Endothelial System
2. Liver
 Key Regulator: Hepcidin
 Hepcidin blocks Ferroportin  Reduced iron
absorption from gut and stores
Diagnosis
SCREENING FOR IDA
 Ferritin <30ng/ml
 Transferrin saturation <20%.
Treatment
ORAL IRON
 Ferrous form is better absorbed
 Most commonly available : Ferrous sulphate,
ferrous fumarate, ferrous gluconate, ferrous
ascorbate.
 Any of these is acceptable.
Advantages:
 Efficacious for most patients
 Low risk of serious side effects
 Low cost
Disadvantages:
 GI toxicity
 Compliance
SOME QUERIES
IV iron
INDICATIONS OF IV IRON
 Failure/intolerance of oral iron
 Noncompliance
 Rapid response required
 Malabsorption
 Continuous bleeding
D. Girelli et al 2017
CONTRAINDICATIONS TO IV IRON
 Pregnancy <12 weeks
 Lack of facilities of managing allergic reaction
 Anaphylaxis to any parenteral iron preparation
 Iron overload
APPROVALS
D. Girelli et al 2017
D. Girelli et al 2017
PARENTERAL IRON STRUCTURE
DILUTION AND DURATION
 Dilute FCM 500mg in 100ml NS and 1gm in 250ml
NS. Concentration of FCM <2mg/ml is not
permissible.
 Infuse 500mg in minimum 6minutes and 1gm in
minimum 15minutes
 Long duration of infusion and excess dilution can
lead to destabilization of iron complex and adverse
effects
Iron Deficiency Anemia - FCM in brief.pptx
Iron Deficiency Anemia - FCM in brief.pptx
Iron Deficiency Anemia - FCM in brief.pptx

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Iron Deficiency Anemia - FCM in brief.pptx

  • 1. TREATMENT OF IRON DEFICIENCY ANEMIA WITH FERRIC CARBOXYMALTOSE Dr. Kunal Chhattani MBBS MD DrNB [Clinical Hematology] Hematologist and Hemato-Oncologist, Chhattani Hematology Clinic, Nagpur
  • 3.  WHO Cut Offs:  M<13g/dl  F<12gm/dl  Anemia in pregnancy:  1st Trimester Hb< 11  2nd trimester Hb <10.5  3rd trimester Hb<11  Post partum Hb <10
  • 5. IRON HOMEOSTASIS  1-2mg of iron –absorbed and lost every day  Most absorption- Duodenum  2 forms- Ferrous and ferric  Ferric iron Ferrous iron at brush border  Iron Blood transferrinBone marrow2/3rd in Hb
  • 6.  Storage: 1. Reticulo Endothelial System 2. Liver  Key Regulator: Hepcidin  Hepcidin blocks Ferroportin  Reduced iron absorption from gut and stores
  • 7.
  • 8.
  • 10. SCREENING FOR IDA  Ferritin <30ng/ml  Transferrin saturation <20%.
  • 11.
  • 12.
  • 14. ORAL IRON  Ferrous form is better absorbed  Most commonly available : Ferrous sulphate, ferrous fumarate, ferrous gluconate, ferrous ascorbate.  Any of these is acceptable.
  • 15. Advantages:  Efficacious for most patients  Low risk of serious side effects  Low cost Disadvantages:  GI toxicity  Compliance
  • 16.
  • 19. INDICATIONS OF IV IRON  Failure/intolerance of oral iron  Noncompliance  Rapid response required  Malabsorption  Continuous bleeding
  • 20. D. Girelli et al 2017
  • 21. CONTRAINDICATIONS TO IV IRON  Pregnancy <12 weeks  Lack of facilities of managing allergic reaction  Anaphylaxis to any parenteral iron preparation  Iron overload
  • 23. D. Girelli et al 2017
  • 24.
  • 25. D. Girelli et al 2017
  • 27.
  • 28. DILUTION AND DURATION  Dilute FCM 500mg in 100ml NS and 1gm in 250ml NS. Concentration of FCM <2mg/ml is not permissible.  Infuse 500mg in minimum 6minutes and 1gm in minimum 15minutes  Long duration of infusion and excess dilution can lead to destabilization of iron complex and adverse effects