HARSA KURIAKOSE

M PHARM 1ST YEAR

DEPARTMENT OF PHARMACY PRACTICE
GRACE COLLEGE OF PHARMACY
SUBJECTIVE
A 41 years old female patient was admitted in female
medicine ward on 17-12-19

with chief complaints of:

 General tiredness
 Easy fatiquability and diminished capacity to perform
labor
Red cramps which occur on climbing stairs
 Dizziness
PAST MEDICAL HISTORY

Anemia since 1 year, blood transfusion done for

same.
PAST MEDICATION HISTORY
Nil

SOCIAL/FAMILY HISTORY
-Mixed diet
- sleep adequate
- Deworming done once in 6 months
General examination:
 Glossy tongue
 pallor(+)
Objective evidence
VITAL SIGNS

PARAMETERS DAY 1 DAY 2 DAY 3

BP (120/80mmHg) 90/70 100/70 110/80

PR (72 bpm) 70 90 82

SpO2 99 99 98
Laboratory investigation
PARAMETERS OBSERVED VALUE REFERENCE RANGE
Heamoglobin 7.3 g/dl 14-17.5 g/dl
ESR 40mm/hr 0 -15 mm/hr
DC P58L39E02M01 P55-70L20-40E1-4M2-8

TLC 6300 cells/mm3 cells/mm3

PLT 2.7 lakh/mm3 1.4-2.5 lakh/mm3
S.Ferritin 3.2 ng/dl 12-150 ng/dl

P.Smear: microcytic hypo chromic tear drop cells

Ulcer (+)
 ASSESSMENT
On the basis of Subjective and Objective evidence the patient
was found to have: IRON DEFICIENCY ANAEMIA
DEFINITION
Anemia's are a group of diseases characterized by
a decrease in either the hemoglobin (Hgb) or the
volume of red blood cells (RBC’s) in blood.
Results in decreased oxygen-carrying capacity of
the blood.
WHO define Anemia in adult as hemoglobin
levels less than 13g/dl in males, less than 12g/dl in
females and less than 13g/dl in pediatrics.
 Anemia can result from :
1) Inadequate RBC production.
2) Accelerated loss of RBC mass.
3) host of systemic disorders such as infection, chronic
renal diseases or malignancy.
ETIOLOGY
 Etiology basically consist of three mechanism:

1) Reduced Hemoglobin synthesis which may be due to

lack of nutrients or bone marrow failure. This leads to either
reduced proliferation of precursors or defective maturation
of precursors or both.

2) Increased hemoglobin loss due to hemorrhage (red

cell loss) or heamolysis (red cell destruction)

3) Decreased red cell production i.e. disturbance in

stem cell proliferation or differentiation.
Classification :-

Anemias can be classified on the basis of

1. Morphology of the RBCs,

2. Etiology, or
3. Pathophysiology.
 1. Morphological Class
Anemias are classified by RBC size as

Macrocytic Anemias
Megaloblastic anemia
 Vitamin B12 deficiency anemia
 Folic acid deficiency anemia

Microcytic, hypochromic anemias

Iron deficiency anemia
Genetic anomaly
 Sickle cell anemia
 Thalassemia
Normocytic anemias
Recent blood loss
Hemolysis
Bone marrow failure
Anemia of chronic disease
Renal failure
Endocrine disorders
 Etiology Class
Deficiency
Iron
Vitamin B12
Folic acid
Pyridoxine
impaired bone marrow function
Anemia of chronic disease
Anemia of the elderly
Malignant bone marrow disorders
Peripheral
Bleeding (hemorrhage)
Hemolysis (hemolytic anemias)
Pathophysiology Class
Excessive blood loss
Recent hemorrhage
Trauma
Peptic ulcer
Gastritis
Hemorrhoids
Chronic hemorrhage
– Vaginal bleeding
– Peptic ulcer
– Intestinal parasites
– Aspirin and other NSAIDs
 Iron deficiency Anemia (IDA)
Decreased level of ferritin and serum iron,as well as decreased
transferrin saturation .Hb and Hematocrit decrease later.
Daily requirement of Iron 0.9mg in males, 2mg females, in
pregnancy it is 3-5mg and in infant it is 0.5mg.
 Iron deficiency results from prolonged negative iron balance.
Pathophysiology of IDA
Diminished total body iron content, developing in stages
over a period of negative iron balance

Iron depletion – Stage One

Iron deficient erthyropoiesis – Stage Two
Iron deficiency anemia – Stage Three
Stage One

Iron storage is decreased - indicated by decrease in serum ferritin

levels
Stage Two
Insufficient iron to insert into protoporphyrin ring to form heme –
Protoporphyrin accumulates in cell and complexes with zinc to
form ZPP, No anemia, no hypochromia, but slight microcytosis
may be decreased

Stage Three

All laboratory tests for iron status become abnormal, Most

significant finding is microcytic, hypochromic anemia and there is
hyperplasia of erythroids.
Signs of IDA
1) Pale skin and mucous membrane
2) Painless glossitis (Inflammation of the tongue)
3) Angular stomatitis (Inflammation of the mucous membrane
of the mouth)
4) Koilonchia (Spoon shaped nails)
Chronic Iron
5) Dysphagia deficiency
6) Pica (Unusual cravings)
7) Atrophic Gastritis
8) Poikilocytes (misshapen red cells appear on the blood smear
as cigar-or pencil-shaped forms)
 Symptoms

1) Faintness
2) Fatigue
3) Dizziness
4) Irritability
5) Malaise
6) Palpitation
7) Headache
8) Shortness of breath
9) Angina
10) Ankle edema
NON PHARMACOLOGICAL TREATMENT

 Iron rich food including beef, other meat, beans,

dark green leafy vegitables, dried fruits.
 food rich in vit B12 meat, dairy products, soy
products.
 Folic acid can be found in fruits, dark green leafy
vegetables, green pees, peanuts.
PHARMACOLOGICAL TREATMENT
1.Oral iron preparations
Ferrous sulfate
Ferrous gluconate
Ferrous fumarate
Ferrous succinate
Carbonyl iron
2.Parentral iron preparations
Iron dextran
Iron sorbitol citric acid
Ferrous sucrose
Ferric carboxy maltose
3.Maturation factors
vitamin B12: Cyanocobalamine, Hydroxycobalamine
Folic acid
4.Erythropoietine
Epoetin α,β
TREATMENT ALGORITHM
 TREATMENT

N BRAND GENERIC NAME DOSE/TIME DAY DAY

O NAME DAY 2 3
1
1. 2 unit - - √ - -
compatible
blood
transfusion
2. FEROLITE FERROUS HS √ √ √
CAP ASCORBATE+FOLIC
ACID
3. T.BANDYPLU ALBENDAZOLE + STAT √ - -
S IVERMECTIN

4. INJ.RENERVE MECOBALAMINE+ - √ √
PLUS NIACINAMIDE+ √
PYRIDOXINE
PHARMACIST INTERVENTION

 Dose of inj. Renerve plus is not mentioned

Proton pump inhibitor are not prescribed
Since the patient has iron deficiency anemia, dose of
feralite capsule should be mentioned, which is not written
yet
THANK YOU