IRON

Iron is present in the human body chiefly as a component of haemoglobin in blood (2/3) and the rest (1/3) in bone marrow, spleen (Iron stores)and muscle. As is well known, Iron deficiency essentially results in a fall in blood haemoglobin content which causes a variety of symptoms like poor general well being, early fatiguability, vertigo palpitation, neuropathic symptoms cloudiness of intellectual process, breathlessness, vague muscle& body aches depending on the severity, rapidity, duration of iron deficiency anaemia. Also certain physiological states like pregnancy, lactation or infancy need more iron to maintain haemoglobin due to more physiological demand. Daily Iron requirement for adult 1-1.5 mg/day (higher demand in females). Iron absorption from G.I.T. 10% of dietary intake, this figure can go upto 30% in case of Iron deficiency anaemia. In pregnancy/lactation, Iron requirement 2-2.5/day. In infancy 1-1.5 mg/kg body wt/day. Iron therapy is indicated only for case of Iron deficiency states and for prophylaxis in case of pregnancy and infancy. Oral therapy is the preferred method but in certain condition like severe iron deficiency states or inability to retain oral Iron or in case of G.I. disease state or severe side effects parenteral Iron therapymay be resorted to but it can cause rapid hypotension/anaphylaxis. The amount of parenteral Iron requirement can be calculated as 4.4xbody wt in kgxHb dificients in gram percent. In Iron deficiency states Iron stores are first depleted then haemoglobin falls and after therapy stores are replanished very slowly even after haemoglobin has returned to normal therefore oral Iron therapy should be continued much longer even after restoring Hb to normal. The preferred Oral Iron preparation scientifically is Ferrous sulphate but it usually causes severe G.I. side effects like gastritis, constipation/diarrhoea. All iron preparation change the colour of stool to black. Ferrous Fumerate is less gastritis irritant and salts containing succinic acid are believed to enhance Fe absorption.

Indications

Iron deficiency due to chronic blood loss. Pregnancy, foetus takes up to 600 mg of iron from the mother even if she is iron deficient. In various abnormalities of the gastro-intestinal tract where the proportion of dietary iron absorbed may be reduced. In premature babies. During the treatment of severe pernicious anaemia.

Dosage

Ferrous sulphate : 200-600 mg daily. Ferrous gluconate : 300-1200 mg daily.

Special Precautions

History of peptic ulcer, severe renal failure. Iron & tetracycline bind together leading to impairment of absorption.

Side Effects

G.I. upset, black stools, abdominal discomfort or pain.