Anemia Defisiensi Besi 2023 DR Addin

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GEJALA, DIAGNOSIS, DAN TATALAKSANA
ANEMIA DEFISIENSI BESI
YOGYAKARTA, 11 JUNI 2023
Kota Yogyakarta
Epidemiology
• More than one-quarter of the world's population is anemic, with
approximately one-half of the burden from iron deficiency
• The prevention and treatment of iron deficiency is a major public
health goal, especially in women, children, and individuals in low-
income countries
• Challenges in the treatment of iron deficiency include finding and
addressing the underlying cause and the selection of an iron
replacement product that meets the needs of the patient
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Kota Yogyakarta YOGYAKARTA, 11 JUNI 2023
Indications for treatment
• Regardless of the presence of symptoms, all patients with iron deficiency
anemia and most with iron deficiency without anemia should be treated
• Anemia — Some patients with iron deficiency anemia will be asymptomatic;
others will have symptoms that may include the following: Symptoms of
anemia,which may include weakness,headache,decreased exercise
tolerance, fatigue, irritability, or depression
• Iron deficiency without anemia — Some individuals with reduced or
absent iron stores who have not yet developed anemia may have symptoms
such as fatigue or reduced exercise tolerance.
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IRON REPLACEMENT PRODUCTS
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Oral iron
• Uses for oral iron — Oral iron provides an inexpensive and effective
means of restoring iron balance in a patient with iron deficiency without
complicating comorbid conditions. Uses for oral iron supplements include
the following:
• ● Treatment of iron deficiency anemia
● Treatment of iron deficiency withoutanemia
• ● Nutritional support to prevent deficiency
• In contrast, oral iron may not be effective for individuals with ongoing blood
loss, inflammatory bowel disease or gastric bypass, chronic kidney disease,
or those with substantial distress from the side effects of oral iron
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Choice of oral preparation
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Dosing and administration (oral iron)
• Dosing schedule–We typically advise our patients to take one dose every other
day; a reasonable variation on the schedule that is easier to follow is to give the
dose on Monday, Wednesday, and Friday. Some individuals may reasonably
choose every-day dosing if they find that it improves tolerability or ease of use.
• Number of doses per day– There is no reason to give more than one dose per
day.
• Amount of iron per dose– We use one tablet per dose(either every-other-day
or Monday-Wednesday-Friday). Although data are limited, we do not think
higher doses are needed. We believe higher doses carry a greater risk of
adverse effects, which are generally dose related, without any improvement in
absorption.
• Supporting evidence for dosing schedule–Evidence suggests that alternate-
day dosing (taking the iron every other day rather than every day) appears to
result in equivalent or better iron absorption than daily dosing, usually with fewer
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adverse effects GEJALA, DIAGNOSIS, DAN TATALAKSANA
Dosing and administration (oral iron)
• Duration of therapy–The duration of treatment with oral iron differs among
experts and in different settings. Some stop treatment when the hemoglobin
level normalizes because this allows early detection of recurrent anemia
from further blood loss (following therapy for a gastric lesion). Others treat
for at least six months after the hemoglobin has normalized to completely
replenish iron stores (following delivery for a multigravid female).
• Treatment with oral iron may take as long as six to eight weeks to fully
ameliorate the anemia, and as long as six months to replete iron stores.
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Interventions to enhance absorption
● Food – Phosphates, phytates, and tannates in foods may bind iron and impair its absorption.
• Iron generally should not be given with food.
• Iron should especially be taken separately from calcium-containing foods and
• beverages (milk), calcium supplements, cereals, dietary fiber, tea, coffee, and eggs.
● pH – Iron is best absorbed as the ferrous(Fe++) salt in a mildly acidic medium. Gastric
acidity is helpful, and medications that reduce gastric acid (eg, antacids, histamine receptor
blockers, proton pump inhibitors) may impair iron absorption.
• Iron should be given two hours before, or four hours after, ingestion of antacids.
● Vitamin C –We do not routinely advise our patients to take vitamin C to increase iron
absorption, as we are unaware of high-quality data to support this practice. We are aware that
many clinicians recommend giving oral iron along with a source of ascorbic acid, either by
taking it with orange juice or with a 500 mg ascorbic acid tablet. This is based on the
hypothesis that ascorbic acid may increase iron absorption.
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Side effects (oral iron)
• Gastrointestinal side effects are extremely common with oral iron

administration. These include metallic taste, nausea, flatulence,
constipation, diarrhea, epigastric distress, and/or vomiting. Patients may
also be bothered by itching and by black/green or tarry stools that stain
clothing or cause anxiety about bleeding. As a result, compliance with oral
iron administration may be low
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Strategies to improve tolerability
• Increasing the interval to every other day if not done already.
• Making dietary modifications(taking iron with food or milk),although this may
reduce absorption.
• Switching to a formulation with a lower amount of elemental iron
• Switching from a tablet to a liquid, for which it is easier to titrate the dose.
• Once a tolerated dose is found, the patient can sometimes increase the
dose slowly as tolerated.
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RESPONSE TO IRON SUPPLEMENTATION
• If pagophagia (pica for rice) is present , it often disappears almost as soon

as oral or intravenous (IV) iron therapy is begun, well before there are any
observable hematologic changes such as reticulocyte response.
• The patient will note an improved feeling of well-being within the first few
days of treatment.
• The hemoglobin concentration will rise slowly , usually beginning after
approximately one to two weeks of treatment, and will rise approximately 2
g/dL over the ensuing three weeks. The hemoglobin deficit should be halved
by approximately one month, and the hemoglobin level should return to
normal by six to eight weeks.
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THANK YOU
MATURNUWUN
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Anemia Defisiensi Besi 2023 DR Addin

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Preparat Besi Oral untuk

• Gastrointestinal side effects are extremely common with oral iron

• If pagophagia (pica for rice) is present , it often disappears almost as soon

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