tailieunhanh - Chapter 098. Iron Deficiency and Other Hypoproliferative Anemias (Part 8)

Of the complications of oral iron therapy, gastrointestinal distress is the most prominent and is seen in 15–20% of patients. Abdominal pain, nausea, vomiting, or constipation may lead to noncompliance. Although small doses of iron or iron preparations with delayed release may help somewhat, the gastrointestinal side effects are a major impediment to the effective treatment of a number of patients. The response to iron therapy varies, depending on the erythropoietin (EPO) stimulus and the rate of absorption. Typically, the reticulocyte count should begin to increase within 4–7 days after initiation of therapy and peak at 1½ weeks. The absence. | Chapter 098. Iron Deficiency and Other Hypoproliferative Anemias Part 8 Of the complications of oral iron therapy gastrointestinal distress is the most prominent and is seen in 15-20 of patients. Abdominal pain nausea vomiting or constipation may lead to noncompliance. Although small doses of iron or iron preparations with delayed release may help somewhat the gastrointestinal side effects are a major impediment to the effective treatment of a number of patients. The response to iron therapy varies depending on the erythropoietin EPO stimulus and the rate of absorption. Typically the reticulocyte count should begin to increase within 4-7 days after initiation of therapy and peak at PA weeks. The absence of a response may be due to poor absorption noncompliance which is common or a confounding diagnosis. A useful test in the clinic to determine the patient s ability to absorb iron is the iron tolerance test. Two iron tablets are given to the patient on an empty stomach and the serum iron is measured serially over the subsequent 2 hours. Normal absorption will result in an increase in the serum iron of at least 100 pg dL. If iron deficiency persists despite adequate treatment it may be necessary to switch to parenteral iron therapy. Parenteral Iron Therapy Intravenous iron can be given to patients who are unable to tolerate oral iron whose needs are relatively acute or who need iron on an ongoing basis usually due to persistent gastrointestinal blood loss. Parenteral iron use has been rising rapidly in the last several years with the recognition that recombinant erythropoietin therapy induces a large demand for iron a demand that frequently cannot be met through the physiologic release of iron from RE sources. The safety of parenteral iron particularly iron dextran has been a concern. The serious adverse reaction rate to intravenous iron dextran is . Fortunately newer iron complexes are available in the United States such as sodium ferric gluconate Ferrlecit and