Adolescent Anemia and its treatment.

• Slideshow prepared by Dr. Ashok Moses for Franco Indian Laboratories Ltd.

Treatment of Anemia.

Blood transfusion if heart failure is eminentIV or IM iron in pregnant womenOral iron 3-5 mg Fe/kg/dayTreat underlying causeDietary education

PREVENTION OF IDA

Dietary modification

Food fortification

Iron supplementation

Oral Iron Therapy

• Most appropriate iron therapy is the use of formulations containing ferrous or ferric salts.

Ferrous fumarateFerrous sulphateFerric ammonium citrate (Dexorange).Recommended dose is 150 to 200 mg of elemental iron per

day.

There is no evidence that one preparation is better than the other but it is known that ferric salts are better tolerated than the ferrous forms.

Which iron form to use?

The major factors governing the choice of iron compound include:BioavailabilityCostSafety

Ideally we should go for a safe, cheap, highly bioavailable iron, which causes no organoleptic side-effects

Oral Iron supplements commonly contain Iron as

1.Ferric Salts2.Ferrous Salts3.Iron amino acid chelates4.Iron Polymaltose Complex (IPC)5.Carbonyl Iron

FERRIC SALTS- FERRIC AMMONIUM CITRATE

• The Ferric iron is reduced to ferrous form in intestinal lumen and is then absorbed

• Ferric ammonium citrate is one of the best tolerated iron supplements

• It is provides an optimum tolerance of iron preparations hence helpful to maintain long term patient compliance.

• It rapidly supplements elemental Iron so that iron deficiency is quickly controlled thus leading to faster correction of anemia.

FERRIC SALTS- FERRIC AMMONIUM CITRATE

• Ferric ammonium citrate contains citrate group which increase iron absorption by forming soluble complexes which readily enters epithelial cells lining the upper GI tract

FERRIC SALTS- FERRIC AMMONIUM CITRATE

FERRIC SALTS- FERRIC AMMONIUM CITRATE

• It contains 20.5% elemental Iron• Thus, 160 mg of Ferric ammonium citrate

provides 32.8 mg of Iron.• This regimen corrects anemia rapidly as iron is

absorbed at maximum rate during period of iron deficiency

FERRIC SALTS- FERRIC AMMONIUM CITRATE

• Smaller doses of iron will produce fewer GI side effects as the concentration of ionic iron in GI tract is rapidly reduced

• The high elemental Iron in many preparations may cause severe GI disturbances.

• These GI upsets are more common in pregnant women for whom Iron therapy is essential

• Hence Ferric ammonium salt is ideal salt with least astringent compounds.

FERRIC SALTS- FERRIC AMMONIUM CITRATE

FERROUS SALTS

• All dietary iron has to be reduced to ferrous form to enter the mucosal cells

• Ferrous sulphate (20% elemental Iron) is commonly used for tablet preparations.

• These salts have good bioavailability but it markedly decreased in presence of dietary inhibitors like phytates, tannic acid.

FERROUS SALTS• These salts are having high GI side effects

• Teeths may get stained if drops are not properly placed at the back of tongue

• Salty astringent taste which is not palatable

• Overdose can easily override the mucosal barrier to cause acute toxicity

IRON AMINO ACID CHELATES

• These are conjugates of ferrous or ferric Iron with amino acids.

• Ferris Glycine Sulphate is the only salt of this group available in India

• Have relatively high bioavailability.• No studies in children

• IPC is an Iron preparation which contains non-ionic iron and Polymaltose in a stable complex.

• There are several reports of inadequate or slower rise of Hb with IPC

IRON (III) POLYMALTOSE COMPLEX

CARBONYL IRON

• It is a small particle preparation of highly purified metallic Iron.

• Gastric acid solubalizes carbonyl Iron in this process H+ ions are consumed thereby increasing the pH.

• Also as a result absorption of Iron is slow and self limited by rate of acid secretion by gastric mucosa

FOOD FORTIFICATION

compounds used in food fortification can be divided into 4 groupsFreely water soluble (ferrous sulphate, gluconate, lactate & ferric ammonium citrate).Poorly water soluble (ferrous fumarate, succinate

& saccharate).Water insoluble (ferric pyrophosphate, ferric orthophosphate & elemental iron).Experimental (sodium-iron EDTA & bovine Hb concentrate).

Thank You