Hematology and Oncology Book

Tranfusion

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Iron Supplementation

Aka: Iron Supplementation, Ferrous Sulfate, Iron Sulfate, Ferrous Gluconate, Feosol, Fer-In-Sol, Ferrous Fumarate, Hemocyte, Ferric Compounds
  1. See also
    1. Dietary Iron
    2. Iron
    3. Hemochromatosis
    4. Iron Deficiency Anemia
    5. Acute Iron Toxicity
  2. Indications
    1. Iron Deficiency Anemia
  3. Precautions
    1. Iron supplements in overdosage may be lethal in children (FDA black box warning)
      1. See Iron Ingestion
    2. Ferrous Sulfate and Ferrous Fumarate are preferred preparations
      1. Delivers highest elemental iron amounts
      2. Ferrous Gluconate supplies only 50% of the elemntal iron
    3. Formulations with risk of lower iron absorption
      1. Extended release or enteric coated iron formulations
    4. Formulations with no evidence of benefit
      1. Polysaccharide-iron complex (e.g. Ferrex 150)
      2. Carbonyl iron (ICAR)
      3. Heme Iron Polypeptide (Proferrin ES)
    5. References
      1. (2017) Presc Lett 24(3)
  4. Preparations
    1. Ferrous Sulfate (FeSO4)
      1. Elemental Iron: 15 mg per 75 mg/0.6 ml Dropper
      2. Elemental Iron: 60 mg per 300 mg/5 ml Syrup
      3. Elemental Iron: 44 mg per 220 mg/5 ml Elixir/Liquid
      4. Elemental Iron: 65 mg per 325 mg Tablet (or 60 mg per 300 mg tablet)
    2. Ferrous Fumarate
      1. Elemental Iron: 106 mg per 325 mg tablet (or 29.5 mg per 90 mg tablet)
    3. Ferrous Gluconate (Fergon)
      1. May be better tolerated that other forms, but supplies only 50% of the iron in other formulations
      2. Elemental Iron: 36 mg per 325 mg tablet (or 27 mg per 240 mg tablet)
      3. Elemental Iron: 30 mg per 300 mg/5 ml syrup
    4. Iron Dextran (Imferon)
      1. See Parenteral Iron
  5. Dosing
    1. General Anemia management (adults)
      1. Ferrous Sulfate 325 mg orally daily (65 to 100 mg elemental iron daily)
    2. Postpartum Iron Deficiency Anemia
      1. Hemoglobin 7-9
        1. Ferrous Sulfate 325 mg PO tid
      2. Hemoglobin 9-10
        1. Ferrous Sulfate 325mg PO bid
      3. Hemoglobin >10
        1. Ferrous Sulfate 325mg PO qd
    3. Pediatric Anemia
      1. Severe Pediatric Anemia
        1. Ferrous Sulfate 4-6 mg/kg/day PO tid
      2. Mild Pediatric Anemia or Prophylaxis
        1. Ferrous Sulfate 1-2 mg/kg/day PO qd-bid
      3. Overall daily dietary requirements (or supplementation) in non-anemic children
        1. Preterm Infants (born <37 weeks) age <12 months
          1. Exclusively Breast fed: 2 mg/kg/day
          2. Iron-fortified formula: 1 mg/kg/day
        2. Term infants age <12 months
          1. Exclusively Breast fed: 1 mg/kg/day
          2. Iron-fortified formula: No additional needed
        3. Children age 1 to 3 years
          1. Requirement: 7 mg/day elemental iron total via diet or supplementation
        4. Children age 4 to 8 years
          1. Requirement: 10 mg/day elemental iron total via diet or supplementation
  6. Drug Interactions
    1. Food and drugs reducing iron absorption
      1. Antacids (raise pH, low acidity)
        1. Tums, Maalox, or Mylanta
        2. Histamine H2 Receptor Blockers (e.g. Ranitidine)
        3. Proton Pump Inhibitors (e.g. Prilosec)
      2. Inhibitors of iron absorption
        1. Polyphenol (in vegetables)
        2. Tannins (in tea)
        3. Phytate (in bran, cereal)
        4. Calcium (dairy products)
    2. Drugs increasing iron absorption
      1. Vitamin C (Ascorbic Acid)
    3. Drugs with decreased absorption when taken with iron
      1. Levodopa
      2. Methyldopa
      3. Penicillamine
      4. Quinolones
      5. Tetracyclines
  7. Adverse Effects
    1. Gastrointestinal distress
      1. Ferrous iron causes mucosal irritation
      2. Start with once daily dosing and titrate to two to three times daily
      3. Tolerance is directly related to iron concentration
        1. Start with normal concentration elemental iron
          1. Decrease to lower concentrations as needed
        2. Lower elemental iron concentration better tolerated
          1. Ferrous Gluconate
          2. More expensive iron preparations
      4. Enteric coated Iron has decreased absorption
    2. Black stools
    3. Hemochromatosis
      1. Prolonged, excessive Iron Supplementation
  8. References
    1. Little (1999) Am Fam Physician 59(6):1598-604 [PubMed]
Medication Costs
hemocyte (on 11/23/2016 at Medicaid.Gov Pharmacy Drug pricing)
HEMOCYTE PLUS CAPSULE $0.51 each
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information.

Ferric Compounds (C0015860)

Definition (MSH) Inorganic or organic compounds containing trivalent iron.
Concepts Chemical Viewed Structurally (T104)
MSH D005290
SnomedCT 111072007
English Compounds, Ferric, Ferric Compounds, FERRIC CPDS, Ferric Compounds [Chemical/Ingredient], Ferric iron compound, Ferric iron compound (substance), Ferric iron compound, NOS
Spanish Compuestos Férricos, compuesto de hierro férrico (sustancia), compuesto de hierro férrico
French Composés du fer III, Composés ferriques
Swedish Ferriföreningar
Czech železité sloučeniny
Finnish Ferriyhdisteet
Russian ZHELEZA TREKHVALENTNOGO SOEDINENIIA, ZHELEZA III SOEDINENIIA, ЖЕЛЕЗА III СОЕДИНЕНИЯ, ЖЕЛЕЗА ТРЕХВАЛЕНТНОГО СОЕДИНЕНИЯ
Polish Żelazowe związki
Croatian Not Translated[Ferric Compounds]
Norwegian Jern(III)forbindelser
German Eisen(III)-Verbindungen
Italian Composti ferrici
Portuguese Compostos Férricos
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Hemocytes (cell) (C0019000)

Definition (MSH) Any blood or formed element especially in invertebrates.
Concepts Cell (T025)
MSH D006434
English Hemocytes, Hemocyte, Hematocyte, Hemocytes (cell), hemocyte, hemocytes
Portuguese Hemócitos, Hematócitos
Spanish Hemocitos, Hematocitos
French Hémocyte, Hémocytes
Swedish Hemocyter
Czech hemocyty
Finnish Hemosyytit
Russian GEMOTSITY, ГЕМОЦИТЫ
Latvian Hemocīti
Polish Hemocyty bezkręgowców
Norwegian Hemocytter
German Hämozyten
Italian Emociti
Dutch Bloedcel, Hemocyt, Hemocyten
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Ferrous fumarate (C0060276)

Definition (NCI) The fumarate salt form of the mineral iron. Administration of ferrous fumarate results in elevation of serum iron concentration, which is then assimilated into hemoglobin, required for the transport of oxygen, or trapped in the reticuloendothelial cells for storage. This agent is used as a dietary supplement, and to prevent or treat iron deficiency related syndromes.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C031621
SnomedCT 387289009, 52108005
English ferrous fumarate, fumar, Ferrous fumarate, iron (as ferrous fumarate), ferrous fumarate [Chemical/Ingredient], Ferrous Fumarate, FERROUS FUMARATE, Ferrous fumarate (product), Ferrous fumarate (substance), IRON (AS FERROUS FUMARATE)
Spanish fumarato ferroso (producto), fumarato ferroso (sustancia), fumarato ferroso
Sources
Derived from the NIH UMLS (Unified Medical Language System)


ferrous gluconate (C0060277)

Definition (NCI) A form of mineral iron for oral administration, Ferrous Gluconate is absorbed in the stomach and small intestine and combines with apoferritin to form ferritin, which is stored in the liver, spleen, red bone marrow, and intestinal mucosa. Important in transport of oxygen by hemoglobin to the tissues, iron is also found in myoglobin, transferrin, and ferritin, and is as a component of many enzymes such as catalase, peroxidase, and cytochromes. (NCI04)
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C011819
SnomedCT 26736008, 387147005
English ferrous gluconate, hematinics ferrous gluconate, ferrous gluconate (medication), Ferrous Gluconate, ferrous gluconate [Chemical/Ingredient], FERROUS GLUCONATE, gluconate ferrous, Ferrous gluconate, Ferrous gluconate (product), Ferrous gluconate (substance), ferroglucon, IRON (AS FERROUS GLUCONATE)
Spanish gluconato ferroso (producto), gluconato ferroso (sustancia), gluconato ferroso
Sources
Derived from the NIH UMLS (Unified Medical Language System)


ferrous sulfate (C0060282)

Definition (NCI_NCI-GLOSS) A form of the mineral iron that is used to treat anemia caused by low amounts of iron in the blood. Anemia is a condition in which the number of red blood cells is below normal. Ferrous sulfate is a type of hematinic and a type of dietary supplement.
Definition (NCI) A sulfate salt of mineral iron formulated for oral administration and used as a dietary supplement, ferrous sulfate is absorbed in the stomach and small intestine and combines with apoferritin to form ferritin, which is stored in the liver, spleen, red bone marrow, and intestinal mucosa. Important in transport of oxygen by hemoglobin to the tissues, iron is also found in myoglobin, transferrin, and ferritin, and is a component of many enzymes such as catalase, peroxidase, and cytochromes.
Definition (PDQ) A sulfate salt of mineral iron formulated for oral administration and used as a dietary supplement, ferrous sulfate is absorbed in the stomach and small intestine and combines with apoferritin to form ferritin, which is stored in the liver, spleen, red bone marrow, and intestinal mucosa. Important in transport of oxygen by hemoglobin to the tissues, iron is also found in myoglobin, transferrin, and ferritin, and is a component of many enzymes such as catalase, peroxidase, and cytochromes. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=467929&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=467929&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C29049" NCI Thesaurus)
Concepts Pharmacologic Substance (T121) , Inorganic Chemical (T197)
MSH C020748
SnomedCT 384975004, 387402000, 71724000
English ferrous sulfate, ferrous sulphate, sulfuric acid, iron(2+) salt (1:1), Iron(II) Sulfate, ferrous sulfate (medication), hematinics ferrous sulfate, iron (as ferrous sulfate), FERROUS SULFATE, ferrous sulfate [Chemical/Ingredient], iron ferrous sulfate, sulphate of iron, ferrous sulfate iron, iron sulfate, iron sulphate, sulfate ferrous, Ferrous Sulfate, Ferrous sulfate, FESO4 - Ferrous sulfate, FESO4 - Ferrous sulphate, Ferrous sulphate, Iron sulfate, Iron sulphate, Ferrous sulfate (product), Ferrous sulfate (substance), Ferrous sulphate (substance), IRON (AS FERROUS SULFATE), Iron (Ferrous Sulfate)
Spanish Ferrous sulphate (substance), Ferrous sulphate, Ferrous sulfate (substance), Ferrous sulfate, sulfato, ferroso (sustancia), sulfato, ferroso, sulfato ferroso (producto), sulfato ferroso, sulfato ferroso (sustancia)
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Feosol (C0720403)

Concepts Pharmacologic Substance (T121)
MSH D007505
English feosol, Feosol, GlaxoSmithKline Brand of Iron-Dextran Complex
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Fer-in-Sol (C0720405)

Concepts Pharmacologic Substance (T121) , Inorganic Chemical (T197)
MSH C020748
English Fer-in-Sol, Fer-In-Sol, fer-in-sol, fer in sol, Bristol-Myers Squibb brand of ferrous sulfate, Mead Johnson brand of ferrous sulfate
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Iron supplement therapy (C3537005)

Concepts Health Care Activity (T058)
SnomedCT 438911000124105
English Iron supplementation, Iron supplement therapy (regime/therapy), Providing iron based on suboptimal food or fluid intake, iatrogenic deficiency or medical diagnosis. (Source: IDNT Reference Manual, edition 4; ISBN #978-0-88091-467-3)., Iron supplement therapy
Dutch ijzersupplement
French Apport complémentaire de fer
German Eisenergaenzung
Italian Integrazione di ferro
Portuguese Administração de suplemento de ferro
Spanish Suplemento de hierro
Japanese 鉄補給, テツホキュウ
Czech Suplementace železa
Hungarian Vaspótlás
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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