Iron deficiency Anemia :- Deficiency in number of redblood cells or deficiency in total hemoglobin content per unit of blood volum. Anemia can be caused by :- 1- Excessive blood loss. 2 – Blood destruction caused by :- i-drug therapy. ii- Infection and toxines. iii- Defective hemoglobin( thalassemias). 1

3 – Decreased blood formation can be caused by:- i- deficiencies of key materials such as :- folic acid, iron, pyridoxin ( V B6 ) coblamin (V B12 ), ii- Renal insufficiency. iii - Bon marrow failiar. iv – Infections. Anemia treatment : - 1- Blood transfution. 2 – Using the deficient materials necessary for red blood cells formation. 3 – Treatment the pathological condition causing the anemia. 4 – Supplemental therapy. 2

Iron – deficiency Anemia in Infants :- Infant iron stores exhausted due to : - 1- Very low iron intake in first few months. 2-High iron needs requird for rapid growrh. Infant iron stores is about 250 mg. This value is fond even if the mother is iron deficient. This iron store prevents anemia during the first few months. Infants need about 0.9 mg iron daily. 3

Iron replacement & supplemental therapy Drugs used for this purpose : - 1- Must be biologically available compounds. 2- Non irritating compounds. When iron replacement and supplemental therapy prescribed these points must be taken : - 1- The oral rout is the best of choice. 2- Ferrous salts are better absorbed than ferric salts, but thy have the same side effects. Ferrous sulphat FeSO 4 is the standerd drug used. 4

Iron is protein precipetant and can be irritant to the G.I. tract, so it is usually given after meals. Iron is bestly absorbed in between meals in the duodenum. Official Iron Products : 1- Ferrous fumarate FeC 2 H 2 (CO 2 ) 2 O=C CH CH C O O O Fe M.wt

It is red-orang to red-brown oderless powder. Slightly soluble in water. Very low soluble in alcohol. Dissolved in dil. HCl producing fumaric acid. FeC 2 H 2 (CO 2 ) + 2HCl FeCl 2 + C 2 H 2 (CO 2 H) 2 It is resistant to oxidation on air exposure Little conversion to ferric form. Dose : 200 mg tablet( equal to 60 mg iron ) 1-3 times daily USP name : ircon, toleron. 6

2- Ferrous gluconate M.wt COO H C OH HO C H CH 2 OH Fe 2+. H 2 O Yello-green powder with oder like burnt sugar. Its solution(1/20conc.) is acidic to litmus. Soluble in water but insoluble in alcohol. It has good bioavailability. Dosage : 300 mg,3 times / day ( equiv. To 35 mg iron N.F. Name :Fergon 7 2

3-Ferrous sulphate : FeSO 4 ( M.wt.278.) Blue- green oderless crystals or granules. It has saline test and efflorescent in dry air. Oxidized in moist air producing ferric sulphate Fe 4 [ (OH) 2 (SO 4 ) 5 ] Its sol.(1/10 con. ) is acidic to litmus. It can be irritating for G.I. mucosa due to astringent action of the soluble ion. Ferrous sulphate is the drug of choice. Dose : 300 mg tablets( equiv. 60 mg iron ) 2-3 times Syrup,every 1000cc, sucrose825gm,as stabilizing agent and2.1gm citric acid as an acid buffer. 8

4- Iron Dextran injection(USP imferon) Ferric hydroxide Fe(OH) 2 complexed with dextrane(glucose polymer of low M.wt.) Its solution has PH for intramuscular injection. Used in sever iron deficiency where oral drugs are not effective The dose must be carefully measured according to tables. Dose : 100 mg iron equivalent 9

5- Iron sorbitol injection ( USP : Jectofer) Acomplex of iron, sorbitol and cetric acid stabilized with dextrin and sorbitol. Brown clear liquid PH for intramuscular injection, mg daily Non – official preparatios : - 1- Dextriferron ( Astrafer ) : - Aquous sol. of ferric chloride complexed with dextrin, used for I.V. injection only. 10

Immidiate reactions of dextriferron : - Flushing of face,nausea,headache,vomitting abdominal pain, hypertention,collapse and severe anaphylactoid responses. Delayed effects : fever,chills. And sensation of stiffness in arms and legs. Dose mg/daily. 2- Ferro cholinate : - Ferric iron chelated preparation for pediatric use. Used as drop, liquid and tablets. Other preperations include : ferric ammonium citrate. Ferric cacodylate,FeCl 3, Fe 2 O 3,FeCO 3, etc. 11