Iron deficiency anaemia is one of the largest problem during pregnancy in a country like India.
So here is a short presentation on iron therapy which we are currently prescribing to our patients.
2. Indications of iron therapy :
- Iron deficiency anaemia
-Pregnancy
-Infancy
Routs of iron therapy
1. Oral route
2. Parenteral route
3. • Iron is best absorbed in ferrous form within the body.
• Preparations available are
Ferrous gluconate
Ferrous fumarate
Ferrous succinate
Tab. Fersolate
- Contains 60 mg of elemental iron, trace of copper &
manganese.
- Doses : 1tab. thrice a day, before meal.
If larger dose is necessary then maximum
6 tab./day can be given.
- 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.
4. Drawbacks of oral iron therapy :
Intolerance : It is evidenced by
- Pain - Nausea
- Vomiting - Diarrhoea
- 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
Unpredictable absorption rate : Various factors are
involved in the iron absorption & it’s utilization
Reduce Absorption Increase Absorption
Antacids Ascorbic acid
Phosphates Lactate
Oxalates Amino acids
5. 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
6. Indications :
- Intolerence to oral iron
- Cases seen for the first time during the last 8-10
weeks with severe anemia.
Routes
1. Intravenous route
2. Intramuscular route
1. Intravenous route:
a. Total dose infusion (TDI)
b. Repeted injections
7. a. Total dose infusion (TDI) :
- Iron dextran or Iron sucrose are used to correct the
deficit in a single sitting.
- Estimation of dose :
• For Iron dextran
0.3 x W(100-Hb%) (W= weight of the pt. in pounds)
• For Iron sucrose : polynuclear ferric hydroxide
Dose = 2.3 x W x D + 500 (W= weight in kg before pregnancy)
D= Hb ( target-actual )
• 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
8. 2. 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