Pharmacotherapy of _____Anemia, Iron Deficiency_____
Nicholas Tsourounis, PharmD Candidate 2007
Epidemiology Approximately 3.4 million Americans have some form of anemia
 175,000 nursing home residents have anemia
 7% of children 1 to 2 years of age have anemia
 12% of females ages 12 to 49 have anemia
 Iron deficiency is the most common cause of anemia, accounting for 1/4th of all anemia cases
 4,500 deaths per year because of all types of anemia combined
Effects on Productivity
 loss of productivity of workers with anemia due to weakness and fatigue
Ethnic Differences
 people of Mexican-American descent have 3x the rate of iron deficiency anemia as
compared to Caucasians, according to results from the National Health and Nutrition
Examination Survey (NHANES III)
Disease State
Definition
Pathophysiology
Anemia refers to a group of diseases that are characterized by a decrease in hemoglobin or a reduction
in the oxygen carrying capacity of the blood.
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Classification of anemia is based on red blood cell (RBC) morphology, its cause, or its
pathophysiology
o RBC morphology is based on cell size (macrocytic, normocytic, or microcytic) and
iron content (hypochromic or normochromic)
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Iron deficiency anemia is usually caused by inadequate iron intake through diet, inadequate
absorption through the gastrointestinal tract, increased demand by the body for iron (such as
during pregnancy), blood loss, iron loss due to dialysis in chronic renal failure, and other
chronic diseases where iron release from reticuloendothelial cells may be blocked
Clinical
Presentation
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Clinical presentation of anemia patients depends on the etiology and speed of onset
 When onset is more rapid, anemia usually presents as cardiorespiratory symptoms such as
tachycardia, light headedness, and shortness of breath
 When onset is due to a chronic condition, anemia cases usually present as fatigue,
headache, vertigo, fainting, decreased cold tolerance, pallor, and loss of skin tone
 Iron deficiency is characterized by spooning of the nails, angular stomatitis, glossitis,
smooth tongue, brittle nails, cracks in the corners of the mouth (cheilosis), dysphagia due to
esophageal webs, and strange dietary cravings (pica).
Risk Factors
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Being of Mexican-American descent
Prolonged bottle-feeding as an infant
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Heavy menstrual periods
Pregnancy
A diet low in iron content
Known or unknown source of blood loss
Vegetarianism
Female
Nick Tsourounis, PharmD Candidate 2007
University of Maryland School of Pharmacy
Pharmacotherapy Presentation – Pharmaceutical Care Rotation
Happy Harry’s Pharmacy Patient Care Center, Perryville, MD
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Diagnosis
Diagnosis of iron deficiency anemia is based on a Complete Blood Count that includes RBC indices
and a reticulocyte index, as well as a peripheral blood smear and Fecal Occult Blood Test.
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Desired
Therapeutic
Outcomes*
*Reference of
Guidelines Used
Treatment
Options**
(Non-drug and
Drug Therapy
– include all
therapeutic
classes/agents
available and
preferences
per treatment
guidelines)
Infants/children undergoing rapid growth
Long term NSAID therapy
Colon cancer
Peptic ulcer disease
According to the World Health Organization (WHO) criteria, anemia is diagnosed in males when Hb is <13
g/dL and HCT is < 39%; in females, when Hb is < 12 g/dL and HCT is < 36%. ( Iron deficiency anemia. WHO Tech
Rep Ser 1959;182:4.)
In iron deficiency anemia, also see a decreased serum ferritin (<10-12 ng/mL), decreased
transferrin saturation (<15%), and an increased total iron binding concentration
(TIBC>400ug/dL) before levels of other markers drop below cutoffs necessary to diagnose
anemia
1. Alleviate signs and symptoms
2. Correct underlying etiology of iron deficiency
3. Prevent recurrence of etiology and signs and symptoms
Depiro Pharmacotherapy Handbook
*Please see Pharmacological Treatment Options Table
 Oral Iron Replacement therapy
 Parenteral Iron Replacement therapy
 Iron Replacement Therapy in conjunction with other Anemia treatments
o Erythropogenics
o Androgens
**See Treatment
Options Table
Monitoring
(Efficacy and
Toxicity
Parameters)
Efficacy: Monitor Hct, Hgb, serum Fe, TIBC, CBC with differential, reticulocyte count,
transferrin saturation, serum ferritin, and patient specific signs and symptoms of anemia –
frequency dependent on patient demographics and treatment setting.
Toxicity:
 For Oral Iron Tx - GI irritation, stomach ulcers, hematemesis, lethargy, acidosis, hepatic
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or renal impairment, and coma
For Parenteral Iron Tx - anaphylaxis, pulmonary edema, convulsions, tachycardia,
hematemesis, hepatic and renal impairment, acidosis, lethargy, coma
For Erythropogenic Tx - BP, polycythemia, MI, CVA, TIA, seizures, peripheral edema, fluid
overload
For Androgen therapy - LFT’s, BG, jaundice, and blood lipids Q6months. Prostate
exam Qyear
Nick Tsourounis, PharmD Candidate 2007
University of Maryland School of Pharmacy
Pharmacotherapy Presentation – Pharmaceutical Care Rotation
Happy Harry’s Pharmacy Patient Care Center, Perryville, MD