Nama Lengkap : Dr.

Dairion Gatot SpPD-KHOM

Pekerjaan : Staf Pengajar Dep IPD FK-USU
Ketua Divisi Hematologi & Onkologi Medik
Institusi : Divisi Hematologi Onkologi Dep IP Dalam
FK-USU/RSUP H. Adam Malik Medan
Alamat Kantor : Jl Bunga Lau No 17 Ke. Medan
Alamat Rumah : Jl.T. Amir Hamzah/Taman Binjai Indah
No E-5 Binjai – 20746
E-mail : drdairion@yahoo.com

Pendidikan :
S1/Dr Umum 1988 USU/Medan
Sp-1/Internis 2003 USU/Medan
Sp-2/Konsultan
Hematologi Onkologi Medik 2009 USU/Medan

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 TATALAKSANA BESI
SECARA PARENTERAL

2
 OPTIONS FOR ANAEMIA MANAGEMENT

Transfusion
(15%)

Iron alone
(7%)
No treatment
(60%)

Epoetin
(18%)

European Cancer Anaemia Survey (ECAS), Ludwig et al. Ann Oncol 2002; 13 (Suppl 5): 169 [A623PD]
Iron Supplement for
Iron Deficiency Anemia

Intravenous iron: when to use it?

4
Iron values in the development of iron
deficiency anaemia

13-16
1316
13-16
12-14

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 TREATMENT
Therapeutic Trial
•Should be via oral route

* Expect
- peak reticulocytosis at 1 to 2 week
- significant increase in Hb concentration at 3-4 weeks
- one-half of Hb deficit corrected at 4-5 weeks
- Hb level normal at 2 to 4 months

• Unless there is continued bleeding, absence of these

changes indicates that iron deficiency is not cause of
anemia. Iron treatment should be stopped and another
mechanism sought
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 TREATMENT

Oral Iron Therapy

 Dietary sources may not be sufficient for treatment
 Safest, cheapest are oral ferrous salt
 Nonenteric coated forms are preferred
 Avoid multiple hematinics
 Do not give with meals or antacids or inhibitor acid
productions
 Continue for 12 months after Hb level is normal to replenish
iron stores
 Daily total 150-200 mg elemental iron in 3 to 4 doses, each 1
h before meals
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 TREATMENT

Parental Iron Therapy

Routine use rarely justifed
* Indications are:
- malabsorpsi
- intolerance to oral iron preparations (colitis, enteritis)
- needs in excess of amount that can be given orally
- patient uncooperative or unavailable for follow-up

* Continue therapy for 12 months after Hb level is normal, in

order to replenish iron stores.
* Therapy may be needed indefinitely if bleeding continues.
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Intravenous versus oral iron for treatment of
anaemia in pregnncy; a randomised trial

 n = 90
 Randomised open label study
 Hb betweeen 80 and 105 g.L-1
 Ferritin levels < 13 µg.L-1
 Either Iron polymaltose complex (300mg
elemental iron per day)
 Or Intravenous iron sucrose

Al RA et al, Obstet Gynecol. 2005;106(6):1335-1340

Intravenous versus oral iron for treatment of
anaemia in pregnancy: a randomised trial

 Intravenous iron sucrose dosage

 Weight before pregnancy x actual Hb x 0.24 +
500mg
 Hb and Ferritin measured at 14 and 28 days and
at delivery and first post-partum day
 Hb higher in IV iron group
 Ferritin levels higher in IV iron group
 No serious adverse drug reactions

Al RA et al, Obstet Gynecol. 2005;106(6):1335-1340

 IV Iron Therapy and AEs

12 High molecular-  FDA Medwatch reports (2001-

weight dextran
Life-Threatening AEs per 1 Million

Low molecular- 2003) show iron dextran was

10 weight dextran associated with a 3.4-fold increase
Ferric gluconate
in odds of life-threatening AEs[1]
Administrations

8 Iron sucrose
 4 separate reports confirm
6 2- to 8-fold increase in reactions
with high molecular-weight
4 dextran compared with low
molecular-weight dextran[2-5]
2

0
1. Chertow GM, et al. Nephrol Dial Transplant. 2006;21:378-382. 2. Fletes R, et al. Am J Kidney Dis. 2001;37:743-749.
3. McCarthy JT, et al. Am J Nephrol. 2000;20:455-462. 4. Mamula P, et al. J Pediatr Gastroenterol Nutr. 2002;34:286-290.
5. Coyne DW, et al. Kidney Int. 2003;63:217-224. 11
 Update on adverse drug events associated with parenteral iron

Iron sucrose 0.6 per million

Sodium ferric gluconate 0.9.per million
LMW iron dextran 3.3 per million
HMW iron dextran 11.3 per million

Chertow GM et al Nephrology Dialysis Transplantation. 2006 21(2):378-382

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 Reports by Breymann over 2000
women treated
 Stepwise approach to use of iv iron in pregnancy
 Max single dose 200mg / Cumulative 1600mg

Hb<9

Hb 9-10
Iron
Iron sucrose Sucrose
Hb >10 200mg
100 -200mg iv
1-2 weekly 2 weekly

Oral Fe

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 Treatment Correction
 To increased Hb 1 gr/dL Need Fe endogen ± 2,5 mg/bw
 initial Fe:
◦ Fe = (D Fe serum x 0,2 x BW) mg, or
◦ Fe = (D Hb x 2,5 x BW) mg

 Iron Dextran max. 1,5 mg/kgBW/day

◦ Jectofer ® 75 mg/2mL amp.
◦ Injection 75 mg/deep im

 Iron Sucrose
◦ Venofer ® 100 mg/amp
◦ Infusion 100 mg in 100cc NS 1h

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Management Options for Anaemia :
Summary
 Red blood cell transfusion has many
disadvantages

 Eritropoetin treatment produces smooth and

sustained Hb increases and is an alternative
treatment option to transfusion
 In Iron deficiency anemia, iron supplement should
be adequatly optimalized, therefore parenteral iron
therapy is indicated.

 No treatment is not an appropriate option

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