{"id":601,"date":"2020-02-17T20:30:11","date_gmt":"2020-02-17T15:00:11","guid":{"rendered":"https:\/\/medicineplexus.com\/?p=601"},"modified":"2020-02-17T20:30:11","modified_gmt":"2020-02-17T15:00:11","slug":"iron-therapy","status":"publish","type":"post","link":"https:\/\/medicineplexus.com\/iron-therapy\/","title":{"rendered":"Iron therapy"},"content":{"rendered":"\n<p><strong>Iron therapy<\/strong><\/p>\n\n\n\n<ul><li>Iron is<strong> stored only in ferric form, <\/strong>in combination with a large protein<strong> apoferritin<\/strong><\/li><li>most important <strong>storage<\/strong> sites are reticuloendothelial<strong> (RE) cells<\/strong><\/li><li><strong>Daily requirement<\/strong><\/li><\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"345\" height=\"151\" src=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2020\/02\/image-214.png?w=345\" alt=\"\" class=\"wp-image-633\" srcset=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2020\/02\/image-214.png 345w, https:\/\/medicineplexus.com\/wp-content\/uploads\/2020\/02\/image-214-300x131.png 300w\" sizes=\"(max-width: 345px) 100vw, 345px\" \/><\/figure>\n\n\n\n<ul><li><strong>Dietary Source<\/strong><\/li><\/ul>\n\n\n\n<ul><li><strong>Rich :<\/strong> Liver, egg yolk, oyster, dry beans, dy fruits, wheat germ, yeast.<\/li><li>Medium : Meat, chicken, fish, spinach, banana, apple.<\/li><li>Poor : Milk and its products, root vegetables.<\/li><\/ul>\n\n\n\n<ul><li><strong>absorptio<\/strong>n occurs all over the <strong>intestine<\/strong>, but majority in the <strong>upper part<\/strong><\/li><\/ul>\n\n\n\n<p><strong>Factors facilitating iron absorption<\/strong><\/p>\n\n\n\n<ul><li><strong>Acid:<\/strong><\/li><li>by favouring dissolution and reduction of ferric iron.<\/li><li><strong>Reducing substances: ascorbic acid<\/strong>, amino acids containing SH radical. These agents reduce ferric iron and form absorbable complexes.<\/li><li><strong>Meat:<\/strong> by increasing HCI secretion and providing haeme iron.<\/li><\/ul>\n\n\n\n<p><strong>Factors impeding iron absorption<\/strong><\/p>\n\n\n\n<ul><li>Alkalies (antacids) render iron insoluble, oppose its reduction. }<\/li><li>Phosphates (rich in egg yolk)<\/li><li>Phytates (in maize, wheat) iron<\/li><li>Tetracyclines<\/li><li>Presence of other foods in the stomach<\/li><\/ul>\n\n\n\n<p><strong>Oral iron<\/strong><\/p>\n\n\n\n<ul><li><strong>preferred route<\/strong> of iron administration<\/li><li>Dissociable <strong>ferrous salts are inexpensive<\/strong>, have <strong>high iron content<\/strong> and are better absorbed than ferric salts, especially at higher doses.<\/li><li><strong>Gastric irritation and constipation (the most important side effects<\/strong> of oral iron) are related to the total quantity of elemental iron administered.<\/li><li>Some simple oral preparations are:<\/li><li><strong>Ferrous sulfate:<\/strong> (hydrated salt 20% iron, dried salt 32% iron) is the cheapest; may be preferred on this account. It often leaves a <strong>metallic taste in mouth<\/strong><\/li><li>Ferrous gluconate ( 12% iron)<\/li><li><strong>Ferrous fumarate (33% iron):<\/strong><\/li><li><strong>Colloidal ferric hydroxide (50% iron)<\/strong><\/li><li>A <strong>total of 200 mg elemental iron<\/strong> (infants and children 3- 5 mg\/kg) given daily in 3 divided doses produces the maximal haemopoietic response.<\/li><li>Prophylactic dose is 30 mg iron daily.<\/li><li>S\/E \u00e0 Epigastric pain, heartburn, nausea, vomiting, bloating. staining of teeth, metallic taste, colic, etc. are the frequent complaints.<\/li><li><strong>Tolerance to oral iron can be improved by initiating therapy at low dose and gradually escalating to the optimum dose.<\/strong><\/li><li>Constipation is more common<\/li><\/ul>\n\n\n\n<p><strong>Parenteral iron<\/strong><\/p>\n\n\n\n<p>Iron therapy by injection is indicated only when:<\/p>\n\n\n\n<ul><li><strong>Oral iron is not tolerated:<\/strong> bowel upset is too much.<\/li><li>Failure to absorb oral iron: <strong>malabsorption: <\/strong>inflammatory bowel disease.<\/li><li><strong>Chronic inflammation<\/strong> (e.g. rheumatoid arthritis) decreases iron absorption, as well as the rate at which iron can be utilized.<\/li><li><strong>Non-compliance to oral iron<\/strong>.<\/li><li>In presence of <strong>severe deficiency with chronic bleeding.<\/strong><\/li><li>Along with erythropoietin <strong>in chronic kidney disease (CKD) patients<\/strong>: oral ion may not be absorbed at sufficient rate to meet the demands of induced rapid erythropoiesis.<\/li><\/ul>\n\n\n\n<ul><li>Parenteral iron therapy \u00e0 calculation<\/li><li>Iron requirement (mg) = <strong>4.4 x body weight (kg) x Hb deficit (g\/dl)<\/strong><\/li><li>This formula <strong>includes iron needed for replenishment of stores<\/strong><\/li><\/ul>\n\n\n\n<ul><li>The ionized salts of iron used orally cannot be injected because they have strong protein precipitating action and free iron in plasma is highly toxic.<\/li><\/ul>\n\n\n\n<ul><li><strong>lron-dextran<\/strong><\/li><li>Ferrous sucrose and Ferric carboxymaltose<\/li><li>latest one \u00e0 Iron Isomaltoside 1000.<\/li><\/ul>\n\n\n\n<p><strong>lron-dextran<\/strong><\/p>\n\n\n\n<ul><li>high molecular weight colloidal solution containing <strong>50 mg elemental iron\/ml.<\/strong><\/li><li>only preparation that can be <strong>injected i.m. as well as i.v.<\/strong><\/li><li>By i<strong>.m. route it is absorbed through lymphatics<\/strong>, circulates without binding to transferrin and is engulfed by RE cells where iron dissociates and is made available for haeme synthesis.<\/li><li>In the <strong>injected muscle 10- 30% of the dose remains locally<\/strong> bound and becomes unavailable for utilization for several weeks.<\/li><li><strong>Thus, 25% extra needs to be added to the calculated dose.<\/strong><\/li><li>Because dextran is antigenic, anaphylactic reactions are more common than with the newer preparations.<\/li><li><strong>Intramuscular:<\/strong> Injection is given deeply in the <strong>gluteal region using Z track technique (to avoid staining of the skin).<\/strong><\/li><li><strong>Intravenous:<\/strong> A dose of 2 ml containing 100 mg iron is injected per day taking 10 min for the injection.<\/li><li>Alternatively, the total calculated dose is diluted in 500 ml of glucose\/saline solution and infused i.v. over 6-8 hours under constant observation.<\/li><li>Injection should be terminated if the patient complains of giddiness, paresthesias or tightness in the chest.<\/li><\/ul>\n\n\n\n<ul><li><strong>Adverse effects<\/strong><\/li><li>local Pain at site of i.m. injection, pigmentation of skin. sterile abscess- especially in old and debilitated patient.<\/li><li>Systemic \u00e0 Fever, headache, joint pains, flushing, palpitation, chest pain, dyspnoea, lymph node enlargement are more common than with the newer formulations.<\/li><li>An anaphylactoid reaction<\/li><\/ul>\n\n\n\n<p><strong>Ferrous-sucrose<\/strong><\/p>\n\n\n\n<ul><li>high molecular weight complex of iron hydroxide with sucrose, that on i.v. injection is taken up by RE cells, where iron dissociates and is utilized.<\/li><li><strong>safer than the older iron dextran and a dose of 100 mg (max 200 mg) can be injected i.v. taking 5 min<\/strong>, once daily to once weekly till the total calculated dose ( including that to replenish stores) is administered.<\/li><li><strong>However, total dose i.v. infusion is not possible<\/strong>.<\/li><li>solution is highly alkaline ruling out i.m.\/s.c. injection.<\/li><li>The <strong>incidence of hypersensitivity reaction is very low.<\/strong><\/li><li>This preparation is particularly indicated for anaemia in kidney disease patients.<\/li><li>Oral iron should not be given concurrently and till 5 days after the last injection.<\/li><\/ul>\n\n\n\n<p><strong>Ferric carboxymaltose<\/strong><\/p>\n\n\n\n<ul><li>ferric hydroxide core is stabilized by a carbohydrate shell.<\/li><li>The macromolecule is rapidly taken up by the RE cells, primarily in bone marrow (upto 80%), as well as in Iiver and spleen.<\/li><li>Administered either as daily 100 mg i.v. injection, or <strong>upto 1000 mg is diluted with I00 ml saline (not glucose solution)<\/strong> and in fused i. v. taking 15 min or more.<\/li><li>should not be injected i.m \u00e0 clinical trials, it has caused a rapid increase in haemoglobin level in anaemia patients and replenished stores.<\/li><li>Pain at injection site. And rashes have occurred, but anaphylaxis is rare.<\/li><li>Not recommended for children &lt; 14 years.<\/li><\/ul>\n\n\n\n<p><strong>Iron isomaltoside-1000<\/strong><\/p>\n\n\n\n<ul><li>Latest injectable iron formulation for i.v. use marketed in India in 2016.<\/li><li>consists of iron bound tightly in a matrix of isomaltosie-1000, which is an oligosaccharide with mean M.W. o f 1000.<\/li><li>After i.v. injection, iron isomaltoside is rapidly taken up into the RE cells and then slowly released for use by the erythropoietic cells.<\/li><li><strong>The tight binding within the matrix releases very little labile iron which is responsible for toxicity.<\/strong><\/li><li><strong>This permits administration of high single dose of 1- 2 g (upto 20 mg\/kg) i.v. over 15- 30 min.<\/strong><\/li><li><strong>Thus, full iron deficit can be corrected by a single short-period i.v. infusion, <\/strong>which is not only more convenient and cost saving, but also avoids multiple exposure of the patient to i.v. iron.<\/li><li>Alternatively I00-200 mg i.v. may be injected over 5 min daily.<\/li><li>Efficacy of iron isomaltoside comparable to iron dextran or iron sucrose<\/li><li>the immunogenic potential of iron isomaltoside-1000 is low<\/li><li>It may be concluded that currently ferric carboxymaltose and iron isomaltoside-1000 are the two most convenient and safest i.v. iron formulations.<\/li><\/ul>\n\n\n\n<p>Use<\/p>\n\n\n\n<p><strong>Iron deficiency anaemia<\/strong><\/p>\n\n\n\n<ul><li>Most important indication for medicinal iron.<\/li><li>The RBCs are microcytic and hypochromic<\/li><li>Apart from nutritional deficiency, chronic bleeding from g.i. tract {ulcers, inflammatory bowel disease, hookworm infestation) is a common cause.<\/li><li>Iron should be normally administered orally; parenteral therapy is to be reserved for special circumstances<\/li><li><strong>rise in Hb level by 0.5- 1 g\/dl per week is an optimum response to iron therapy.<\/strong><\/li><li>therapy should be continued till normal Hb level is attained (generally takes 1- 3 months depending on the severity of anemia) and 2- 3 months or more thereafter to replenish the stores.<\/li><\/ul>\n\n\n\n<p><strong>Prophylaxis:<\/strong><\/p>\n\n\n\n<ul><li>The amount of iron available from average diet &#8211; 3 mg\/day.<\/li><li>Later half of pregnancy and infancy are periods when iron deficiency will develop unless medicinal iron is supplemented.<\/li><\/ul>\n\n\n\n<ul><li>Megaloblastic anemia<\/li><\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Iron therapy Iron is stored only in ferric form, in combination with a large protein apoferritin most important storage sites are reticuloendothelial (RE) cells Daily requirement Dietary Source Rich : Liver, egg yolk, oyster, dry beans, dy fruits, wheat germ, yeast. Medium : Meat, chicken, fish, spinach, banana, apple. Poor : Milk and its products,[&#8230;]\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_seopress_robots_primary_cat":"","_seopress_titles_title":"","_seopress_titles_desc":"","_seopress_robots_index":"","footnotes":""},"categories":[3],"tags":[],"_links":{"self":[{"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/posts\/601"}],"collection":[{"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/comments?post=601"}],"version-history":[{"count":0,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/posts\/601\/revisions"}],"wp:attachment":[{"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/media?parent=601"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/categories?post=601"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/tags?post=601"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}