TREATMENTIRON DEFICIENCY ANEMIA

3 Approaches in the Treatment of IDA:1. Red Cell Transfusion2. Oral Iron Therapy3. Parenteral Iron Therapy

Braunwald et al, Harrison’s Principles of Internal Medicine, pp. 590-591

Red Cell Tranfusion

INDICATIONS: for patients who have symptoms of anemia, cardiovascular instability, and continued and excessive blood loss from whatever source, and those who require immediate intervention.

Braunwald et al, Harrison’s Principles of Internal Medicine, pp. 590-591

Red Cell Transfusion

• Treats anemia ACUTELY• transfused red cells provide a source of iron

for reutilization

Braunwald et al, Harrison’s Principles of Internal Medicine, pp. 590-591

Oral Iron Therapy

• INDICATIONS: for patients with established iron deficiency anemia who are asymptomatic wherein treatment with oral iron is usually adequate.

• MOST APPLICABLE to the PATIENT

Braunwald et al, Harrison’s Principles of Internal Medicine, pp. 590-591

• The goal of the therapy is to repair anemia provide stores of at least 0.5-1.0 g of iron (for a treatment period of 6-12 months after anemia correction)

• Dosage of 200 - 300 mg of elemental iron per day should result in the absorption of iron up to 50 mg/d. which supports a red cell production level of 2-3x normal in an individual with a normally functioning marrow and appropriate erythropoietin stimulus

Braunwald et al, Harrison’s Principles of Internal Medicine, pp. 590-591

• COMPLICATIONS: gastrointestinal distress in 15-20% of patients (abdominal pain, nausea, vomiting, or constipation)

Braunwald et al, Harrison’s Principles of Internal Medicine, pp. 590-591

Parenteral Iron Therapy

• INDICATIONS: for patients who are unable to tolerate oral iron, whose needs are relatively acute, or who need iron on an ongoing basis (due to persistent gastrointestinal blood loss)

Braunwald et al, Harrison’s Principles of Internal Medicine, pp. 590-591

Used in 2 ways:1.Administer total dose required to correct HGB

deficit and provide 500mg iron stores2.Repeated small doses

• Amount of iron needed= BW(kg)x2.3x (1.5-patient’sHGB g/dl)+500 or 1000mg (stores)

Braunwald et al, Harrison’s Principles of Internal Medicine, pp. 590-591

Anaphylaxis- with iron dextran (0.7% of cases)– iron gluconate (alternative)– if large doses are needed, dilute in 5%

dextrose in water or 0.9%NaCl, infuse over 60-90 minutes– stop infusion: chest pain, wheezing,

hypotension or other systemic symptoms

Braunwald et al, Harrison’s Principles of Internal Medicine, pp. 590-591