Patient/caregiver was educated on contraindications for using Feosol as follows:
- Feosol intake must be avoided in individuals with history of porphyria. Porphyria is a condition resulting from accumulation of porphyrins, which are natural chemicals in the body. Porphyrins bind to iron forming the heme. Heme in association with globin forms the hemoglobin of red blood cells, which binds and carries the oxygen to tissues. The association of porphyrins with iron and synthesis of heme is a multi-step process, mediated by many enzymes. Deficiency of these enzymes can be inherited, which results in poor association of porphyrins and iron, leading to compromised synthesis of heme. Deficient heme synthesis leads to poor hemoglobin and red blood cell synthesis and individuals present with findings of anemia. The deficiency in individuals with history of porphyria is with the enzymes needed for synthesis of heme, but not iron, as it manifests to be. As heme synthesis is compromised, unused porphyrins and iron in these individuals accumulate in the body in various vital organs, leading to the symptoms of porphyria and tissue iron toxicity. Administering Feosol in these individuals, to offset anemic symptoms, can worsen the toxicity with iron overload and so, must be avoided.
- Feosol must be administered with extreme caution in individuals with history of hemolytic anemias, such as, sickle cell or thalassemia. Hemolytic anemias usually are inherited genetic defects, resulting in poor structural stability of the red blood cells. Structurally deficient red blood cells are prone to damage and lysis, before completion of their lifespan. Hemolytic anemia can also be secondary to autoimmunity, when individuals can develop antibodies acting against their own red blood cells, thus resulting in damage of lysis of the cells. Irrespective to the basic pathology, individuals with history of hemolysis can present with findings of anemia. As blood cells are lysed in these individuals, the released heme and iron accumulate in the body in various vital organs, leading to the symptoms of tissue iron toxicity. Administering Feosol in these individuals, to offset anemic symptoms, can worsen the toxicity with iron overload and so, must be done with extreme caution.
