1. TREATMENT IRON DEFICIENCY ANEMIA

2. 3 Approaches in the Treatment of IDA: 1.Red Cell Transfusion 2.Oral Iron Therapy 3.Parenteral Iron Therapy Braunwald et al, Harrison’s Principles of Internal Medicine, pp. 590-591

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. Used in 2 ways: 1.Administer total dose required to correct HGB deficit and provide 500mg iron stores 2.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

10. 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