Medical Chronicle May 2017 | Page 57

CLINICAL IRON DEFICIENCY EXPLORING ANAEMIA Iron deficiency is the most common cause of anaemia. Anaemia is defined as a haemoglobin concentration lower than normal for the age and sex of the person involved. Anaemia is not a diagnosis, and an underlying cause should always be sought. CAUSES Stage 1: Iron loss exceeds intake. As a result, there is a negative iron balance and the iron stored in the bone marrow is progressively depleted. As stored iron decreases, there is a compensatory increase in the absorption of iron in the diet and an increase in the iron binding capacity of the cells. Iron deficiency occurs when the rate of loss or use of iron exceeds its rate of uptake and assimilation. The reasons for this are: Chronic blood loss is most commonly due to excessive menstruation or due to bleeding into or from the gut as a result of a peptic ulcer, gastritis, haemorrhoids, or worm infestation in children. An increased need for iron occurs in pregnancy, due to the growth of the foetus, or in children undergoing rapid growth spurts in infancy and adolescence. Inadequate intake of iron to meet the body’s requirements is often because of diets with insufficient iron. It also occurs during the weaning period when babies are switched from breast milk to solids. Breast milk contains lactoferrin, a type of iron which is very easily absorbed. Decreased absorption of iron is common after a partial or total removal of the stomach, lack of stomach acid, chronic diarrhoea or malabsorption. Stage 2: The exhausted iron stores cannot meet the needs of the bone marrow. This means that there is progressively less iron available for the formation of red blood cells. Stage 3: By now anaemia has developed, but the red blood cells still look normal. Stage 4: The red blood cells become smaller (microcytic) and pale (hypochromic). Stage 5: Iron deficiency affects the tissues, resulting in the symptoms and signs of iron deficiency anaemia. Source: Mediclinic Infohub ASTYFER offers patients with iron deficiency various benefits SYMPTOMS AND SIGNS Symptoms such as tiredness, weakness, shortness of breath are commonly seen, sometimes accompanied by tachycardia. There may also be difficulty concentrating, and some neurocognitive deficits. The tongue may be smooth, shiny and inflamed (glossitis). Angular stomatitis may also occur. In some children, there may be poor growth overall, and growth faltering. Pica - a craving for strange foods such as starch, ice, and sand - may develop. The symptoms of the underlying cause of the iron deficiency may be present, such as menorrhagia or abdominal pain due to peptic ulceration. ASTYFER contains: The best-absorbed form of iron 1 Folic acid - that promotes the synthesis of haem 2 Ascorbic acid (Vitamin C) - improves absorption 3 B-Vitamins - fights fatigue Amino acids (glycine, histidine and lysine) - encourages absorption 4 Each capsule contains 150 mg of iron fumarate, equal to 49,5 mg of elemental iron Iron deficiency can leave patients feeling off-colour Oesophageal sphincter Oesophagus ASTYFER capsules dissolve and release stomach acidity-resistant, film-covered granules that spread through the stomach. Pyloric sphincter Let ASTYFER put your patients in the PINK! STAGES OF DEVELOPMENT Granules easily move through the Pylorus sphincter due to their size. The filmy cover dissolves in the small intestines and the contents are released for absorption. The body keeps the amount of iron in balance by regulating iron absorption in the gastro-intestinal tract. Red blood cells account for 90% of the body’s iron. When these cells die, the iron is carefully recycled by the body. There is a balance that the body needs to maintain, and this is carefully regulated. However, the demands at some periods, e.g. growth, or when there is excess blood loss, may be far greater than the diet can provide. If this occurs, iron deficiency will develop. Iron deficiency develops slowly in stages. DE EFFECTS DUE TO DECREASED GASTRIC SI ION TECHNIQUE 5 ADVANCED PELLETISAT References: 1. TREVOR, A.J., KATZUNG, B.G., & MASTERS, S.B. 2002. Katzung & Trevor’s Pharmacology, USA: McGraw-Hill Companies. 662p 2. JOHNSON. L.E. 2007. Folate (Folic Acid). http://www.merckmanuals.com/home/disorders_of_nutrition/vitamins/folate.html 3. TEUCHER, B., OLIVARIS, M. & CORI, H. 2004. Enhancers of iron absorption: ascorbic acid and other organic acids. http://ukpmc.ac.uk/abstract/MED/1574 4. DAVIDSON, S., PASSMORE, R & EASTWOOD, M. 1986. Davidson and Passmore human nutrition and dietetics. New York: Churchill Livingstone. 666 p. 5. RAHMAN, A., AHUJA, A., BABOOTA, S., BALI. V., SAIGAL, N. & ALI, J. 2009. Recent advances in pelletization technique for oral drug delivery. http://www.benthamscience.com/cdd/sample/cdd6-1/015AP.pdf Activo Health (Pty) Ltd. Reg. No: 2009/009541/07. 272 West Avenue, Centurion, 0157, South Africa. PO Box 11911, Zwartkop, 0051, South Africa. Office: 0800 ACTIVO /228486 / +27 (0)12 848 7600. Fax: +27 (0)86 619 5833. www.activo.co.za. PMA197_03/2016 9670MC Astyfer Ad REVISED.indd 1 2017/05/02 8:38 AM MEDICAL CHRONICLE | MAY 2017 57