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Hematology Case No 4.Iron Deficiency Anemia

IDA_তে_কতটুকু_হিমোগ্লোবিন_থাকলে_কতটুকু_Iron

Iron deficiency anaemia তে Iron correction করার জন্য প্রথমত Oral iron দেওয়া হয়, কারো যদি Oral iron খেতে সমস্যা হয়, যেমন indigestion, abdominal discomfort ইত্যাদি, সেইক্ষেত্রে IV iron দেওয়া হয়-

Iv iron দেওয়ার সময় iron deficit calculation করে iron দেওয়া হয়–

Iron deficit হিসাব করার জন্য Ganjony formula follow করা হয়-

Total iron requirement = (Target hemoglobin – Actual hemoglobin) × Body weight ×2.4 + (500-1000 mg storage)

body weight < 50 kg হলে 500 mg storage add করবে,

Body weight >50 kg 1000 mg storage add korbe

ধরুন, একজন মানুষের ওজন ৬০ কেজি-

তার Hemoglobin 8gm/dl এবং তার আয়রন ডেফিসিয়েন্সি রয়েছে– CBC তে MCV, MCHC, ছোট-

আমরা তার Target Hemoglobin =11 gm/dl ধরি-

তাহলে এই ব্যক্তির anaemia Correction করতে কি পরিমান Iron লাগবে?

According to Ganzony formula হিসাব করুন-

iron requirement = Target Hemoglobin – actual Hb) × Body weight × 2.4 + (500-700) এই 500-700 store iron এর জন্য দেওয়া হয়-

এবার উপরের ব্যক্তির হিসাব করি-

(11-8) × 2.4 ×60 + (500 থেকে 1000 storage)

432+500 = 932

এখন উপরের এই ব্যক্তির আয়রন কারেকশন করতে প্রায় 932 mg iron লাগবে- যদি storage এর জন্য 500 ধরি,

আর 1500 লাগবে যদি storage 1000 mg ধরি

আয়রন ইঞ্জেকশন Maltofer 500 mg ২ টা ইনজেকশন দিলে হবে, অথবা Maltofer 1000 mg ১ টা দিলেই Hemoglobin 8 gm/dl থেকে 11 gm/dl হবে-

সপ্তাহে 1000 mg এর বেশি আয়রন ইনজেকশন দেওয়া যায়, এর বেশি দিতে হলে ২ সপ্তাহে দিবে,

এখন একটা প্রশ্ন থাকে– storage এর জন্য কত টুকু দেওয়া উচিৎ – storage এর জন্য 500-1000 দেওয়া হয়, তবে 1000 mg দিলে কারেকশন ইফেক্টিভ হয়-

এইটা গেলো IV iron এর ডোজ-

এবার যদি৷ ওরাল iron এর ডোজ বলি-

তাহলে আমরা বাজারে যেসব iron tablet গুলি পাই,

তার মধ্যে রয়েছে ferrous sulphate, ferrous fumarate, Ferrous ascorbate, এই সব

গুলি সবের Absorption rate only 10% or less, except Ferous Ascorbate, ferrous ascorbate এর absorption rate > 30%, indian journal of obstetric and Gynecology তে absorption rate >60% বলা হয়েছে-

অর্থাৎ Ferrous sulphate form এ দৈনিক 200 mg খেলে circulation এ যাবে 10%, 200 mg এর মধ্যে elemental iron = 20% বা 40 mg, এখান থেকে ১০% absorb হলে দৈনিক 200 mg এর একটা ferrous sulphate খেলে

blood এ যাবে 8-10 mg.

আর ascorbate এর 100 mg এর মধ্যে Elemental iron 15%. , Absorption rate >60%

বাজারে Hemofix নামে পাওয়া যায়- যেখানে 275 mg এর tablet থাকে, এর মধ্যে 15% হচ্ছে elemental iron

তার মানে 275 mg এর একটা খেলে Elemental iron পাওয়া যাবে 40 mg, 40 এর 60% absorb হলে 24 mg.

যা ferrous sulphate এর দ্বিগুণ এর চেয়ে বেশি–

আর Hemofix FZ এর মধ্যে elemental iron থাকে প্রায় 48 mg, তার যদি 30-60 % absorb হয়, তাহলে absorbed iron এর পরিমান হয় 15-30 mg…

Hemofix FZ দিনে ২ টা করে খেলে উপরের সিনারিওতে 1000 mg correction করতে সময় লাগবে প্রায় ৩-৪ সপ্তাহ –

আমরা যদি 1500 mg কারেকশন করি, তাহলে সময় লাগবে সর্বোচ্চ ৬ সপ্তাহ, এই জন্য IDA তে oral form দিলে Ferrous ascorbate হবে ড্রাগ অফ চয়েজ-

Tablet1.- Hemofix 33mg (AS A Ferrous Ascorbate AS A Oral Iron preparations).

Indications of Tablet:- Hemofix 33mg (AS A Ferrous Ascorbate AS A Oral Iron preparations).

Hemofix is indicated in the treatment of iron deficiency anemia.

Pharmacology of Tablet:- Hemofix 33mg (AS A Ferrous Ascorbate AS A Oral Iron preparations).

Ferrous ascorbate, a synthetic molecule of ascorbic acid and iron. Iron replenishes the iron stores in your body and corrects iron deficiency anemia. Vitamin C (ascorbate) is added to enhance the absorption of iron in the body.

Dosage & Administration of Tablet:- Hemofix 33mg (AS A Ferrous Ascorbate AS A Oral Iron preparations).

Adult & Elderly: One tablet a day before or after meal (food independent absorption) or as directed by the physician. In more severe cases, two tablets a day may be required as prescribed by the physician.

Pediatric patients: Safety and effectiveness in pediatric patients have not been established.

Contraindications of Tablet:- Hemofix 33mg (AS A Ferrous Ascorbate AS A Oral Iron preparations).

It is contraindicated in hemosiderosis, hemochromatosis, hemolytic anemia.

Side Effects of Tablet:- Hemofix 33mg (AS A Ferrous Ascorbate AS A Oral Iron preparations).

The treatment of a neurotic patient was interrupted because of nausea and regurgitation. In pregnant women, the incidence of pyrosis and chronic constipation is slightly increased.

Precautions & Warnings of Tablet:- Hemofix 33mg (AS A Ferrous Ascorbate AS A Oral Iron preparations).

Oral iron preparations may aggravate existing peptic ulcer, regional enteritis and ulcerative colitis. Iron compounds taken orally can impair the absorption of tetracycline antibiotics. Antacids given concomitantly with iron compounds decrease iron absorption.

Overdose Effects of Tablet:- Hemofix 33mg (AS A Ferrous Ascorbate AS A Oral Iron preparations).

The chance of poisoning is rare in adults with iron overdose.

Therapeutic Class of Tablet:- Hemofix 33mg (AS A Ferrous Ascorbate AS A Oral Iron preparations).

Oral Iron preparations

OR

Tablet 2. Hemofix FZ( (48mg+0.5mg+22.5mg ) (AS A Ferrous Ascorbate+Folic Acid+Zinc Sulfate).AS A Iron, Vitamin & Mineral Combined preparation).

0+1+0 (২ মাস) ১ মাস কারেকশন এর জন্য, বাকি ১ মাস storage maintain এর জন্য-

VERY eassy to understand if If body wt <50kg ( add 500mg ) , when body wt >50 kg ( add 1000mg ) loud and clear.

Indications of Tablet:-Hemofix FZ( (48mg+0.5mg+22.5mg ) (AS A Ferrous Ascorbate+Folic Acid+Zinc Sulfate).AS A Iron, Vitamin & Mineral Combined preparation).

It is indicated on prophylaxis of iron deficiency especially when inadequate diet calls for supplementary zinc and iron during pregnancy and anemia.

Description of Tablet:-Hemofix FZ( (48mg+0.5mg+22.5mg ) (AS A Ferrous Ascorbate+Folic Acid+Zinc Sulfate).AS A Iron, Vitamin & Mineral Combined preparation).

It is an oral iron, folic acid and zinc preparation indicated for the treatment of iron, folic acid and zinc deficiency.

Pharmacology of Tablet:-Hemofix FZ( (48mg+0.5mg+22.5mg ) (AS A Ferrous Ascorbate+Folic Acid+Zinc Sulfate).AS A Iron, Vitamin & Mineral Combined preparation).

Ferrous Ascorbate, Folic Acid & Zinc is a combination of three nutritional supplements. Ferrous Ascorbate is a combination of iron and vitamin C. Iron replenishes the iron stores in your body and corrects iron deficiency anemia. Vitamin C (ascorbate) is added to enhance the absorption of iron in the body. Folic Acid is a form of vitamin B. It plays a vital role in the formation of red blood cells, which carry oxygen throughout the body. It is also essential in pregnancy due to its role in the development of the unborn baby’s brain and spinal cord. Zinc is a micromineral that provides nutrition.

Dosage & Administration of Tablet:-Hemofix FZ( (48mg+0.5mg+22.5mg ) (AS A Ferrous Ascorbate+Folic Acid+Zinc Sulfate).AS A Iron, Vitamin & Mineral Combined preparation).

Adult & Elderly: One tablet a day before or after meal (food independent absorption) or as directed by the physician. In more severe cases, two tablets a day may be required as prescribed by the physician.

Pediatric patients: Safety and effectiveness in pediatric patients have not been established.

Interaction of Tablet:-Hemofix FZ( (48mg+0.5mg+22.5mg ) (AS A Ferrous Ascorbate+Folic Acid+Zinc Sulfate).AS A Iron, Vitamin & Mineral Combined preparation).

Iron chelates with tetracycline. Since oral iron products interfere with absorption of oral tetracycline antibiotics, Hemofix FZ should not be taken within two hours of each other. Occasional gastrointestinal discomfort may be minimized by taking with meals. Absorption of iron may be impaired by concurrent administrations of penicillamine and antacid. In patients with renal failure, a risk of zinc accumulation may exist.

Contraindications of Tablet:-Hemofix FZ( (48mg+0.5mg+22.5mg ) (AS A Ferrous Ascorbate+Folic Acid+Zinc Sulfate).AS A Iron, Vitamin & Mineral Combined preparation).

It is contraindicated in patients with haemolytic anaemia and in conditions with increased hypersensitivity to any of its components and increased body iron content.

Side Effects of Tablet:-Hemofix FZ( (48mg+0.5mg+22.5mg ) (AS A Ferrous Ascorbate+Folic Acid+Zinc Sulfate).AS A Iron, Vitamin & Mineral Combined preparation).

Side effects of iron, folic acid and zinc supplementation are mild and transient. These include epigastric pain, nausea, constipation, vomiting, diarrhoea, heart burn, etc. Allergic sensitization has been reported following both oral and parenteral administration of folic acid.

Pregnancy & Lactation of Tablet:-Hemofix FZ( (48mg+0.5mg+22.5mg ) (AS A Ferrous Ascorbate+Folic Acid+Zinc Sulfate).AS A Iron, Vitamin & Mineral Combined preparation).

If pregnant, or planning to become pregnant or are currently breast-feeding please contact your physician, before taking or continuing the drug. Administration in first trimester of pregnancy should be avoided unless definite evidence of iron deficiency is observed. Prophylaxis of iron deficiency is justified during the remainder of pregnancy specifically when zinc supplementation is required.

Precautions & Warnings of Tablet:-Hemofix FZ( (48mg+0.5mg+22.5mg ) (AS A Ferrous Ascorbate+Folic Acid+Zinc Sulfate).AS A Iron, Vitamin & Mineral Combined preparation).

Care should be taken in patients who may develop iron overload, such as those with haemochromatosis, haemolytic anemia or red cell aplasia. Failure to respond to treatment may indicate other causes of anemia and should be further investigated.

Overdose Effects of Tablet:-Hemofix FZ( (48mg+0.5mg+22.5mg ) (AS A Ferrous Ascorbate+Folic Acid+Zinc Sulfate).AS A Iron, Vitamin & Mineral Combined preparation).

The clinical course of acute iron overdosage can be variable. Initial symptoms may include abdominal pain, nausea, vomiting, diarrhoea, tarry stools, melena, hematemesis, hypotension, tachycardia, metabolic acidosis, hyperglycemia, dehydration, drowsiness, pallor, cyanosis, lassitude, seizures, shock and coma.

Therapeutic Class of Tablet:-Hemofix FZ( (48mg+0.5mg+22.5mg ) (AS A Ferrous Ascorbate+Folic Acid+Zinc Sulfate).AS A Iron, Vitamin & Mineral Combined preparation).

Iron, Vitamin & Mineral Combined preparation

এবার একটা কমন প্রশ্ন IV iron এর ক্ষেত্রে –

এইটা কাকে দেওয়া যাবেনা?

এক কথায় যাদের এইটার প্রতি hypersensitivity রয়েছে, তারা দিতে পারবেনা- সেইজন্য দেওয়ার সময়

প্রথম ৫ মিনিট 15-20 drops /minutes করে দিবে,

দেখবে কোনো রিয়েকশন হয় কিনা, যেমন Rash, fever, chest pain ETC… যদি না হয়, পরবর্তী ৩০-৪০ মিনিটের মধ্যে পুরো infusion দেওয়া হবে–

iron injection directly দেওয়া হয়না,

সাথে একটা N/S থাকে, ওইটাতে মিক্স করে দেওয়া হয়, যাতে hypersensitivity না হয়-

N/S:Normal saline (NSS, NS or N/S) is the commonly used phrase for a solution of 0.90% w/v of NaCl, 308 mOsm/L or 9.0 g per liter. Less commonly, this solution is referred to as physiological saline or isotonic saline (because it is approximately isotonic to blood serum, which makes it a physiologically normal solution).

Raiyyan Tahsan. Date:-23-01-2025 Thursday Time:5-26-55 PM

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