Anemia, Iron Deficiency Flashcards
Treatment of anemia with an iron preparation is justified only in the presence of a demonstrable _______________
iron-deficiency state
Before starting treatment, it is important to exclude any __________________
serious underlying cause of the anaemia (e.g. gastric erosion, gastro-intestinal cancer).
In which cases is prophylaxis with an iron preparation appropriate? (6)
- Malabsorption
- Menorrhagia
- Pregnancy
- After subtotal or total gastrectomy
- Hemodialysis patients
- Low birth-weight infants such as preterm neonates
Iron salts should be given ____________ unless there are good reasons for using another route.
by mouth
_________________ 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
Haemoglobin regeneration rate
- Choice of preparation is thus usually decided by the incidence of side-effects and cost
The oral dose of elemental iron for iron-deficiency anaemia should be ___________ mg daily
100 to 200
- It is customary to give this as dried ferrous sulfate
Preparations containing iron and __________ are used during pregnancy in women who are at high risk of developing iron and folic acid deficiency
folic acid
- they should be distinguished from those used for the prevention of neural tube defects in women planning a pregnancy
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 _____________
megaloblastic anaemias
Some oral preparations contain ______________ to aid absorption of the iron but the therapeutic advantage of such preparations is minimal and cost may be increased
ascorbic acid (Vit C)
______________ preparations of iron are licensed for once-daily dosage, but have no therapeutic advantage and should not be used
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
Iron can be administered parenterally in which forms? (4)
- Iron dextran
- Iron sucrose
- Ferric carboxymaltose
- Ferric derisomaltose
In which cases is parenteral iron used? (4)
when oral therapy is unsuccessful because…
- the patient cannot tolerate oral iron,
- does not take it reliably, or
- if there is continuing blood loss, or in
- malabsorption
Parenteral iron may also have a role in the management of _____________ anaemia, when given with erythropoietins, in specific patient groups
chemotherapy-induced
Many patients with _______________ also require iron by the intravenous route on a regular basis
chronic renal failure who are receiving haemodialysis (and some who are receiving peritoneal dialysis)
Does parenteral iron produce a faster hemoglobin response than oral iron?
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
How is iron treatment monitored? (2)
- Hb
2. Serum iron concentrations
What are the common side effects of oral iron? (4)
- Constipation
- Diarrhea
- GI discomfort
- Nausea
Also decreased appetite, discolored stools
Iron can be constipating and occasionally lead to _____________
faecal impaction
Oral iron, particularly modified-release preparations, can exacerbate ______________ in patients with ______________; care is also needed in patients with intestinal strictures and diverticular disease
diarrhoea
inflammatory bowel disease
When monitoring response to treatment, the haemoglobin concentration should rise by about ____________ per day or _____________ over 3-4 weeks
100–200 mg/ 100 mL (1–2 g/litre)
or
2 g/100 mL (20 g/litre)
Oral iron preparations are best absorbed ______________
On an empty stomach
However, they can be taken with food to reduce GI side effects
Serious ________________, including life-threatening and fatal _____________, have been reported in patients receiving intravenous iron
hypersensitivity reactions
anaphylactic reactions
- These reactions can occur even when a previous administration has been tolerated
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.
30
- In the event of a hypersensitivity reaction, treatment should be stopped immediately and appropriate management initiated
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.
known allergies, immune or inflammatory conditions, or those with a history of severe asthma, eczema, or other atopic allergy
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
first
second or third
What are the common or very common side effects of IV iron? ()
- Dizziness
- Flushing
- Headache
- HTN or hypotension
- Hypophosphatemia
- Nausea
- Skin reactions
- Altered taste
Anaphylactic reactions can occur with parenteral administration of iron complexes and facilities for _______________ must be available
cardiopulmonary resuscitation
Fetal monitoring is recommended during administration of IV iron due to the risk of fetal ______________
bradycardia
Is IV iron safe to use in hepatic and/or renal impairment?
Avoid in decompensated cirrhosis and hepatitis
Avoid in acute renal failure
