Iron deficiency treatment

Different iron salts provide different amounts of elemental iron, as shown in Table 33-3. In an iron-deficient individual, about 50-100 mg of iron can be incorporated into hemoglobin daily, and about 25% of oral iron given as ferrous salt can be absorbed. Therefore, 200-400 mg of elemental iron should be given daily to correct iron deficiency most rapidly. Patients unable to tolerate such large doses of iron can be given lower daily doses of iron, which results in slower but still complete correction of iron deficiency. Treatment with oral iron should be continued for 3-6 months after correction of the cause of the iron loss. This corrects the anemia and replenishes iron stores. 

Anemia is a decrease in the number of red blood cells (RBCs), a decrease in die amount of hemoglobin in RBCs, or bodi a decrease in die number of RBCs and hemoglobin. When diere is an insufficient amount of hemoglobin to deliver oxygen to die tissues, anemia exists. There are various types and causes of anemia For example, anemia can be die result of blood loss, excessive destruction of RBCs, inadequate production of RBCs, and deficits in various nutrients, such as in iron deficiency anemia Once the type and cause have been identified, die primary health care provider selects a method of treatment. 

The anemias discussed in this chapter include iron deficiency anemia, anemia in patients witii chronic renal disease pernicious anemia, and anemia resulting from a folic acid deficiency. Table 45-1 defines these anemias. Drugp used in treatment of anemia are summarized in die Summary Drug Table Drugp Used in die Treatment of Anemia. 

Iron salts, such as ferrous sulfate or ferrous gluconate, are used in the treatment of iron deficiency anemia, which occurs when there is a loss of iron that is greater than the available iron stored in the body. Iron preparations act by elevating the serum iron concentration, which replenishes hemoglobin and depleted iron stores. 

Iron dextran is a parenteral iron that is also used for die treatment of iron deficiency anemia It is primarily used when the patient cannot take oral drugs or when the patient experiences gastrointestinal intolerance to oral iron administration. Other iron preparations, both oral and parenteral, used in the treatment of iron deficiency anemia can be found in the Summary Drug Table Dragp Used in the Treatment of Anemia... 

GABRiELLi G B and DE SANDRE G (1995) Excessive tea consumption can inhibit the efficacy of oral iron treatment in iron-deficiency anemia , Haematologica, 80(6), 518-20. 

The first-line treatment for anemia of CKD involves replacement of erythropoietin with erythropoiesis-stimulating agents (ESAs). Use of ESAs increases the iron demand for RBC production and iron deficiency is common, requiring iron supplementation to correct and maintain adequate iron stores to promote RBC production. Androgens were used extensively... 

Iron Supplementation Use of ESAs can lead to iron deficiency if iron stores are not adequately maintained. If serum ferritin and TSAT fall below the goal levels, iron supplementation is required. Oral iron supplements are less costly than IV supplements and are generally the first-line treatment for iron supplementation. When administering iron by the oral route, 200 mg of elemental iron should be delivered daily to maintain adequate iron stores. 

Shirley, NY) sodium ferric gluconate (Ferrlecit by Watson Pharmaceuticals, Inc., Corona, CA) and iron sucrose (Venofer by American Reagent, Inc., Shirley, NY). Initiation of IV iron should be based on evaluation of iron stores. A serum ferritin level less than 100 ng/mL in conjunction with a TSAT level less than 20% indicates absolute iron deficiency and is a clear indication for the need for iron replacement.31 When TSAT is less than 20% in conjunction with normal or elevated serum ferritin levels, treatment should be based on the clinical picture of the patient, as serum ferritin is an acute phase reactant, which may become elevated with inflammation and stress. Iron supplementation may be indicated if Hgb levels are below the goal level. 

The initial treatment of iron-deficiency anemia is oral iron therapy with 200 mg of elemental iron daily for those who are able to tolerate the oral route. In order to attain this amount of elemental iron daily, many different iron products and salt forms are available. Table 63-3 lists the various salt forms of oral iron available, the amount of elemental iron in each product, and the approximate daily dose of the salt to attain 200 mg of elemental iron daily. 

Pollitt E Univ of California, Administration, Davis, CA The effects of lead and iron interaction on behavioral development the effects of iron treatment on iron status, blood lead level, and behavioral development in children with elevated lead levels and iron deficiency U. S. Department of Agriculture, Competitive Research... 

Some other examples of free radical formation in various pathologies are discussed below. (Of course, they are only few examples among many others, which can be found in literature.) Mitochondrial diseases are associated with superoxide overproduction [428] and cytochrome c release [429], For example, mitochondrial superoxide production apparently contributes to hippocampal pathology produced by kainate [430]. It has been found that erythrocytes from iron deficiency anemia are more susceptible to oxidative stress than normal cells but have a good capacity for recovery [431]. The beneficial effects of treatment of iron deficiency anemia with iron dextran and iron polymaltose complexes have been shown [432,433]. 

Iron deficiency For the prevention and treatment of iron deficiency and iron deficiency anemias. 

The parenteral use of complexes of iron and carbohydrates has resulted in anaphylactic-type reactions. Deaths associated with such administration have been reported therefore, use iron dextran injection only in those patients in whom the indications have been clearly established and laboratory investigations confirm an iron-deficient state not amenable to oral iron therapy. Because fatal anaphylactic reactions have been reported after administration of iron dextran injection, administer the drug only when resuscitation techniques and treatment of anaphylactic and anaphylactoid shock are readily available. 

For treatment of patients with documented iron deficiency in whom oral administration is unsatisfactory or impossible. 

Iron deficiency anemia For the treatment of iron deficiency anemia in patients undergoing chronic hemodialysis who are receiving supplemental erythropoietin therapy. 

Orally administered ferrous salts are the preferred treatment for iron deficiency. Ferrous salts are absorbed about three times as well as ferric salts and the bioavailability of the sulfate, fumarate, succinate, gluconate, and other ferrous salts is approximately the same. Ferrous sulfate, being the least expensive, is then the treatment of choice. Ferrous fumarate is available as a syrup and may be useful in small children for the treatment and prophylaxis of iron deficiency. 

Ahmad I, Gibson PR. Management of iron deficiency in patients admitted to hospital time for a rethink of treatment principles. Intern Med J 2006 36 347-54. 

Singh K, Fong YF, Kuperan P. A comparison between intravenous iron polymaltose complex (Ferrum Haus-mann) and oral ferrous fumarate in the treatment of iron deficiency anaemia in pregnancy. Eur J Haematol 1998 60 119-24. 

Iron deficiency anemia is treated with oral or parenteral iron preparations. Oral iron corrects the anemia just as rapidly and completely as parenteral iron in most cases if iron absorption from the gastrointestinal tract is normal. An exception is the high requirement for iron of patients with advanced chronic kidney disease who are undergoing hemodialysis and treatment with erythropoietin for these patients, parenteral iron administration is preferred. 

Parenteral therapy should be reserved for patients with documented iron deficiency who are unable to tolerate or absorb oral iron and for patients with extensive chronic anemia who cannot be maintained with oral iron alone. This includes patients with advanced chronic renal disease requiring hemodialysis and treatment with erythropoietin, various postgastrectomy conditions and previous small bowel resection, inflammatory bowel disease involving the proximal small bowel, and malabsorption syndromes. 

---