1. PHARMACOLOGY I. PRIMARY PROBLEM II. THERAPEUTIC GOALS III. MANAGEMENT
PHARMACOLOGIC
NON PHARMACOLOGIC

2. PRIMARY PROBLEM Iron Deficiency Anemia
In normal menstruating women, iron requirements are increased.
Cause of iron deficiency anemia is probably due to heavy bleeding during menstruation
The severity and cause of iron-deficiency anemia will determine the appropriate approach to treatment

3. THERAPEUTIC GOALS
The goal of therapy in individuals with iron deficiency anemia is:
To repair the anemia through
Oral Iron Therapy
Parenteral Iron therapy
Adequate dietary intake of iron
To provide iron stores
To regulate bleeding due to heavy blood flow during menstruation

4. MANAGEMENT Pharmacologic Management of Iron Deficiency Anemia
Oral Iron Therapy
Ferrous sulfate, Ferrous gluconate, Ferrous fumarate
Supplemental iron is needed to replenish lost iron stores
Ferrous iron is most easily absorbed
Treatment with oral iron should be continued for 3-6 months to correct the anemia and replenish iron stores

5. Commonly used Oral Iron Preparations
Tablet size
Elemental iron/tablet
Usual Adult Dosage (tablets/day)
Ferrous sulfate hydrated
dessicated
325 mg
200 mg
65 mg
3-4
Ferrous gluconate
36 mg
Ferrous fumarate
106 mg
2-3
Ferrous sulfate, ferrous gluconate and ferrous fumarate are all effective and inexpensive.
Ferrous sulfate – most inexpensive
Table 33-2 Katzung, B. Basic and Clinical Pharmacology, 9th Ed. McGraw-Hill: New York

6. Parenteral Iron Therapy
Reserved for patients with documented iron deficiency who are unable to tolerate or absorb oral iron and patients with extensive chronic blood loss who cannot be maintained on oral iron alone.
Postgastrectomy
Previous small bowel resection
Inflammatory bowel disease
Malabsorption syndrome

7. Parenteral Iron Therapy
Iron Dextran (IV or IM)
Stable complex of ferric hydroxide and low molecular weight Dextran (50mg of elemental iron)
Iron-sucrose complex and Iron Sodium gluconate complex (IV)
Alternative preparations
IV administration eliminates local pain and tissue staining that often occur with IM

8. Parenteral Iron Therapy
Iron gluconate has less allergic reactions as compared to Iron dextran
Iron sucrose also has less side effects, even if there is a prior history of rxn to Iron dextran
Iron dextran – risk of hypersensitivity reaction
Small test dose of iron dextran should always be
given before full IM or IV doses are given.
Faich, G. Am J Kidney Dis 1999; 33:464

9. MANAGEMENT Non-Pharmacologic Management of Iron Deficiency Anemia
Increase intake of iron from foods such as liver, lean meats, beans, peas, tofu, dark green & leafy vegetables, and egg yolks.
Stopler T (2004). Medical nutrition therapy for anemia. In LK Mahan, S Escott-Stump, eds., Krause's Food, Nutrition and Diet Therapy, 11th ed., pp. 838–859. Philadelphia: Saunders.

10. MANAGEMENT
Pharmacologic Management of heavy bleeding during menstruation
Hormonal Treatment
OCP
GnRH agonist
Schorge J. et al(2008). Wiliams Gynecology

11. Thank You!