 Anemia is defined as a reduction in the oxygen-carrying capacity of

the blood caused by a diminished erythrocyte mass.

 Iron deficiency anemia develops when body stores of iron drop too
low to support normal red blood cell (RBC) production. Inadequate
dietary iron, iron absorption, bleeding, or loss of body iron in the
urine maybe the cause.
 HGB<13.5 g/dL (men) <12 (women)
 HCT<41% (men) <36 (women)
 a ferritin concentration of more than 100 ng/mL (100 mg/L)
effectively rules out iron deficiency, and a ferritin of less than
15ng/mL (15 mg/L) rules in iron deficiency.
 More common in women as a result of menstrual losses
Iron-deficiency anemia is usually due to :
blood loss
poor diet
an inability to absorb enough iron from food

1.Blood loss
 Blood lost causes iron depletion
In women, long or heavy menstrual periods or bleeding fibroids
in the uterus.
Childbirth
Internal bleeding
2.Poor Diet
Low iron intake.
During some stages of life,like pregnancy and children
3.Inability To Absorb Enough Iron
Even if you have enough iron in your diet, your body
may not be able to absorb it. This can happen if you have
intestinal surgery or a disease of the intestine.
Prescription medicines that reduce acid in the stomach
also can interfere with iron absorption.
 brittle nails SIGNS & SYMPTOMS
 cracks in the sides of the mouth
 chest pain
 Pale skin
 Fast heart rate
 Headache
 an enlarged spleen
 Cold hands and feet
 frequent infections.
 Irritability
 shortness of breath
 swelling or soreness of the tongue
 An unusual craving for non-nutritive
 An unusual craving for non-nutritive substances such as:
Ice
Dirt
Paint or starch.
This craving is called pica.
 Some people who have iron-deficiency anemia develop restless legs
syndrome(RLS). RLS is a disorder that causes a strong urge to move the
legs.
 Some signs and symptoms of iron-deficiency anemia are related to the
condition's causes.
 A sign of intestinal bleeding is bright red blood in the stools or black,
tarry-looking stools.
 Very heavy menstrual bleeding, long periods,or other vaginal bleeding
may suggest that a woman is at risk for iron-deficiency anemia.
 PATHOPHYSIOLOGY
Iron deficiency anemia is the most common form of anemia and it
develops over time if the body does not have enough iron to
manufacture red blood cells.
 Without enough iron, the body uses up all the iron it has stored in
the liver, bone marrow and other organs.•
 Once the stored iron is depleted, the body is able to make very
few red blood cells.
 If erythropoietin is present without sufficient iron, there is
insufficient fuel for red blood cell production
 The red blood cells that the body is able to make are abnormal
and do not have abnormal hemoglobin-carrying capacity, as do
normal red blood cells.
 TREATMENT
IRON SUPPLEMENT
 IMPORTANT POINTS ABOUT IRON
SUPPLEMENT
 Before using iron medication, check if you are allergic to any
drugs or food dyes, or if you have:
 iron overload syndrome
 hemolytic anemia (a lack of red blood cells)
 porphyria (a genetic enzyme disorder that causes symptoms
affecting the skin or nervous system)
 thalassemia (a genetic disorder of red blood cells)
 liver or kidney disease
 if you are an alcoholic; or
 if you receive regular blood transfusion.
 Most iron medication are taken on an empty stomach, at least 1
hour before or 2 hours after meal.
 TREATMENT OF IRON DEFICIENCY
ANEMIA
 Iron deficiency anemia is treated with oral or parenteral
iron preparation. Oral iron corrects the anemia just as
rapidly and completely as parenteral iron in most cases if
iron absorption from the GIT is normal.
 Different iron salt provide different amount of elemental
iron.
 In iron deficient individual, about 50-80mg of iron can be
incorporated in hemoglobin daily and about 25% of oral
ferrous salt can be absorbed.
• Oral iron treatment may require 3-6 months to
replenish body stores.
• .
 Common adverse effects of oral iron therapy

 Ferrous sulfate is the DOC for iron deficiency anemia

 Nausea
 Epigastric discomfort
 Abdominal cramps
 Constipation and diarrhea.
 Black stool
 These effects are usually dose related.
 Parenteral iron therapy

1)-Iron Dextran- is a stable complex of ferric hydroxide and low-

molecular weight dextran containing 50mg of elemental iron
per milliliter of solution. complex.it can be given deep IM
injection or IV infusion.
2)- Iron sucrose complex & iron sodium gluconate • These are
indicated for patient with hypersensitivity reactions to oral iron
salts. They are only given by IV route
 PATIENT’S DEMOGRAPHIC
PROFILE:

NAME : Mrs.Annapurna

AGE : 30 years

GENDER : Female

DATE OF ADMISSION : 07/09/2017

IP NO : R117 - 016014
 COMPLAINTS
 CHIEF COMPLAINTS:
• Generalized weakness since 4 days.

• Shortness of breath since 4 days.

 HISTORY OF PRESENT ILLNESS:

• Generalized weakness associated with SOB on exertion , easy
fatigability ,cough since yesterday , loss of appetite .

• Regular menses. Palpitations present.

• No black colored stools , joint pains and rashes. Pallor present.

 PAST HISTORY
No history of abdominal pain ,pica and fever.
No History of thyroid disorders, diabetes, HTN , jaundice,CAD

PERSONAL HISTORY
DIET: MIXED
APPETITE: DECREASED
BOWEL & BLADDER :REGULAR
SLEEP : ADEQUATE .
 VITALS
CVS : Pan systolic murmur
PR : 100 / min.
BP : 110/ 80 mmHg
RS : BAE , lungs clear .
CNS : NAD
ABDOMEN : Mild hepatomegaly.
 DAY-1
C/O : SOB on exertion
Cough since yesterday
Generalized weakness

O/E : patient is conscious ,pallor++

VITALS :
BP : 110/80 mmHg, PR :80 b/ min .
RR : 30 b/min , RS : lungs clear .

Medications : INJ MONOCEF 1gm iv BD

TAB AZEE 500 mg
TAB LIVOGEN IN 100 ml NS
TAB PARASAFE 500 mg SOS
INJ PANTOP 40 MG IV OD
1 UNIT OF PCV TRANSFUSION
 DAY-2
C/O: SOB on exertion
Generalized weakness

VITALS :
BP : 110/80 mmHg, PR :80 b/ min .
RR : 30 b/min , RS : lungs clear
CVS : Pan systolic murmur .

Rx : CONTINUE SAME TREATMENT

DAY-3
C/O: No fresh complaints
Loss of appetite

O/E: Patient is conscious coherent

VITALS:
BP : 110/70 mmHg, PR :72 b/ min .
RR : 30 b/min , TEMP : afebrile

Rx:
INJ Optineuron 1amp in 100ml NS
1 UNIT of PCV transfusion with pre medication
Stopped TAB Azee
DAY-4
C/O : Cough ,SOB on exertion
No other fresh complaints
GC better.

O/E : Patient is conscious oriented

VITALS:
BP : 100/70 mmHg, PR :90 b/ min .
RR : 20 b/min , TEMP : afebrile

Rx:
Continue same treatment.
Added TAB Orofer XT OD
DAY-5
C/O : No fresh complaints,
Patient is feeling better,
Discharged.

DISCHARGE MEDICATIONS:

 TAB Orofer XT OD for 1 month

 TAB Benefit
 TAB Pan 40mg OD
 LAB INVESTIGATION
DATE:04/09/17

INVESTIGATION RESULT NORMAL RANGE

HAEMOGLOBIN 6.2 gms% 11.5-16.0 gms%

RBC COUNT 2.6 mil/cu.mm 3.0-5.5 mil/cu.mm

FERRITIN 8.3 ng/ml 10-291 ng/ml

IRON 5.2 ng/ml 59-158 ng/ml

RANDOM BLOOD SUGAR 97mg/dl 70-165 mg/dl

BLOOD UREA 28mg/dl 15-40 mg/dl

SERUM CREATININE 1.1 mg/dl 0.7-1.2 mg/dl

RETICULOCYTE COUNT 01% 0.5-2.0 %

DATE:(06/09/17)

Chest X-ray is normal, HIV & HBSAg are non reactive

 MEDICATIONs:
FREQUEN
S.NO. BRAND NAME DOSE ROA GENERIC NAME
CY
1. Inj. Pantop 40mg IV OD Pantoprazole
2. Inj.monocef 1 gm IV BD Ceftriaxone
3. Tab Azee 500mg PO BD Azithromycin
Ferrous ascorbate+
4. Tab orofer XT 100mg+1.5 mg PO BD
Folic acid
5. Tab Parasafe 500mg IV TID Paracetamol
1amp in 100ml Pyridoxine +Vitamin
6. Inj optineuron IV OD
NS B12
1amp in 100ml Ferrous fumarate +folic
7. Inj livogen PO OD
NS acid
1 unit PCV
8. -- -- -- --
transfussion
 SOAP
Subjective evidence:
A 30 years old female was admitted in the general
medicine department with chief complaints of
generalized weakness and SOB on exertion since 4days.

Objective evidence:
Decrease in levels of Hemoglobin , RBC count ,ferritin
and iron results diagnosing the disease iron deficiency
anemia
 Assessment
PROBLEM 1 : iron deficiency anemia(palpitations, pallor, SOB, fatigue )
Lab reports and patients complaints confirmed IDA
Medications: Tab Livogen
Tab orofer XT
pcv transfusion

PROBLEM 2 : infection(Cough)
Medications : azithromycin.

PROBLEM 4 : generalized weakness

Medications : Tab optineuron
tab benefit ( on discharge)

PROBLEM 5: ulcer prophylaxis

Medications : tab pantoprazole
 PLAN
FREQ
ADVERSE DRUG
BRAND NAME DOSE ROA UENC USES
EFFECTS
Y
Nausea , vomiting, dizziness.
Inj. Pantop 40mg IV OD PPI Gas,stomach pain,tired feeling ,
joint pain
Blood clots,rashes,headeche,
Inj.monocef 1 gm IV BD Antibiotic
flushing ,nausea ,vomiting
Deafness, blurred vision,dark
Tab Azee 500mg PO OD Antibiotic urine, stomach pain,difficulty
swallowing
loss of appetite , anorexia,
100mg+1.
Tab orofer XT PO BD Iron supplement confusion ,
5 mg
seizures,constipation
Steven johnsons
Analgesic
Tab Parasafe 500mg IV TID syndrome,gastric ulcer, allergic
&antipyretic
skin reaction
Branchospasm,shivering
1amp in vitamin
Inj optineuron IV OD ,urticaria,hypersensitivity
100ml NS supplement
reaction.
 Pharmacist intervention
 mild hepatomegaly not evaluated.

 Drug interactions: iron supplement + pantoprazole

pantoprazole inhibit serum iron absorption by increasing the pH of the
stomach and decreasing the solubility of ferrous salts.

ADR : INJ LIVOGEN

After starting intial treatment Of inj livogen for (IDA),patient developed loss of
appetite and sleeping disturbances.
 Patient counsellimng
• ABOUT THE DISEASE
 Anemia is a condition in which the body does not have enough healthy red blood
cells. When your body does not have enough iron, it will make fewer red blood
cells or red blood cells that are too small. This is called iron deficiency anemia.
 You get iron deficiency anemia when your body's iron stores run low. You can get
iron deficiency if:
• You lose more blood cells and iron than your body can replace
• Your body does not do a good job of absorbing iron
• Your body is able to absorb iron, but you are not eating enough foods with iron
symptoms may include:
 Feeling weak or tired more often than usual, or with exercise.
 Headaches, Problems concentrating or thinking,Blue color to the whites of the eyes,
 Brittle nails, Light-headedness when you stand up , Pale skin color , Shortness of
breath,
 Sore tongue , Dark, tar-colored stools or blood , Heavy menstrual bleeding
(women)
 Pain in the upper belly (from ulcers),Weight loss.
 About the medications:
1. Azithromycin: You may take most forms of azithromycin with or without
food.Do not take in larger or smaller amounts or for longer than recommended.
Follow the directions on your prescription label.

2. Livogen : Take Ferrous Fumarate and Folic Acid on an empty stomach, at least
1 hour before or 2 hours after a meal. Do not take extra medicine to make up the
missed dose

3. Orofer XT : consume Orofer Xt Tablet before breakfast. should not drive a

vehicle if using the medicine makes you drowsy, dizzy or lowers your blood-
pressure extensively. Avoid alcohol with medicines .

4. parasafe : avoid using if allergic to thus drug . Take the missed dose as soon as
noticed and if it is the time for next dose then skip the missed dose. Continue the
regular schedule.

5. Pantoprazole : You can take this form with or without food. Take at the same time
every day for best effects. Don’t cut, crush, or chew this medication.
 Lifestyle modifications
 Drink adequate amounts of water prevent dehydration and the likelihood for sickle
cell problems.
 Keep you body refreshed during extreme cold and hot temperatures since exposure
to these extremes can enhance the likelihood of sickle cell problems. so you need to
reduce stress all the time Your body is prone to sickle cell problem when you’re
subjected to too much stress.
 Some types of anemia can be managed with a healthy, balanced diet rich in iron,
vitamin B12, folate, and vitamin C, which helps your body absorb iron. meat is a
main source of nutrients.
 Take iron rich food like:
• Iron is found in red meat, poultry, and some fish (such as salmon, tuna, shrimp).
Other iron-rich foods include beans, lentils, dark green leafy vegetables, dried fruit,
nuts, soy, and iron-fortified cereals and breads.
• Folate is found in fortified cereals, meat, spinach, beans, citrus fruits and juices,
cantaloupe, papaya, and bananas.
• Vitamin B12 is most plentiful in meat, fish, and dairy products, as well as fortified
cereals.
• Vitamin C is found in citrus fruits, melons and berries, bell peppers, broccoli,
Brussels sprouts, and kale.