IRON DEFICIENCY ANEMIA

( IDA )
IN WOMEN

OUTLINE
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. BACKGROUND DEFINITION OF TERMS PREVALENCE PHYSIOLOGY ETHIOLOGY CONSEQUENCES OF IDA CAUSES SYMPTOMS DIAGNOSIS TREATMENT DRUG INTERACTIONS CONCLUSION ROLE OF PHARMACISTS

IRON DEFICIENCY ANEMIA

Iron deficiency is the most widespread nutritional problem in the world. More than two billion people are estimated to suffer from iron deficiency, mostly in developing countries Iron-deficiency anemia affects 10%-15% of menstruating women and 7% of postmenopausal women in the United States. Iron deficiency anemia is characterized by a defect in hemoglobin synthesis, resulting in red blood cells that are abnormally small (microcytic) and contain a decreased amount of hemoglobin (hypochromic).

DEFINITION OF TERMS
Hematocrit The proportion of the blood that consists of packed red blood cell Hemoglobin- is the oxygen-carrying protein pigment in the blood, specifically in the red blood cells Red Blood Cell The blood cell that carries oxygen Mean Corpuscular Volume - A standard part of the complete blood count, the mean cell volume (MCV) is the average volume of a red blood cell. This is a calculated value derived from the hematocrit and the red cell count Mean Corpuscular Hb (MCH ) - The average amount of hemoglobin in the average red cell. The mean cell hemoglobin (MCH) is a calculated value derived from the measurement of hemoglobin and the red cell count.

DEFINITION OF TERMS

PREVALENCE
Women in childbearing years have lower Hb by about 1 gm/dL than men of the same age likely due to sex hormone difference According to the third National Health and Nutrition Examination Survey (NHANES III) data, iron deficiency, defined by two or more abnormal measurements (serum ferritin, transferrin saturation and/or erythrocyte protoporphyrin), continues to be relatively prevalent in U.S. females, affecting 7.8 million adolescents and women of childbearing age. Iron deficiency anemia, a more severe stage of iron deficiency (defined as a low hemoglobin in combination with iron deficiency), was found in 3.3 million females.

PREVALENCE

PREVALENCE

PREVALENCE
The prevalence of iron deficiency and anemia in adolescent males and females, based on the 5th percentile, NHANES III data, is listed in Table below.

PREVALENCE
In 1992, the World Health Organization (WHO) estimated that the prevalence of anemia among pregnant women was sixty percent in Asia, fifty-two percent in Africa, and thirty-nine percent in Latin America.

PHYSIOLOGY
Most people in industrialized countries have 3-4 grams of iron in their bodies. 2.5 g is contained in the hemoglobin needed to carry oxygen through the blood. Physiologically, most stored iron is bound by ferritin molecules; the largest amount of ferritin-bound iron is found in cells of the liver hepatocytes, the bone marrow and the spleen. Macrophages of the reticuloendothelial system store iron as part of the process of breaking down and processing hemoglobin from engulfed red blood cells. Iron is also stored as a pigment called hemosiderin in an apparently pathologic process.

PHYSIOLOGY
Iron absorption occurs predominantly in the duodenum and upper jejunum Most of the iron in the body is recycled by the reticuloendothelial system, which breaks down aged red blood cells Factors reduces absorption) * Phytates, oxalates and phos which influence iron absorption * heme > Fe2+ > Fe3+ * Only about 5 - 15 per cent of iron found in foods is absorbed by the body although this can rise to as much as 50 per cent in cases of anaemia. This means that iron absorption is influenced by the amount of iron in the body's tissues. * Vitamin C * Tannin - found in tea - (which reduces absorption) * Food preservative EDTA (which phates - found in some plant foods (which can reduce absorption)

PHYSIOLOGY

PHYSIOLOGY

PHYSIOLOGY

ETIOLOGY

CONSEQUENCES OF IDA

CAUSES

CAUSES

CAUSES

SYMPTOMS

DIAGNOSIS
The Centers for Disease Control and Prevention (CDC) recommendations for screening adolescents for anemia suggest that all females be screened at least once every five years unless risk factors for anemia are present, resulting in the need for annual anemia screening.

DIAGNOSIS

DIAGNOSIS

DIAGNOSIS

TREATMENT
NON PHARMACOLOGICAL THERAPY

TREATMENT
PHARMACOLOGICAL THERAPY
Aim of Treatment a. Normalize hemoglobin levels and red cell indices; replenish iron stores. b. Individualize disease-specific management depending on underlying cause

PHARMACOLOGICAL THERAPY

TREATMENT

The most economical and effective medication in the treatment of iron deficiency anemia is oral ferrous iron salts. Among the various iron salts, ferrous sulfate is used most commonly

TREATMENT
Parenteral Iron Products
Parenteral iron causes the same therapeutic response as oral iron but can cause adverse effects, such as sanaphylactoid reactions, serum sickness, thrombo phle bitis, and pain. It is reserved for patients who cannot tolerate or will not take oral iron or for patients who steadily lose large amounts of blood because of capillary or vascular disorders. A hematologist can determine the proper dosage of parenteral iron. It is important to remember that parenteral iron therapy is expensive and has greater morbidity than oral preparations of iron. Examples : Iron Dextran (Dexferrum, Infed; 50 mg/mL): Iron Sucrose (Venofer, 20 mg/mL):

DRUG INTERACTIONS
Delayed release iron preparations, although better tolerated, may be less effective and are expensive. A multivitamin containing copper and zinc will prevent impaired absorption or utilization of these nutrients when therapeutic dosages of iron are used. Since the calcium, phosphorous and magnesium contained in multivitamins can impair iron absorption, the iron content of these supplements should not be included in the therapeutic iron dose In addition, they should not be taken within one hour of tetracylines, antacids, acid blockers, calcium supplements or multivitamins. To maximize absorption, iron supplements should be taken with liquids other than milk, coffee, tea or phosphate-containing carbonated beverages such as soft drinks.

CONCLUSION
Iron deficiency anemia is the most common form of anemia. About 20% of women, 50% of pregnant women, and 3% of men are iron deficient (Fishbane, 1999). Some people with iron deficiency anemia always feel cold, because iron plays a role in regulating the body's temperature. Iron can be found in red meat, liver, raisins, spinach, broccoli, and egg yolk. Even though most cases of IDA are the result of poor dietary iron intake, diet changes alone usually aren't enough to replenish depleted iron stores. Likewise, multivitamins with iron aren't adequate for kids with IDA who have such low iron stores, so a separate daily iron supplement may be required. Vitamin C enhances iron absorption and must also be supplemented in the food. Rarely, IDA is so severe and possibly life-threatening that hospitalization and a blood transfusion may be required.

ROLE OF PHARMACISTS
To increase compliance with iron therapy, inform the adolescent of its importance, the possibility of side effects (which will subside with continued use) and that iron supplements may darken stools. Help the adolescent remember to take the supplement by suggesting keeping some in a locker, purse, car or with the school nurse. The adolescent could also put up signs or set a beeper or watch as a reminder Encourage adolescents, particularly those with risk factors for iron-deficiency anemia, to follow the dietary strategies discussed above. Adolescents who are at high risk for anemia, such as female athletes with heavy menses, may benefit from routine or periodic use of a low dose iron supplement.

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