Clinical situation

Evaluating the effectiveness of treatment

In cases of appointment of the pancreas in a sufficient dose of a 7-day 10 from start of treatment observed increase in the number of reticulocytes. Significant increase in hemoglobin levels observed in 3-4 weeks. initiation of treatment. Normalization of hemoglobin usually occurs in terms of 4.9 weeks. Sometimes there is a sharp discontinuous increase in hemoglobin. These individual variations may be due, on the one hand, the severity of IDA, the degree of depletion of iron stores, and on the other - effectively appointed by the pancreas (the number of contained iron, bioavailability, etc.). Also has value nekomplaentnost patients (irregular admission RV, side effects).

The duration of treatment and supportive therapy

Optimal tactics of patients with IDA involves saturating and brand name viagra supportive therapy pancreas. Duration of therapy depends on the saturation rate of growth and timing of normalization of hemoglobin, with an average of 4-6 weeks. Supportive therapy is indicated in those situations where the cause of iron deficiency persists (menorrhagia, pregnancy) or because of different situations is trudnoustranimoy (pathology of the intestine, nasal bleeding and other hemorrhagic diathesis). Women suffering from iron deficient anemia against a background of menorrhagia, after normalization of hemoglobin recommended maintenance therapy in the pancreas within 5-7 days after the next menstruation. Patients need to explain the need for maintenance treatment in connection with the ongoing excessive loss of iron. Pregnant women with IDA should receive RV until the end of pregnancy to ensure adequate fetal demands for iron.

Tolerability of iron supplementation

Among the side effects against the background of the pancreas into the most commonly nausea, anorexia, metallic taste in the mouth, constipation, at least - diarrhea. Development of constipation due, in all probability, the binding of hydrogen sulfide in the intestine, which is one of the drivers of intestinal peristalsis. In most cases, modern RV cause minor side effects that do not require their removal and transfer to the parenteral route of administration.

Dyspeptic disorders may be reduced when taking drugs after meals or reducing the daily dose. Most often side effects of taking registriruyutsyapri PSG, while preparations VLC (gidroksipolimaltozny complex) better tolerated and have therefore a definite advantage. In cases of persistent poor tolerability of oral RV shows RV appointment parenterally (intramuscularly or intravenously). During treatment with parenteral RV, particularly for intravenous administration may be allergic reactions such as hives, fever, phlebitis, anaphylactic shock. In addition, intramuscular injection of RV possible darkening of the skin at injection site, infiltrates, abscesses.

If the RV for parenteral administration designate patients hypochromic anemia not associated with iron deficiency have an increased risk of severe violations of due to "overload" of iron in various organs and tissues (liver, pancreas, etc.) with the development of hemosiderosis.

Causes of ineffectiveness of treatment with iron

In case of absence or lack of effect of treating pancreatic should find out the cause to the possibility of its correction. Possible causes of treatment failure and RV ways to correct them are presented in Table 3. Necessary confidence in the correct interpretation of all clinical and laboratory features and the reliability of syndrome IDA. The reason for the lack or inadequacy of the pancreas may be insufficient daily intake of iron, which is usually linked with the appointment of the pancreas with a low content of iron in it and a small number of tablets taken. For example, in the treatment of drug, which contains only 10 mg of ferrous iron, the number of tablets taken must be at least 10 a day. This dosing regimen is inconvenient for patients, which explains the likely failure of the medical appointment.

With this in mind to ensure that complains should be assigned RV with a high iron content (not less than 100 mg). Preparations with low iron content should be used in pediatric practice. One reason for the ineffectiveness of the pancreas in the appointment of inward Viagra what is the cause of impotence may be malabsorption of iron, particularly in patients with undiagnosed or misunderstood intestinal pathology. In these cases demonstrated the appointment of parenteral RV. In some cases, because patients begin to feel better occasionally to take RV or even stop treatment. As a result of hemoglobin did not reach normal values and IDA in this case is actually nedolechennoy. With this in mind the duration of therapy saturating RV must be determined time frames for achieving a normal level of hemoglobin that requires constant laboratory monitoring. Several patients did not always comply with the appointment of a doctor (regular admission pancreatic sufficient duration, etc.). In some cases this may be due to razvitiempobochnyh effects of RV and independent cessation of treatment. Therefore necessary to monitor treatment efficacy, tolerability RV from the doctor, nurses, patients' relatives.

Lack of effect of the pancreas may be due to the unresolved causes of IDA, among which the most clinically significant are hidden blood loss from the gastrointestinal tract, most often from the intestine (undetected tumor!). With this in mind in such situations to the exclusion of other possible causes of inefficiency RV requires careful endoscopic examination of the intestine (in some cases - re). Thus, in patients with IDA, along with the elimination of the causes obligatory pathogenetic therapy of prostate (PSG and VLC), which should be assigned primarily inside.

Treatment tactics RV provides a choice route of administration of the pancreas in the light of clinical situation, the optimal RV with sufficient iron in it, evaluate the efficacy and tolerability of the drug, the duration of saturation and the validity of maintenance therapy. Timely verification of the syndrome of IDA and the identification of the cause, adequate pathogenetic therapy with the appointment of the pancreas with optimal pharmacokinetic properties, clinical efficacy, tolerability can correct the anemia and to provide a sufficient level of quality of life in these patients.

Sick people
Portuguese researchers