ANAEMIA, IRON DEFICIENCY

DESCRIPTION

Anaemia due to iron deficiency. Common causes of iron deficiency are chronic blood loss or poor nutritional intake.

 Hypochromic microcytic anaemia Investigations

Assess for a haematological response to iron therapy.

GENERAL MEASURES

Identify and treat the cause.

Dietary adjustment.

MEDICINE TREATMENT

Oral iron supplementation

Reticulocytosis begins on the 3rdor 4th

day after therapy, peaks at

approximately day ten and lasts between 12 and 21 days.

The expected haemoglobin rise is approximately 2 g/dL every 3 weeks.

Treatment

• Iron, elemental, oral, 100–200 mg daily with a meal, e.g.:

Ferrous sulphate compound, oral, BPC 170 mg daily with food.

After the haemoglobin has returned to normal, treatment should be continued for 6 months in order to replenish the iron stores adequately.

Prophylaxis

For example during pregnancy:

• Ferrous sulphate compound, oral, BPC 170 mg daily with meals (65 mg elemental iron).

Consider the following if there is failure to respond to iron therapy:

» non-adherence,

» continued blood loss,

» wrong diagnosis,

» malabsorption, and

» mixed deficiency; concurrent folate or vitamin B12 deficiency.

Parenteral iron

Parenteral iron is seldom required.

The use of parenteral iron may be associated with anaphylaxis.

Parenteral iron is only indicated when oral iron is:

» ineffective, e.g. malabsorption or patients on haemodialysis and erythropoietin therapy, or

» not tolerated.

In people who require repeated therapy, the intravenous route is preferred.

Where a once-off dose is required, give intramuscularly. Minimum required

dose is 250 mg of iron per gram of Hb below normal.

Use in consultation with a specialist.

• Iron sucrose, IV.

o Total dose = weight (kg) x [11 g/dL – actual Hb (g/dL)] x 2.4 +200mg.

o Maximum daily dose: 200 mg.

o Administer over 30 minutes in 200 mL sodium chloride 0.9%.

o Repeat every second day until the total dose is given.

Ensure that the correct formulation is given as some preparations can be

given IM, or IV only, or both.

Resuscitation equipment should be ready to manage anaphylaxis.

Blood transfusion

Indicated in patients with:

» anaemia leading to cardiac failure or severe dyspnoea,

» active, ongoing bleeding, or

» where correction of anaemia to at least 7 g/dL is required prior to

performing an urgent invasive procedure or surgery.

Reference and further reading

Standard Treatment Guidelines and Essential Medicines List for South Africa 2012 Edition