Anemia, Iron Deficiency

Question 1

Treatment of anemia with an iron preparation is justified only in the presence of a demonstrable _______________

Answer 1

iron-deficiency state

Question 2

Before starting treatment, it is important to exclude any __________________

Answer 2

serious underlying cause of the anaemia (e.g. gastric erosion, gastro-intestinal cancer).

Question 3

In which cases is prophylaxis with an iron preparation appropriate? (6)

Answer 3

1. Malabsorption
2. Menorrhagia
3. Pregnancy
4. After subtotal or total gastrectomy
5. Hemodialysis patients
6. Low birth-weight infants such as preterm neonates

Question 4

Iron salts should be given ____________ unless there are good reasons for using another route.

Answer 4

by mouth

Question 5

_________________ is little affected by the type of salt used provided sufficient iron is given, and in most patients the speed of response is not critical

Answer 5

Haemoglobin regeneration rate

• Choice of preparation is thus usually decided by the incidence of side-effects and cost

Question 6

The oral dose of elemental iron for iron-deficiency anaemia should be ___________ mg daily

Answer 6

100 to 200

• It is customary to give this as dried ferrous sulfate

Question 7

Preparations containing iron and __________ are used during pregnancy in women who are at high risk of developing iron and folic acid deficiency

Answer 7

folic acid

• they should be distinguished from those used for the prevention of neural tube defects in women planning a pregnancy

Question 8

It is important to note that the small doses of folic acid contained in combined preparations of iron and folate are inadequate for the treatment of _____________

Answer 8

megaloblastic anaemias

Question 9

Some oral preparations contain ______________ to aid absorption of the iron but the therapeutic advantage of such preparations is minimal and cost may be increased

Answer 9

ascorbic acid (Vit C)

Question 10

______________ preparations of iron are licensed for once-daily dosage, but have no therapeutic advantage and should not be used

Answer 10

Modified-release

• These preparations are formulated to release iron gradually; the low incidence of side-effects may reflect the small amounts of iron available for absorption as the iron is carried past the first part of the duodenum into an area of the gut where absorption may be poor

Question 11

Iron can be administered parenterally in which forms? (4)

Answer 11

1. Iron dextran
2. Iron sucrose
3. Ferric carboxymaltose
4. Ferric derisomaltose

Question 12

In which cases is parenteral iron used? (4)

Answer 12

when oral therapy is unsuccessful because…

1. the patient cannot tolerate oral iron,
2. does not take it reliably, or
3. if there is continuing blood loss, or in
4. malabsorption

Question 13

Parenteral iron may also have a role in the management of _____________ anaemia, when given with erythropoietins, in specific patient groups

Answer 13

chemotherapy-induced

Question 14

Many patients with _______________ also require iron by the intravenous route on a regular basis

Answer 14

chronic renal failure who are receiving haemodialysis (and some who are receiving peritoneal dialysis)

Question 15

Does parenteral iron produce a faster hemoglobin response than oral iron?

Answer 15

NO; With the exception of patients with severe renal failure receiving haemodialysis, parenteral iron does not produce a faster haemoglobin response than oral iron provided that the oral iron preparation is taken reliably and is absorbed adequately

Question 16

How is iron treatment monitored? (2)

Answer 16

1. Hb

2. Serum iron concentrations

Question 17

What are the common side effects of oral iron? (4)

Answer 17

1. Constipation
2. Diarrhea
3. GI discomfort
4. Nausea

Also decreased appetite, discolored stools

Question 18

Iron can be constipating and occasionally lead to _____________

Answer 18

faecal impaction

Question 19

Oral iron, particularly modified-release preparations, can exacerbate ______________ in patients with ______________; care is also needed in patients with intestinal strictures and diverticular disease

Answer 19

diarrhoea

inflammatory bowel disease

Question 20

When monitoring response to treatment, the haemoglobin concentration should rise by about ____________ per day or _____________ over 3-4 weeks

Answer 20

100–200 mg/ 100 mL (1–2 g/litre)

or

2 g/100 mL (20 g/litre)

Question 21

Oral iron preparations are best absorbed ______________

Answer 21

On an empty stomach

However, they can be taken with food to reduce GI side effects

Question 22

Serious ________________, including life-threatening and fatal _____________, have been reported in patients receiving intravenous iron

Answer 22

hypersensitivity reactions

anaphylactic reactions

• These reactions can occur even when a previous administration has been tolerated

Question 23

Intravenous iron products should only be administered when appropriately trained staff and resuscitation facilities are immediately available; patients should be closely monitored for signs of hypersensitivity during and for at least ____________ minutes after every administration.

Answer 23

30

• In the event of a hypersensitivity reaction, treatment should be stopped immediately and appropriate management initiated

Question 24

The risk of hypersensitivity reaction to IV iron is increased in patients with ________________; in these patients, intravenous iron should only be used if the benefits outweigh the risks.

Answer 24

known allergies, immune or inflammatory conditions, or those with a history of severe asthma, eczema, or other atopic allergy

Question 25

Intravenous iron should be avoided in the ____________ trimester of pregnancy and used in the _______________ trimesters only if the benefit outweighs the potential risks for both mother and fetus

Answer 25

first

second or third

Question 26

What are the common or very common side effects of IV iron? ()

Answer 26

1. Dizziness
2. Flushing
3. Headache
4. HTN or hypotension
5. Hypophosphatemia
6. Nausea
7. Skin reactions
8. Altered taste

Question 27

Anaphylactic reactions can occur with parenteral administration of iron complexes and facilities for _______________ must be available

Answer 27

cardiopulmonary resuscitation

Question 28

Fetal monitoring is recommended during administration of IV iron due to the risk of fetal ______________

Answer 28

bradycardia

Question 29

Is IV iron safe to use in hepatic and/or renal impairment?

Answer 29

Avoid in decompensated cirrhosis and hepatitis

Avoid in acute renal failure