”Marriage is like vitamins. We supplement each other’s minimum daily requirements.
Definition
A disorder characterized by anaemia with a rise in the man cell volume of red cells above the normal (80-96ft (femtolitres), due mainly to deficiency of vitamin B12, or folate, (and rarely abnormalities of their metabolism), leading to bone marrow turning megaioblastic.
Prognosis
The prognosis is pernicious anaemia is excellent if diagnosed early, and the treatment has to be continued for life. But if nerologic complications develop, they are reversible if of short duration of less than 6 months. It takes 2 months of treatment for the blood picture to normalize. Folic acid administration cures deficiency state, when the cause if reversible.
Treatment
If pallor is severe If Liver/ Spleen are palpable. Then ask for Hb% WBC and Peripheral Smear before starting treatment.
For Nutritional or Iron Deficiency Anemia:
Cap. Autrin 1 daily x 3 monts (Iron Folic acid) Tab. MEbex 1 bd x 3 days to be repeated after 10 days (Anteheleminthie for Hook worms). Good food with green vegetables milk, beans and peas and in Non-vegetarians, meat, eggs, Liver and Kidney. Proteinules 2 tsp in milk 2 times/ day. Inj. Victofol 2cc IM x alt days x 5-10 injections. Inj. Neo-hepatex 2cc IM x alt days x 5-10 days.
If patient gets Nausea or constipation with oral iron
Try another compound of iron Like Ferrous, Ammonium citrate (Dexorange), Ferrous glycine sulphate (Fezocar), Ferrous succinate (Hematrane) etc. Inj. Imferon 2cc x deep IM by Z-technique x after ½ ml deep IM test dose x daily x 10 days. I.V. Imfereon drip: Give Inj. Imfereom ½ cc deep IM on previous week as test dose. If patient gets joint pain. I.V. imferon is avoided. Start I.V. 5% dextrose drip Inject 1 cc Imferon very slowly intravenously as I.V. test dose wait for 5 minutes.
If any reaction or hypotension give Inj. Decadron and Inj. Mephentic 2cc with fast I.V. drip. If no reaction, add 30 ml Imferon to the drip and let it run slowly over 3-4 hours. With any iron preparation oral or injectible, Hemoglobin rises by 1 gm per week or 1% per day.
Calculation of total dose of Imferon:
Total dose of Iron = 2.38 x body weight in kg x (15 – Hb in gms) To this add 1000 mg replenishing Iron stores.
E.g 60kg patient with 6gm% Hb needs 2.38 x 60 x 15-6) + 100mg = 2285 mg of Iron.
This is equivalent to =45.7 ml of Imferon = 22 ampules of Venofer.
If satisfactory response is not seen, Refer to a physician.
Look for the source of blood loss:- Hook worms, piles, PV bleeding malignancies.
If anemia is severe, advise Blood Transfusion.
If Hb< 5 gm% advise Blood transfusion If Hb< 2.5 gm% advise transfusion or packed cells.
In refractory cases, give antibiotic steroids or erythropoietin. Inj. Deca-durabolin 50mg IM x eevert 4th day x 3 to 5 injections.
Inj. Epofer 1000iu (100-200iu/kg) thrice weekly. (Erythropoetin – for Anemia due to CRF, chemotherapy, suppressed bone marrow.
Anemia exaggerates practically all the vague complaint like joint pains, chest pain, backache, weakness, anorexia, digestice disturbances, edema, breathlessness, palpitations, Tingling limbs erc. So you must look for pallor in tongue and conjuctive of every patient and prescribe iron in addition to the symptomatic treatment.
Anemia is very common and Hemoglobin of more than half the patients, even in well to do families is below normal.
Give anthehhelminthic to every patient with pallor.
Oral Iron capsules are preferred to liquid preparations which are costlier and stain the tongue black.
Refer to physician immediately, If patient is very very pale, If Liver/ Spleen is enlarged or if bleeding tendencies like epistaxis/ bleeding gums are seen.
For B12 deficiency- Diet rich in B12 like legumes, met and animal protein foods is to be given Foods rich in Folic Acid are liver, green vegetables, and cereals.
Follow Up
For pernicious anaemia, monthly injections of vitamin B12 for life. Also they are advised to get endoscopy done every 3 years to rule out gastric carcinoma, for which they have predilection. They should also have thyroid function assessed every 2 years to rule out hypo or hyperthyroidism.
Prevention
Early detection and treatment of pernicious anaemia. Prophylactic folic acid 400 ugm/day in pregnancy.
