【病例学习第11期】Iron Deficiency Anemia（缺铁性贫血）

From Pharmacy Times(www.pharmacytimes.com)
Thanks to the author Craig I. Coleman, PharmD(Dr. Coleman is an assistant professor of pharmacy practice and director of the pharmacoeconomics and outcomes studies group at the University of Connecticut School of Pharmacy.)

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Iron Deficiency Anemia

A 48-year-old woman presents to an ambulatory care clinic complaining of weakness, headache, and mild fatigue. Her physician diagnoses her with a mild case of iron deficiency anemia due to poor diet and decides to initiate oral iron replacement. He sees the pharmacist on duty and asks for advice about which formulation of oral iron to use. The physician notes, “I have been using a ferrous gluconate tablet 3 times daily in my patients because this preparation seems to cause less stomach upset, but I do not always get the results I want.”

What advice can the pharmacist provide to the physician?


ANSWER

Gastrointestinal side effects from iron supplementation are strongly and positively correlated with the amount of elemental iron administered; therefore, it is not surprising that the physician sees less stomach upset with ferrous gluconate because it contains a lower amount of elemental iron than other preparations (gluconate: 28-36 mg/tablet; sulfate: 65 mg/tablet; fumarate: 106 mg/tablet). The pharmacist should make the physician aware that prescribing one ferrous gluconate tablet 3 times daily will not provide his patients with the recommended daily amount of elemental iron (150-200 mg/day) required to treat iron deficiency anemia, and consequently, may explain why his patients do not always respond adequately to treatment. The pharmacist might suggest the patient take one ferrous sulfate 325-mg tablet 3 times daily (perhaps with 250 mg of ascorbic acid to increase absorption) in order to provide her with the amount of elemental iron she needs.

以下为翻译后的内容感谢“赵氏药师”提供，欢迎大家对翻译结果进一步完善。

缺铁性贫血
一位48岁的女性到门诊医疗诊所抱怨自己虚弱，头痛。轻微乏力。她的内科医生诊断她有轻微的缺铁性贫血导致得厌世。因此决定给她口服补铁。他问值班的药剂师该给那种口服铁制剂。内科医生说：我曾经给病人服过葡萄糖酸亚铁片，每日3次，因为这种制剂较少引起胃部不适，但也未达到我所期望的治疗效果。
药剂师会给内科医生提供怎样的建议呢？
答案
补铁导致的胃肠道不适是强烈和明确的，和服用铁元素的数量相关，因此，内科医生选用葡萄糖酸亚铁以减少胃部不是就不奇怪了，葡萄糖酸亚铁比其他的铁制剂含铁量低（葡萄糖酸盐：28-36 毫克/片；硫酸盐：65 毫克/片t；  延胡索酸盐：106 毫克/片）。药剂师应该让内科医生意识到处方1片葡萄糖酸亚铁、每日三次，这个剂量不能给病人提供足量治疗缺铁性贫血每日所需的铁元素（150-200 毫克/天），这就可以解释为什么他的病人对治疗无效。药剂师可以建议病人服用硫酸亚铁325毫克，每日3次（可以加服维生素C以增加吸收），以便提供足量她所需要的铁元素。

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