Iron Deficiency Anemia IDA Management : Side Effects,Prevention

4th Pediatric Infectious Diseases Conference

ISSN 0973 - 0958

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Child with Iron Deficiency Anemia

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Results

APPROACH TO A CHILD WITH IRON DEFICIENCY ANEMIA

Related Topics

Introduction and Etiological Classification of Anemia

Decreased Supply

Iron Metabolism and Clinical Features

Investigations

Management and Treatment

Dr. M. R. Lokeshwar
Visiting Pediatrician - P.D.Hinduja National Hospital, Mumbai
Pediatrician and Hematologist-Oncologist,
Lilavati Hospital, Bandra, Mumbai.

Dr. Nitin Shah
Division of Pediatric Hematology-Oncology,
Dept. of Pediatrics, L.T.M.G.Hospital & L.T.M.Medical Collage,
Sion, Mumbai - 400 022.

MANAGEMENT :

Side Effects : Reactions to both IM and IV therapy are either immediate or delayed.

Immediate : This includes pain in vein injected, flushing, metallic taste. Such reactions are brief in duration and often are relieved immediately by slowing the rate of injection. Other immediate side-effects include hypotension, anaphylaxis with cardiac arrest, headache, malaise, vomiting, nausea, etc.
Delayed reactions : They include regional lymphadenitis which may be tender for several weeks, myalgia, arthralgia, fever, etc. Most of the reactions though are mild and transient, the anaphylactic reactions may be life-threatening. Hence one should keep ready Inj adrenaline, Inj Hydrocortisone and measures of resuscitation handy before injection is started. Reported incidence of reaction varies from 13 - 26%.

Total dose of iron to be given intravenously is calculated by follows :

Dose of iron (mg) = Wt (kg) x Desired increment of Hb (gm/dl) x 3.

We tried this modality of treatment in 100 of our patients. The results were as follows :

Certainty of dose was established.
Administration was assured - i.e. compliance by patient eliminated.
Hematological response was achieved more rapidly though there was no statistical difference as compared to oral iron therapy.
Adverse reactions commonly encountered in our series were as follows :
- Fever in 50% of patients.
- Arthralgia in 19%.
- Vomiting 5%.
- Allergic reactions causing skin rash, flushing with sweating 3%.
- Local pain along the vein 2%.
- 3 patients had anaphylaxis or vasogenic shock, needing resuscitation and hence we do not recommend total dose iron therapy parenterally in children routinely.

Prevention of Iron Deficiency Anemia :

The basic approaches for prevention of IDA include :

Supplementation with medicinal iron.
Increase the dietary iron intake.
Control of infection and treatment of helminthiasis.
Fortification of staple food with iron.
Supplementation with medicinal iron : These programs do best when concentrated on high risk groups such as pregnant women, infants and preschool children and captive audiences such as school children or plantation workers who can receive their supplements at school or work place. In infants, promoting breast feeding for as long as possible and encouraging timely introduction of appropriate weaning food is the best method of prevention. Major constraints against the effectiveness of supplementation are :
- Side-effects of oral iron medication
- Continuing iron medication for 2 - 3 months by those who do not perceive themselves as ill.
Iron supplementation should be started in full term infants by 4 months and in pre-term infants by 2 months of age in a dose of 1 mg/kg/day in full term and 2 mg/kg/day in preterm infants.
Dietary Modification :
- Increase total intake to fulfill energy requirements. The total iron consumption has been shown to increase by 25 -30%.
- Include heme iron and vitamin C containing food and reduce inhibitory factors in diet i.e. Tannin and Phytates, etc.
Control of Viral, Bacterial and Parasitic Infections : Feeding and breast-feeding must be continued during illness. Immunization and other preventive public health measures such as safe water, proper sanitation etc. should be ensured. Giardiasis, hookworm and other worm infestations and schistosomiasis should be treated promptly.
Food Fortification : Fortification staple food which will reach the masses at large will virtually eliminate iron deficiency in the world. In India, salt fortification has been successfully tried, but with fortification the cost increased by 20%. Salt contains 3500 ppm of ferric orthophosphate and 5000 ppm of acid sulfate. At this level of fortification each gm of salt will provide 1 mg of elemental iron. However, this was done only in field trials in few places and has to be implemented further. EDTA (NaFeEDTA) increased bioavailability of iron in sugar and condiments and the cost increased by 2 %. This has been tried in Guatemala and should be explored in India too.

Two major sources of fortification iron in infancy are infant formulas and infant cereals using ferric pyrophosphate and ferric orthophosphate, ferrous fumarate and succinate or dried bovine Hemoglobin. Fortification of wheat flour has been done by adding ferrous sulphate and elemental iron powder, ferric pyrophosphate, ferric orthophosphate. NaFeEDTA also have been used for fortification of fish sauce, masala (condiments). Dried bovine hemoglobin have been used for fortification of cereals.