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Resident
Pharmacy Practice (PGY-1)
King Faisal Specialist Hospital & Research Center
Explain background, definition, epidemiology, and etiology of
iron deficiency anemia (IDA)
IDA is defined as
o Anemia with biochemical evidence of iron deficiency based on
following laboratory findings
• Serum ferritin, total iron binding capacity (TIBC), transferrin saturation, or
transferrin receptor
Iron + Hb
Iron is best absorb as ferrous (Fe2+) form in the duodenum, and to a smaller
extent in jejunum
Iron sources
o Heme iron (2-3X more absorbable): meat, fish, and poultry
o Non-heme iron: vegetables, fruits, dried beans, nuts, grain products, and dietary
supplements
Third Considered as IDA and occurs because of Hb falls to less than normal values
Stage
IDA results from prolonged negative iron balance
Etiology Firkin F. Hypochromic anemia. In: de Gruchy’s Clinical Hematology in Medical Practice, 1989
IDA adversely effects
o Cognitive performance, behavior, and physical growth of infants,
preschool, and school-aged children
o The immune status and morbidity from infections of all age groups
o The use of energy sources by muscle and thus the physical capacity
and work performance of adolescents and adults of all age groups
o Increase perinatal risks for mothers and neonates and overall infant
mortality during pregnancy
http://www.who.int/nutrition/publications/en/ida_assessment_prevention_control.pdf
Chief Complaints
Fatigue, lassitude, palpitation, and generalized weakness
History
Chronic blood loss, deficient diet
Clinical Features
1. Palor skin, nailbed, conjunctiva
2. Koilonychia (brittle, spoon shaped nails)
3. Atrophic glossitis (atrophy of tongue papilla; making the tongue
smooth and shiny)
4. Pica (compulsive eating of nonfood items) or pagophagia
(compulsive eating of ice)
Firkin F. Hypochromic anemia. In: de Gruchy’s Clinical Hematology in Medical Practice, 1989
Symptoms Signs
Decreased exercise tolerance Tachycardia
Pale appearance (most prominent in
Fatigue
conjunctiva)
Dizziness Decreased mental acuity
Increased intensity of some cardiac valvular
Irritability
murmurs
Weakness
Palpitations
Vertigo
Shortness of breath
Chest pain
DiPiro J. Anemia. In: Pharmacotherapy: A Pathophysiological Approach, 2011
Complete blood count (CBC), erythrocyte sedimentation rate
(ESR), and peripheral blood film (PBF)
Long term
o Improve quality of life (QOL)
o Prevention of recurrences
o Better growth and development (children)
Pharmacological management
o Oral/parenteral iron therapy
Non-pharmacological
o Blood transfusion
Matthew W. et al. Am Fam Physician. 2013;87(2):98-104
Recommended dosage requirements
o 200 mg elemental iron per day for 3-6 months
o 2-3 divided doses to maximize tolerability
o Administration should be 1 hour before meals or on empty
stomach
Hb-iron deficiency (in mg) = body weight (kg) x (normal Hb - actual Hb in g/L) x 0.24 §
KFSH&RC Formulary
*Iron sucrose
http://online.lexi.com/lco/action/doc/retrieve/docid/faisal_f/289383
SA, 60 kg woman with a hemoglobin concentration of 80 g/L due to
iron deficiency needs parenteral iron replacement, which will be
given intravenously in the form of iron sucrose (20 mg iron/mL).
Calculate total iron deficiency and amount of iron sucrose
(ampules) for SA? [Injection: 5 mL/ampule]
Solution:
o Step 1: calculating elemental iron deficiency in Hb of SA
• 60 kg X (150 g/L – 80 g/L) X 0.24 = 1008
• Total vials of iron requirement for SA:
o Step 2: depot iron • 1508 mg elemental iron / (20 mg/mL)
• 500 mg (since SA >34 kg) • Total iron sucrose = 75 mL
o Step 3: total iron deficiency • Iron sucrose (5 mL / ampule)
• (75 mL / 5) = 15 ampules
• Step 1 + Step 2 = 1008 + 500 = 1508 mg elemental iron
http://online.lexi.com/lco/action/doc/retrieve/docid/faisal_f/
289383
Decision to manage anemia is based on the evaluation of risk and
benefit
Iron profile should be measure in the first week for oral therapy and
2 weeks after large intravenous doses
Hb and Hct should be measured weekly, and serum iron and ferritin
levels should be measured monthly
Provide education on healthy lifestyle
Hb Low
MCV Low
Serum iron Low
TIBC High
Serum ferritin Low
Transferrin saturation Low
Q5: For oral iron products, the following statements are true
except:
A. Ferrous sulfate tablet contains 65 mg elemental iron
B. Administration of oral iron should be 1 hour before meals or on
empty stomach preferably
C. Can cause GI intolerance and discoloration of stools
D. Percent elemental iron of all oral preparations is roughly the same