{ "schema_version": 1, "kind": "condition", "id": "anaemia-of-chronic-disease", "name": "Anaemia of Chronic Disease (Inflammation)", "category": "chronic", "sources": "BSH Guidelines for the Management of Anemia of Chronic Disease 2017", "review_status": "reviewed", "verified_against": "BSH Guidelines for the Management of Anemia of Chronic Disease 2017", "verified_date": "2026-08", "treatments": [ { "id": 157, "generic": "Ferrous fumarate", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 200.0, "adult_dose": "200 mg once daily (or on alternate days) ONLY if co-existing true iron deficiency confirmed (ferritin <100 mcg/L with TSAT <20%)", "adult_duration": "2-3 months", "dose_source": "BSH Guidelines for the Management of Anemia of Chronic Disease 2017", "rationale": "Iron therapy is ineffective and potentially harmful in pure anaemia of chronic disease without absolute iron deficiency - the ferritin and TSAT thresholds in the dose above are the gate, not a formality. Where it is indicated, Egypt's oral iron is ferrous fumarate; 200 mg is 65.57 mg elemental.", "cautions": [ "DO NOT ROUTINELY PRESCRIBE ORAL IRON FOR PURE ACD: High hepcidin levels block intestinal iron absorption and trap iron in macrophages.", "Definitive management is treating the underlying inflammatory, infectious, or malignant condition.", "Differentiate ACD from iron deficiency anaemia: ACD typically shows low serum iron, low TIBC, normal/high ferritin, and low transferrin saturation.", "Most iron tablets in Egypt come with folic acid in them, though not all - check the pack. Folate corrects the blood picture of B12 deficiency while the neurological damage carries on - check B12 before starting if the anaemia is macrocytic, mixed, or unexplained.", "The guideline says ferrous sulphate. The Egyptian formulary has no ferrous sulphate monograph; its oral iron is ferrous fumarate, 200 mg tablet = 65.57 mg elemental. Substitute on elemental iron, not on tablet weight.", "The pack a pharmacy hands over is a combination rather than plain iron - besides folic acid, many Egyptian iron products add vitamin C, and some add zinc or B vitamins. A combination is an acceptable way to give oral iron: the formulary's ferrous fumarate monograph lists the dosage forms as a 200 mg tablet and a 140 mg/5 mL syrup, then adds combination products to that list, and states the adult dose in elemental iron (100 to 200 mg elemental iron daily). The vitamin C is wanted rather than merely tolerated - 200 to 500 mg alongside oral iron is recommended to enhance its absorption. Dose by the elemental iron the pack states, not by tablet weight and not by the other ingredients. The Egyptian register does not record elemental iron content for most of these products, so the carton has to be read." ], "peds_mgkg_low": 3.0, "peds_mgkg_high": 6.0, "peds_max_mg": 180.0, "peds_basis": "day", "peds_unit": "mg", "peds_note": "3-6 mg/kg/day elemental iron in 1-2 divided doses only if co-existing iron deficiency documented. Ceiling of 180 mg is the formulary maximum for a child: 20 mL/day of the 140 mg/5 mL syrup, which is 45 mg elemental iron per 5 mL. This is deliberately above the 130 mg an adult gets here: a growing child needs more elemental iron per kilogram, and modern adult practice is lower and less frequent dosing than the formulary allows. It is not an inversion to correct.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": [ { "weight_kg": 10, "low_mg": 30, "high_mg": 60, "capped": false }, { "weight_kg": 20, "low_mg": 60, "high_mg": 120, "capped": false }, { "weight_kg": 30, "low_mg": 90, "high_mg": 180, "capped": false }, { "weight_kg": 40, "low_mg": 120, "high_mg": 180, "capped": true } ], "brands": [ { "trade_name": "FERROL 10 F.C. TABLET", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMOUN", "price_egp": 2.0, "pack_count": 10, "unit_price": 0.2, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": "folic acid" }, { "trade_name": "FOLIFER 30 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MISR", "price_egp": 7.2, "pack_count": 30, "unit_price": 0.24, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": "folic acid" }, { "trade_name": "FERROZINC-C 24 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SAFE PHARMA > PHARCO", "price_egp": 7.5, "pack_count": 24, "unit_price": 0.31, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": "vitamin c, zinc" }, { "trade_name": "IROFOL 30 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MULTICARE", "price_egp": 40.5, "pack_count": 30, "unit_price": 1.35, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": "copper, folic acid, pyridoxine, vitamin b12, zinc" }, { "trade_name": "HAEMACTIN 30 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "DELTA GRAND PHARMA > NOBEL PHARM. INDUSTRIES", "price_egp": 150.0, "pack_count": 30, "unit_price": 5.0, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": "folic acid, vitamin b12" }, { "trade_name": "TESLAGLOBIN 20 CAP", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "DAWA EGYPT INTERNATIONAL > TESLA", "price_egp": 140.0, "pack_count": 20, "unit_price": 7.0, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": "b12, b6, copper, folic acid, zinc" }, { "trade_name": "CHEMARED CAPSULE", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARMA ZAD > CHEMA HERB", "price_egp": 195.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": "calcium, methyl cobolamine, pyridoxine" }, { "trade_name": "FERRONIL 125MG/5ML SYRUP 120 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NILE.", "price_egp": 4.0, "pack_count": null, "unit_price": null, "strength_mg": 125.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "anaemia-of-chronic-disease" } ] }