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Internal Medicine
Absorption increased by giving between meals, but side effects are less if
given with meals
Common Side effects; GI upset, nausea, dyspepsia, constipation /diarrhea. If
the side effects are not tolerable, reduced dose or change brand e.g. to ferrous
gluconate or ferrous lactate syrup.
Response to treatment; an expected daily rise of hemoglobin by 0.1-0.2 gm /dl
Follow-up; reticulocytosis will start at 3-4 days and peak on the 10th day of
initiation of treatment.
An increase in Hgb concentration of at least 2gm/dl after 3wks of therapy is
considered as a good response.
Treatment should be continued for about 3 months after resolution of anemia to
replenish the iron store.
Inadequate response may imply
Continuing hemorrhage
non compliance to therapy
Wrong diagnosis
Mixed deficiency – associated folate or vit.B12 deficiency
Another cause for anemia e.g. malignancy, inflammation
Malabsorption – rare cause
Use of slow release preparations
Parentral iron
1. Oral Iron intolerance despite modification in dosage regimen
2. Malabsorption
3. Inability or unwillingness to take orally
• Iron-dextran complex or iron sorbitol citrate can be used Intra-muscularly or intra-venous
Dose (ml) = 0.0442 (desired Hgb – Observed Hgb.) X weight (Kg.) + (0.26 x weight Kg.)
Anemia of chronic diseases (ACD)
It occurs in association with a variety of chronic inflammatory and malignant diseases.