Description and Clinical Goals
Jessica, 16, complains that she has had fatigue, has been pale, and has not been able to exercise as much as before for the last two months. After the administration of necessary blood tests, the patient is diagnosed with iron-deficiency anemia. The first clinical goal is to identify the underlying cause of the condition, as it may be related to Jessica’s diet or the presence of a disease (or diseases) that led to anemia. The second goal is to design an appropriate treatment plan, an important part of which is constituted by prescribed medicines. Third, Jessica and her mother should be educated on iron-deficiency anemia and its management.
The main non-pharmacological intervention is related to the necessary dietary changes. If the patient is found to have no contraindications for oral intake of iron-rich foods, she should be advised to consume more such foods. Before the intervention is provided, additional tests may be needed, such as allergy tests.
Clinical Practice Guideline
A clinical practice guideline on the management of iron-deficiency anemia was developed by Jimenez, Kulnigg-Dabsch, and Gasche (2015) by summarizing conventional practices and procedures related to diagnosis and treatment. The authors referred to 130 academic sources, which constitute strong evidence, on which the guideline is based. It is applicable to general patients without specific conditions that might prevent the use of measures normally taken to treat the condition.
Class of Medication
The class of medication that the patient should be prescribed is iron products (“Feraheme,” 2015), also known as iron supplements (Jimenez et al., 2015). The presented case does not indicate any factors that could prevent Jessica from taking iron products.
Safe and Appropriate Dose of a Medication
The selected medication is Feraheme, which is a brand name for ferumoxytol (“Feraheme,” 2015). It is injected through an IV; the initial dose is 510 mg (over 15 minutes at least), and the second dose (three to eight days later) is the same. Jimenez et al. (2015) confirm that intravenous iron is a highly effective treatment measure.
Feraheme is chosen because the patient has been pale for two months, and pallor indicates severe anemia (Lopez, Cacoub, Macdougall, & Peyrin-Biroulet, 2016). Moreover, Jessica is menstruating currently, which presents a risk of deterioration of the condition. Therefore, intravenous iron, which is normally administered in severe cases, is an appropriate solution.
Feraheme intravenous solution (30 mg/mL) costs approximately 850 USD depending on the pharmacy. The generic version at a reduced rate is not currently available; however, discount programs exist, and the purchase can be covered by an insurance plan.
Assessing and Monitoring the Efficacy
The patient should be monitored during the administration of the medication and within several hours after it. Feraheme may cause allergic reactions even if it was used before and caused none (“Feraheme,” 2015). During the administration of the second dose, the patient should be assessed as per her fatigue, pallor, and physical strength; improvements will indicate the success of the medication use.
Negative side effects are not common but may include swelling of the face, arms, hands, or feet as well as blurred vision, chest pain, and confusion. It is not expected that the side effects will require pharmacological interventions.
Drug-Drug, Drug-Food Interactions
Only one major interaction is known for Feraheme: dimercaprol, a drug that is used to remove heavy metals from the blood, which is needed to treat metal poisoning. No drug-food interactions should be stressed. Any vitamin or mineral supplements should be avoided by the patient unless prescribed.
First, Jessica and her mother should be explained that increased consumption of iron-rich foods can prevent readmission. Second, such foods should be listed; e.g., liver, meat, fish, tofu, breakfast cereals, or bread fortified with iron, and eggs. Third, the patient should be recommended to take iron supplements, especially during menstrual periods.
Jimenez, K., Kulnigg-Dabsch, S., & Gasche, C. (2015). Management of iron deficiency anemia. Gastroenterol Hepatol, 11(4), 241-250.
Lopez, A., Cacoub, P., Macdougall, I. C., & Peyrin-Biroulet, L. (2016). Iron deficiency anaemia. The Lancet, 387(10021), 907-916.