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 4^th 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.

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.

Cap. Autrin

Proteinules

Inj. Victofol

Inj. Neo-hepatex

Inj. Imfereom