Download - Treatment of Nutritional Anemias
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Treatment of NutritionalAnemias
Posan S Limbu
Resource Person: Dr. Nabin Pandey
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Treatment Guide
Raw materials
Supply Line
Factory
Market
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Iron
Oral Iron Therapy G
oal repair anemia replenish stores200-300mg/d elemental iron for 6m 1 yr
Iron PreparationsFerrous sulfate 325mg (65mg), 195mg (39mg)Extended release 525mg (105mg)Ferrous Fumarate 325 mg (107mg), 195 mg (64mg)Ferrous gluconate 325mg (39mg)Polysachharide Iron 15mg(150mg), 50mg (50mg)
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Iron
S ide effects of Oral Iron Therapy G astrointestinal side effectsNausea, Vomiting, Abdominal discomfort,Constipation
Use of small doses of iron or iron preparations withdelayed release may help
If compliance is a major issue and patient is notresponding switch to parenteral iron therapy
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Iron
Parenteral Iron Therapy
Indicated for1. Patients who are unable to tolerate oral irontherapy 2. Needs are relatively acute
3. Require iron on an ongoing basis, usually dueto persistent gastrointestinal blood loss
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Iron
Amount of iron needed by an individual patient
B ody wt. (kg) 2.3 (Hb Deficit) + Storage(15-Pt. Hb (g/dl) (500 or 1000mg)
One shot Multi shot
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Iron
S ide effects of Parenteral Iron Therapy Dose related arthralgias, skin rash, and low-gradefever dies not preclude the further use of parenteraliron
ANAPHYLAXIS- Not seen with newer preparations
- B eware h/o multiple allergies or a prior allergicreaction to dextran- If chest pain, wheezing, a fall in blood pressure, or other
systemic manifestations occur immediate interruptionof infusion
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F olic Acid
1mg/d oral
5mg/d oral for malabsorption
Patients with a continuously increasedrequirement (such as patients with hemolytic
anemia) or those with malabsorption or chronicmalnutrition should continue to receive oral folicacid indefinitely
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C obalamin
Parenteral
IM cyanocobalamin 1000 g per week for 8 weeks (or 6 -1000 g IM injections at 3-7 day intervals)Followed by - 1000 g per month for the rest of
the patients life (or 1000 g IM inj. Every 3m)
Oral crstalline B 12 2mg/day for those withdeficient intake
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B lood Transfusion
One unit of packed red cells increases Hb level by 1g/dlCorrects anemia and also provides iron
Iron chelation therapy (with desferrioxamine) required toprevent hemosiderosis for pts. who have received > 100units of Packed R B Cs
Indications
1. Symptomatic (up to 8g/dl tolerated by individuals without cardiovascular or pulmonary disease)2. Cardiovascular instability (Hb levels need to be keptabove 11g/dl)3.Continued and excessive blood loss from whateversource (eg. acute blood loss > 25 % blood volume)
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Thanks a lot!