Haematology

Anaemia

خون کی کمی

Palpitations, generalised weakness, shortness of breath and body aches with pallor. Treatment is chosen by haemoglobin level: oral iron with B12, then IV iron.

ICD-10: —
Source: OPD handbook pp.81–84
Status: Draft

Not yet reviewed by a clinician. Check doses and brands against current national guidelines before use.

Symptoms

Palpitations
Generalised weakness
Shortness of breath
Body aches

Diagnosis

Pallor positive on examination
Advise CBC: Hb under 10.5 g/dL (the book writes mg/dL)
Iron deficiency: MCV and MCH are reduced (normal MCV 75–93 fL; MCH 26–32 pg)

Treatment

Step 1 of 5

1. Hb under 10.5 and above 9.5

Inj Neuromet 500 mcg stat
Tab Polymalt-F: 1 daily during breakfast for 1 month

Prescription

Methylcobalamin (vitamin B12)Nervine tonic / B12

Dose500 mcg stat

Brand Inj Neuromet

Also sold as Neuromet, Mexamine, Cobalamin, Mexamin, Methycobal

Iron polymaltose complex + Folic acidOral iron

Dose1 daily with breakfast

Brand Tab Polymalt-F 1 month

Step 2 of 5

2. Hb under 9.5 and above 8.5

Inj Neuromet stat IM
Tab Polymalt-F: 1 daily during breakfast for 3 months

Prescription

Methylcobalamin (vitamin B12)Nervine tonic / B12

Dosestat IM

Brand Inj Neuromet

Also sold as Neuromet, Mexamine, Cobalamin, Mexamin, Methycobal

Iron polymaltose complex + Folic acidOral iron

Dose1 daily with breakfast

Brand Tab Polymalt-F 3 months

Step 3 of 5

3. Hb under 8.5 and above 7.5: plan IV iron

Pass an IV line
Inj normal saline 100 mL
Inj Hifer / Bisleri / Sangobion: 2 ampoules in normal saline
Inj Neuromet / Cobalamin IV stat
Keep Inj Avil (chlorpheniramine) and Dexa in hand to combat an anaphylactic reaction

Prescription

Normal saline IV (0.9%)IV fluid

Dose100 mL

Brands Generic / hospital supply

IV iron (iron sucrose type)Parenteral iron

Dose2 ampoules in normal saline

Brand Inj Hifer / Bisleri / Sangobion

Also sold as Hifer, Bisleri (as written), Sangobion (as written)

Methylcobalamin (vitamin B12)Nervine tonic / B12

DoseIV stat

Brand Inj Neuromet / Cobalamin

Also sold as Neuromet, Mexamine, Cobalamin, Mexamin, Methycobal

Chlorpheniramine injectionAntihistamine (anaphylaxis cover)

DoseKeep ready for anaphylaxis

Brand Inj Avil

DexamethasoneCorticosteroid

DoseKeep ready for anaphylaxis

Brand Inj Dexa

Also sold as Decadron, Dexa, D-Cort

Step 4 of 5

4. Signs of anaphylaxis and its management

Signs: itching; wheals and flare; tachycardia / palpitation
Management: stop the infusion
Inj Avil + Dexa IV stat
Slow the infusion of IV iron

Step 5 of 5

5. Discharge

Tab Polymalt-F: 1 daily at breakfast
Repeat IV iron on the 10th day
Advice (Urdu): you have a lack of blood, treatable; do not take too many painkillers; avoid stomach-irritating capsules; eat one apple daily and take an egg and other healthy foods

Prescription

Iron polymaltose complex + Folic acidOral iron

Dose1 daily at breakfast

Brand Tab Polymalt-F 3 months (in samples)

Methylcobalamin (vitamin B12)Nervine tonic / B12

Dose1 daily at night

Brand Tab Mexamin 500 mcg

Also sold as Neuromet, Mexamine, Cobalamin, Mexamin, Methycobal

Vitamin D3 injectionSupplement

DoseOne ampoule in milk, weekly for 4 weeks (per the Urdu note; sample 1)

Brand Inj D3

Also sold as D3 (200,000 IU), D3 200,000 IU/mL

NaproxenNSAID

Dose1 as needed for body pain

Brand Tab Neoprox 500 mg

Also sold as Neoprox, Neopron, Flexin, Synflex

Sample prescriptions from the book (patient details removed)

Female, 26 y, palpitations and SOB on work with generalised weakness, body ache and backache; pallor positive; Hb 9.2: Inj Mexamine 500 mcg IM stat; Tab Polymalt-F 1 daily during breakfast for 3 months; Inj D3 one ampoule in milk once a week for 4 weeks; Tab Neoprox 500 mg 1 as needed for body pain.
Female, 28 y, generalised weakness and palpitations, unable to perform strenuous work; Hb 8 g/dL: Plan: pass IV line; Inj Cobalamin 500 mcg stat; Inj Avil + Dexa IV stat; Inj N/S 100 mL IV continue; Inj Hifer 2 ampoules in IV fluid. Discharge: Tab Polymalt-F 1 daily with water at breakfast for 3 months; Tab Mexamin 500 mcg 1 daily at night; eat an apple daily.