Anemia

Anemia is defined as the reduction in circulating red-cell mass below normal levels. Anemia is a very common condition which is widespread in the human population. Circulating red blood cells (RBCs) contain a protein known as hemoglobin, that protein has four polypeptide chains and one heme ring that contains iron in reduced form. Iron is the main component of hemoglobin and is the prime carrier of oxygen.

Decreased iron reserves in the body affect the production of hemoglobin which, subsequently hinders the transport of oxygen to organ systems of the body. Anemia reduces the oxygen-carrying capacity of the blood and leads to tissue hypoxia. Usually, it is diagnosed by hematocrit (the ratio of packed RBCs to blood volume) and the hemoglobin concentration.

Treatment / Management

After the diagnosis of hypochromic microcytic anemia is established, iron replacement therapy can be commenced. Therapy includes 325 mg of ferrous sulfate three times a day orally. Of this, up to 10 mg of iron can be absorbed from the gut and is the preferred initial treatment. Nausea and constipation are the side effects which limit the compliance of this therapy.

Compliance can be increased by gradually increasing the dose of the treatment while monitoring the patient for side effects. The maximum tolerable dose is usually selected for the replacement of lost iron. The impact of this treatment usually appears after 3 weeks, while the full effects will be evident by 2 months.
Parenteral iron products may be used when:

• Oral drugs produce unrelenting side effects
• The anemia is resistant to oral therapy
• There is some git disease preventing proper absorption of iron
• There is continued blood loss which cannot be corrected by oral supplementation.

The iron preparation with sorbitol is slowly infused over 5 minutes at a dose of 50 mg/kg body weight in males and 35 mg/kg body weight in females. The parenteral dose is usually the iron deficit plus one extra gram of iron to replenish the iron reserves of the body.

Enhancing Healthcare Team Outcomes

The diagnosis and management of hypochromic microcytic anemia is done with a multidisciplinary team that includes a primary care provider, a nurse practitioner, gynecologist, hematologist, a surgeon, and a gastroenterologist. The key is to find the cause of the anemia. After the diagnosis of hypochromic microcytic anemia is established, iron replacement therapy can be commenced. Therapy includes 325 mg of ferrous sulfate three times a day orally. Of this, up to 10 mg of iron can be absorbed from the gut and is the preferred initial treatment.

Nausea and constipation are the side effects which limit the compliance of this therapy. Compliance can be increased by gradually increasing the dose of the treatment while monitoring the patient for side effects. The maximum tolerable dose is usually selected for the replacement of lost iron. The impact of this treatment usually appears after 3 weeks, while the full effects will be evident in 2 months. Close follow up is required to ensure that the patient's hematocrit is improving.