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.

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 programmes 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 : (1) Side effects of oral iron medication, and (2) 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 preterm 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.
  
  

Cost and benefits of prevention :

Levin from the world bank has prepared a cost benefit analysis of the impact of fortification and supplementation on iron deficiency anemia. The conclusions drawn are that when it comes to benefit, anemia control produces an immediate increase in physical work output and long term leads to reduced morbidity and mortality, higher productivity, improved quality of leisure time, increased capacity and a greater sense of well being. Apart from many of the benefits, which cannot be measured in material terms, impressive improvement in the earnings occur out of increased labor productivity. He concludes that both iron fortification and supplementation programmes represent highly productive investments for developing countries.

CONCLUSION :

In conclusion, iron deficiency anemia is the commonest type of anemia seen in as high as 70 - 80% of children in India. The commonest causes of this are : faulty dietary habits with recurrent infections and infestations. It is easily preventable and treatable by simple, safe and cheap oral iron therapy.

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Last created on 04-05-2002
Last updated on 01-07-2006