Patient councelling for anaemia: Part I

In this blog, I would like to lay down a brief patient counseling for anemia. Since this is a blog entry, this would be a one-sided interaction instead of a general two-sided conversation. The given information is purely meant for informative purpose and readers are kindly requested not to practice it in reality without prior consent by a practicing health specialist.

Introduction

Anemia, in common language is reduction of hemoglobin count below the normal range in males and females.

Males- 12-16 g%
Females- 10-14 g%

Anemia may be due to various reasons; iron deficiency (iron deficiency anemia), blood loss (hemorrhagic anemia), vitamin 12 (megaloblastic anemia), genetic disorder (sickle-cell anaemia) etc. Hence, the patient counseling involves the determination of the cause and type of anemia. In the current blog, patient counseling on few types of anemia would be dealt with.

Iron Deficiency Anemia:

Non-Pharmacotherapic approach—

Initially, the diet of the patient must be known. Any food that he takes and that may decrease the bioavailability of iron coming from iron rich diet must be forbidden.

e.g.-
• Food that enhances alkalinity like antacids like sodium bicarbonate, aluminium hydroxide, calcium hydroxide etc. must be readjusted suitably since these decreases the absorption of iron from gastrointestinal tract.
• Drugs or agents that may have high possibility of complexing up with iron must be reduced or readjusted.
• Drugs or food containing oxidizing activity must be brought under consideration, these oxidize iron to ferric form which can’t be absorbed.

Secondarily, intake of food containing higher iron content must be increased.

e.g.-
• Vegetarian Source- apple, beet,
• Non-vegetarian Source- Meat, liver, fish, egg etc.

Additionally, such food must be suggested which increases the absorption of iron from Gastrointestinal System.

e.g.-

• Anti-oxidants like vitamin C (lemon, orange, amla, sweet lime etc.), vitamin E (meat, liver, fish etc.) must be suggested as these reduce the iron from ferric state to its ferrous state (since iron can be absorbed only in its reduced form).
• Acidic conditions increase the absorption of iron. Hence, intake of food rich in iron must be regulated suitably in conditions when pH is higher like during antacid therapy, alkalosis, hypochlorhydria etc., since high pH decreases iron absorption.

Sometimes, iron deficiency may also occur due to reduction in concentration of iron binding proteins in blood like apotransferrin, storage proteins like apoferritin. This phenomenon, though doesn’t contribute much. However, few factors may come into play, some of which are:

• Inadequate protein intake which may be corrected by correcting the ratio of protein and fats in diet. Additionally, hypoproteinemia causes similar problem and necessary corrective measures should be taken to cure such conditions.

e.g. - Liver diseases cause reduction in serum protein level and hence liver disease must be cured initially.

• Genetic abnormality in which the gene responsible for coding for binding and storage proteins are abnormal; probably due to gene mutation or some other reasons.

Sometimes, iron loss is significant, though they usually don’t lead to iron-deficiency anemia. Such conditions are diarrhea and erosion of gastrointestinal mucosal cells (since, iron is stored as ferritin in gastrointestinal mucosal cells). Hence, such conditions must be monitored since these minor factors do sometimes play important role in controlling the situation.

Pharmacotherapeutic Approach—

This includes proper dose regimen and effective drug monitoring of the patient. The most important part involved is interpreting the medication history of the patient. Few drugs involved and associated instructions may be enumerated as follows-

Oral route-

• Ferrous sulphate capsules
• Ferrous fumarate capsules
• Ferrous succinate capsules
• Ferrous gluconate syrup
• Colloidal Ferrous Hydroxide syrup

The medications can cause irritation on empty stomach. Moreover, it causes constipation. Hence, laxatives should be administered along with it (combined drug therapy). Iron containing syrups cause staining of teeth. Hence, they must be taken directly at the back of the tongue.

Other common side-effects are nausea, vomiting, metallic taste in mouth and epigastric pain. Hence, the patient must be informed about these effects.

Parenteral route-

• Iron dextran intramuscular injection
• Iron sorbitol intramuscular injection

Intramuscular injection of iron preparation causes localized pain at the site of injection, metallic taste in mouth, fever, headache, joint ache etc. In patients having kidney disease, iron- sorbitol injection must be avoided.