ANEMIA AND IRON PREPARATIONS
Though traditionally Anemia is defined either as a decrease in number of red blood cells or the decrease in hemoglobin levels below a predetermined level, generally 10g/dl (is 11 in children,12 in females and 13 in males) but since the most important purpose of blood is to carry oxygen, I am giving a different definition.
“Anemia can be defined as the decrease in oxygen carrying capacity of blood, either less red blood cells or decreased hemoglobin, which result in clinical signs and symptoms in the person’
This can be called the clinical definition of Anemia and the diagnosis can be made clinically. The person gives history of symptoms which can include shortness of breath (dyspnea), muscular weakness, chest pain, palpitations, fatigue, dizziness.
Some signs which can be elicited include paleness of skin, cold touch of skin, low blood pressure, etc.
Any of the above can be present in different cases of Anemia in various permutations and combinations. But a sign which can be elicited both by the person and clinician is the degree of paleness of palpebral conjunctiva color which should generally be diffuse red or deep pink. Lesser the hemoglobin levels in the blood, the more pale the color.
Red ----------dark pink------pink-------faint pink-----yellow white --------pale white--------dead white
This corresponds to
Adequate hemoglobin -------------less---------------low hemoglobin
Once a diagnosis of Anemia is made, reason is to be found and treated. Here I am interested in discussing Anemia due to deficiency of Iron in particular, but at times can be due to vitamin B12 and or folic acid deficiencies. This can be called Nutritional Anemia.
For all Anemia due to Iron deficiency, which is the commonest cause of Anemia, Iron replacement is done by giving Iron through various Iron formulations. Plenty are present in the market. But before analyzing these Iron formulations, we will list some foods which taken sufficiently can prevent Nutritional Anemia and can help in faster recovery of Anemia.
Some foods rich in both Iron and vitamin B12 are shellfish (cooked clams),oysters, liver(beef), fish, crustaceans, soy products, red meat(beef), cheese, eggs, nuts, dark leafy greens like spinach, kale, dark chocolate and cocoa powder, dried herbs, spirulina, caviar, sun dried tomatoes.
Some fruits and vegetables rich in Iron are sun dried potatoes, dried apricots, spinach, coconut, olives, raisins, asparagus, broccoli, pears, dried figs, dried apples, raw mulberries, raw tamarind, raw garlic, raw kale etc.
Some folic acid rich foods are yeast extract, liver, dried herbs, sunflower seeds, dry soybeans, dark leafy greens, bean sprouts, peas, asparagus, peanuts.
Next I am going to discuss the various Iron formulations available in the market and their efficiency in ameliorating anemia.
An important conclusion I came up after studying the various Iron formulations available in the market is that larger the size of the drug molecule carrying iron, lesser its absorption and hence its bioavailability in general. Thus I found that smaller sized Iron carrying drug molecules are better for Iron replacement than larger sized iron carrying drug molecules.
I am giving the most efficient Iron formulation first along with its relative compound mass followed by next efficient Iron formulation and best compound available in some cases and so on.
Elemental Iron (fe) > Iron hydroxide (Fe2 ,18) > Iron polysucrose complex (Fe 38) > Ferrous sulphate (Fe 96) >Iron dextran (Fe 98)( used parentally) > Iron fumarate (Fe 114) > Iron succinate (Fe 116 or Fe 118) > Iron protein succinylate (Fe 158) = Iron hydroxide polymaltose complex (Fe 158 ) ( C12H14Fe) > Colloidal Iron hydroxide (Fe 172) > Iron ammonium citrate (Fe 207) > Iron Ascorbate (Fe 209) > Iron Choline citrate (Fe 293) > Iron feredetate (Fe 311) > Iron gluconate (Fe 314 ) > Iron Carbonyl (Fe 438)
Ferrous sulphate (FeSO4) is commonly used in developing countries as its easy to prepare and cheap. But it gives only 20% elemental Iron. Another drawback I was able to find was that in the stomach, where Hydrochloric acid is present, in some conditions it reacts with it to produce Sulphuric acid, which is stronger than hydrochloric acid and causes erosion of the stomach and later duodenum to cause gastric ulcer and duodenal ulcer.
FeSO4 + 2 HCl = FeCl2 + H2SO4
Thus Ferrous sulphate though cheap is not acceptable Iron replacement formulation.
From above its very clear that Elemental Iron is the best replacement for Iron in the body followed by Iron hydroxide.
Because Iron has a corrosive action on mucosa, so Iron capsules which release Iron compounds in the stomach are far better than tablets which under certain conditions can release Iron in the mouth and oesophagus causing apthous ulceration.
Thus capsules of purely elemental Iron are the best treatment for Iron deficiency Anemia and 100 milligrams elemental Iron per capsule is ideal to be taken twice a day about 1 to 2 hours after meals. This decreases almost all side effects of Iron tablets and hence is highly recommended.
Because in many cases Iron deficiency is accompanied by vitamin B12 and folic acid deficiency, each capsule of elemental iron can be fortified by 100 micrograms of vitamin B12 and 1 mg of folic acid. Together this fortified Iron –B12- folic acid capsule has more chances of patient compliance and treating Iron than Iron alone.
My findings are very different and sometimes contrary to scientific literature presented by companies producing Iron formulations, but my method and scientific explanation for the grading is better, valid and logical.
May Iron deficiency Anemia be cured !