1. Adolescent Anemia and its
treatment.
• Slideshow prepared by Dr. Ashok Moses for
Franco Indian Laboratories Ltd.

19. Treatment of Anemia.
Blood transfusion if heart failure is eminent
IV or IM iron in pregnant women
Oral iron 3-5 mg Fe/kg/day
Treat underlying cause
Dietary education

20. PREVENTION OF IDA
Dietary modification
Food fortification
Iron supplementation

21. Oral Iron Therapy
• Most appropriate iron therapy is the use of
formulations containing ferrous or ferric salts.
 Ferrous fumarate
Ferrous sulphate
Ferric ammonium citrate (Dexorange).
Recommended dose is 150 to 200 mg of elemental iron
per day.
There is no evidence that one preparation is better than
the other but it is known that ferric salts are better
tolerated than the ferrous forms.

22. Which iron form to use?
The major factors governing the choice of iron
compound include:
Bioavailability
Cost
Safety
Ideally we should go for a safe, cheap, highly
bioavailable iron, which causes no
organoleptic side-effects

23.  Oral Iron supplements commonly contain
Iron as
1.Ferric Salts
2.Ferrous Salts
3.Iron amino acid chelates
4.Iron Polymaltose Complex (IPC)
5.Carbonyl Iron

24. FERRIC SALTS- FERRIC AMMONIUM
CITRATE
• The Ferric iron is reduced to ferrous form in
intestinal lumen and is then absorbed
• Ferric ammonium citrate is one of the best
tolerated iron supplements

25. • It is provides an optimum tolerance of iron
preparations hence helpful to maintain long term
patient compliance.
• It rapidly supplements elemental Iron so that
iron deficiency is quickly controlled thus leading
to faster correction of anemia.
FERRIC SALTS- FERRIC AMMONIUM
CITRATE

26. • Ferric ammonium citrate contains citrate group
which increase iron absorption by forming
soluble complexes which readily enters
epithelial cells lining the upper GI tract
FERRIC SALTS- FERRIC AMMONIUM
CITRATE

27. FERRIC SALTS- FERRIC AMMONIUM
CITRATE
• It contains 20.5% elemental Iron
• Thus, 160 mg of Ferric ammonium citrate
provides 32.8 mg of Iron.
• This regimen corrects anemia rapidly as iron is
absorbed at maximum rate during period of
iron deficiency

28. FERRIC SALTS- FERRIC AMMONIUM
CITRATE
• Smaller doses of iron will produce fewer GI
side effects as the concentration of ionic iron
in GI tract is rapidly reduced
• The high elemental Iron in many preparations
may cause severe GI disturbances.

29. • These GI upsets are more common in
pregnant women for whom Iron therapy is
essential
• Hence Ferric ammonium salt is ideal salt with
least astringent compounds.
FERRIC SALTS- FERRIC AMMONIUM
CITRATE

30. FERROUS SALTS
• All dietary iron has to be reduced to ferrous
form to enter the mucosal cells
• Ferrous sulphate (20% elemental Iron) is
commonly used for tablet preparations.
• These salts have good bioavailability but it
markedly decreased in presence of dietary
inhibitors like phytates, tannic acid.

31. FERROUS SALTS
• These salts are having high GI side effects
• Teeths may get stained if drops are not properly
placed at the back of tongue
• Salty astringent taste which is not palatable
• Overdose can easily override the mucosal barrier
to cause acute toxicity

32. IRON AMINO ACID CHELATES
• These are conjugates of ferrous or ferric Iron
with amino acids.
• Ferris Glycine Sulphate is the only salt of this
group available in India
• Have relatively high bioavailability.
• No studies in children

33. • IPC is an Iron preparation which contains non-
ionic iron and Polymaltose in a stable
complex.
• There are several reports of inadequate or
slower rise of Hb with IPC
IRON (III) POLYMALTOSE COMPLEX

34. CARBONYL IRON
• It is a small particle preparation of highly
purified metallic Iron.
• Gastric acid solubalizes carbonyl Iron in this
process H+ ions are consumed thereby
increasing the pH.
• Also as a result absorption of Iron is slow and
self limited by rate of acid secretion by gastric
mucosa

35. FOOD FORTIFICATION
compounds used in food fortification can be
divided into 4 groups
Freely water soluble (ferrous sulphate, gluconate,
lactate & ferric ammonium citrate).
Poorly water soluble (ferrous fumarate, succinate
& saccharate).
Water insoluble (ferric pyrophosphate, ferric
orthophosphate & elemental iron).
Experimental (sodium-iron EDTA & bovine Hb
concentrate).

37. Thank You