OBJECTIVES

1.
2.
3.
4.

Describe the mechanism of regulation of iron

absorption and storage in the body
Describe the clinical applications of iron
supplementation
Describe the acute and chronic toxicity of iron
Name the major hematopoietic growth factor and
describe their clinical use

PHARMACOKINETICS
A. Absorption
Duodenum and proximal jejunum
Excess iron can be stored in mucosal
cell as ferritin
B.Transport
Iron is transported in the plasma
bound to transferrin

PHARMACOKINETICS
C. Storage
Iron is stored, primarily as ferritin in
intestinal mucosalcells
macrophages in the liver
spleen, and bone
D. Elimination
feces, bile, sweat, urine, saliva

Body Iron Distribution and Storage

Utilization

Duodenum
(average, 1 - 2 mg
per day)

Dietary iron
Utilization

Plasma
transferrin
(3 mg)
Muscle
(myoglobin)
(300 mg)

Liver
(1,000 mg)

Circulating
erythrocytes
(hemoglobin)
(1,800 mg)

Storage
iron

Sloughed mucosal cells

Desquamation/Menstruation
Other blood loss
(average, 1 - 2 mg per day)
Iron loss

Bone
marrow
(300 mg)

Reticuloendothelial
macrophages
(600 mg)

Mechanism of Iron Absorption

Systemic Manifestations of
Iron Deficiency

Glossitis

Koilonychia

Angular chelitis

Normal RBC

Microcytic hypochromic
anemia

Therapeutic uses of Iron

Iron Deficient Anemia

Hookworn infestation

Pregnancy

Malabsorption Syndrome

Premature Babies
Blood loss

GI Bleeding due to:

Ulcers
Aspirin
Excess consumption of
coffee

Treatment with Oral Iron:

General Principles
Ferrous salts are absorbed better
than ferric
All ferrous salts are absorbed to the
same extent

 Ascorbic acid increases absorption and

toxicity
Iron is absorbed best on an empty stomach
Iron should not be given with antacids
Oral Iron
Ferrous sulfate, ferrous gluconate, and
ferrousfumarate: 200-400 mg daily
Ferrous slfate 325 mg
Will need 3-6 months of oral iron to replete
stores. If no response, or unable to absorb,
refer to hematology for Intravenous Iron
therapy

GENERAL MECHANISM OF
ACTION OF IRON
SUPPLEMENT
During the process of absorption, oxygen
combines with iron and is transported into the
plasma portion of blood by binding to transferrin.
From there, iron and transferrin are used in the
production of hemoglobin (the molecule that
transports oxygen in the blood) and myoglobin
( helps your muscle cells store oxygen.)

COMMON ADVERSE EFFECTS

OF ORAL IRON THERAPY

Nausea
Epigastric discomfort
Abdominal cramps
Constipation and diarrhea.
Black stool

PARENTERAL IRON THERAPY

1. Iron Dextran
containing 50mg of elemental iron per
milliliter of solution.
It can be given deep IM injection or IV
infusion

2. Iron sucrose complex & iron sodium

gluconate complex
patient with hypersensitivity
reactions to oral iron salts

 Indications
Malabsorption
Iron-limited response to erythropoietin
Toxicity/noncompliance with oral iron

Response
Maximal increase in hemoglobin
synthesis
Rapid increase in iron stores

TOXICITY OF IRON
Sign and symptoms:
- Acute: necrotizing gastroenteritis,
shock, metabolic acidosis, coma and
death
- Chronic: patients receive frequent
transfusions, hemochromatosis and
herited abnormality of iron
absorption

 Treatment of acute iron intoxication

- Correction of acid-base and
electrolyle abnormalities,
Deferoxamine
Treatment of chronic iron intoxication
Phlebotomy

HEMATOPOIETIC
GROWTH FACTOR
1.

Erythropoietin
- Stimulate the production of red cell
- Used for anemias associated with renal failure
2. Myeloid growth factors
- Filgrastim (G-CSF) and sargramostim (GM-CSF)
neutrophils
- GM-CSF
myeloid and megakaryocyt
3. Megakaryocyt growth factors
- Oprelvekin and thrombopoietin
4. Other hematopoietic growth factors
- M-CSF, SCF and interleukins 3, 6, 9

SUMMARY
1.
2.
3.

Microcytic hypochromic anemia is treated by

ferrous iron supplementation, in special case by
parenteral administration
Toxicity of iron: correction of acid base and
electrolyte abnormality, administration of
deferoxamine and phlebotomy
Four growth factor produced by recombinant
DNA technology for patient with blood cell
deficiencies