検診で貧血と指摘された為、薬を飲む事になりました。
貧血に良いと聞くが、レバーは苦手です。
アセスメント
診断について
・鉄剤の処方から、鉄欠乏性貧血（iron deficiency anemia：IDA)と診断された様子。検査値は不明だが、IDAの特徴として、網赤血球指数RPI<2、MCVが75~115の小球性、フェリチン<20などが挙げられる。
・MCV<70、もしくはフェリチン<20では、それだけでIDAを診断可能とする報告がある。［J Gen Intern Med.1992 Mar-Apr;7(2):145］
治療について
・鉄投与量15mg、50mg、150mgでどの群も60日後のフェリチン値、Hb値は有意差なく改善、消化器症状などの副作用は15mg/群で最も少なかった。［J Med.2005 Oct;118(10):1142-7］
・骨髄で使用出来る鉄量は20-60mg程度、腸管から吸収される鉄量は1日15mg程度であり、悪心などが問題になれば継続可能な少ない用量での投与を検討しても良いかも知れない。
鉄を補う薬と胃薬です。
緑茶のようなタンニンを含む飲料で飲むと一時的に歯が黒くなることあり。その場合は重曹で磨いてください。
レバーの他、ほうれん草や小松菜、大豆、ひじきなどは鉄分を多く含むので、できる範囲で食事に取り入れるようにしましょう。
次回、鉄剤への反応（網赤血球の増加、MCV,Hb値の上昇）が確認出来ればチェック。
鉄剤による悪心が無かったか、服薬継続出来そうかもチェック。
参考「ホスピタリストのための内科診断フローチャート」
20161209
Am J Med. 2005 Oct;118(10):1142-7.
Are we giving too much iron? Low-dose iron therapy is effective in octogenarians.
Rimon E1, Kagansky N, Kagansky M, Mechnick L, Mashiah T, Namir M, Levy S.
Author information
- 1Geriatrifc Department, Kaplan Medical Center, Rehovot, and the Hebrew University and Hadassah Medical School, Jerusalem, Israel. efraim_r@clalit.org.il
Abstract
PURPOSE:
Elderly patients are vulnerable to the dose-dependent adverse effects of iron replacement therapy. Our study examines whether low-dose iron therapy can efficiently resolve iron-deficiency anemia in patients over the age of 80 years and reduce adverse effects.
SUBJECTS AND METHODS:
Ninety hospitalized patients with iron-deficiency anemia were randomized to receive elemental iron in daily doses of 15 mg or 50 mg as liquid ferrous gluconate or 150 mg of ferrous calcium citrate tablets for 60 days. Thirty control patients without anemia were given 15 mg of iron for 60 days. A 2-hour iron absorption test was performed after the initial dose. Hemoglobin and ferritin levels were measured on day 1, 30, and 60 after initiating therapy. Each patient completed a weekly questionnaire regarding drug-induced adverse effects.
RESULTS:
Serum iron rose significantly in the anemic patients beginning 15 minutes after the first dose but not in nonanemic patients. Two months of iron treatment significantly increased hemoglobin and ferritin concentrations similarly in all 3 groups of iron-deficiency anemia patients (for example, hemoglobin levels rose from 10.0 g/dL to 11.3 g/dL with 15 mg/d of iron therapy and from 10.2 g/dL to 11.6 g/dL with 150 mg/d). Abdominal discomfort, nausea, vomiting, changes in bowel movements, and black stools were significantly more common at higher iron doses.
CONCLUSIONS:
Low-dose iron treatment is effective in elderly patients with iron-deficiency anemia. It can replace the commonly used higher doses and can significantly reduce adverse effects.
Comment in
- Low dose iron supplementation was effective in older patients with iron deficiency anaemia. [Evid Based Med. 2006]
- Low-dose iron supplementation was effective in older patients with iron-deficiency anemia. [ACP J Club. 2006]
- PMID:
- 16194646
- DOI:
- 10.1016/j.amjmed.2005.01.065
- [PubMed - indexed for MEDLINE]