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Treatment of NutritionalAnemias

Posan S Limbu

Resource Person: Dr. Nabin Pandey

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Treatment Guide

Raw materials

Supply Line

Factory

Market

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Iron

Oral Iron Therapy G

oal repair anemia replenish stores200-300mg/d elemental iron for 6m 1 yr

Iron PreparationsFerrous sulfate 325mg (65mg), 195mg (39mg)Extended release 525mg (105mg)Ferrous Fumarate 325 mg (107mg), 195 mg (64mg)Ferrous gluconate 325mg (39mg)Polysachharide Iron 15mg(150mg), 50mg (50mg)

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Iron

S ide effects of Oral Iron Therapy G astrointestinal side effectsNausea, Vomiting, Abdominal discomfort,Constipation

Use of small doses of iron or iron preparations withdelayed release may help

If compliance is a major issue and patient is notresponding switch to parenteral iron therapy

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Iron

Parenteral Iron Therapy

Indicated for1. Patients who are unable to tolerate oral irontherapy 2. Needs are relatively acute

3. Require iron on an ongoing basis, usually dueto persistent gastrointestinal blood loss

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Iron

Amount of iron needed by an individual patient

B ody wt. (kg) 2.3 (Hb Deficit) + Storage(15-Pt. Hb (g/dl) (500 or 1000mg)

One shot Multi shot

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Iron

S ide effects of Parenteral Iron Therapy Dose related arthralgias, skin rash, and low-gradefever dies not preclude the further use of parenteraliron

ANAPHYLAXIS- Not seen with newer preparations

- B eware h/o multiple allergies or a prior allergicreaction to dextran- If chest pain, wheezing, a fall in blood pressure, or other

systemic manifestations occur immediate interruptionof infusion

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F olic Acid

1mg/d oral

5mg/d oral for malabsorption

Patients with a continuously increasedrequirement (such as patients with hemolytic

anemia) or those with malabsorption or chronicmalnutrition should continue to receive oral folicacid indefinitely

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C obalamin

Parenteral

IM cyanocobalamin 1000 g per week for 8 weeks (or 6 -1000 g IM injections at 3-7 day intervals)Followed by - 1000 g per month for the rest of

the patients life (or 1000 g IM inj. Every 3m)

Oral crstalline B 12 2mg/day for those withdeficient intake

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B lood Transfusion

One unit of packed red cells increases Hb level by 1g/dlCorrects anemia and also provides iron

Iron chelation therapy (with desferrioxamine) required toprevent hemosiderosis for pts. who have received > 100units of Packed R B Cs

Indications

1. Symptomatic (up to 8g/dl tolerated by individuals without cardiovascular or pulmonary disease)2. Cardiovascular instability (Hb levels need to be keptabove 11g/dl)3.Continued and excessive blood loss from whateversource (eg. acute blood loss > 25 % blood volume)

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Thanks a lot!