Q: My 18 years old sister weighs just 38 kg. Earlier she used to have pain in her nose and now her nose starts bleeding suddenly. I consulted an ENT surgeon who prescribed nasal drops, which helped initially but the problem rose again after a few days. The doctor did endoscopy and told that there is no problem inside the nose. My sister’s blood report states that her haemoglobin and iron is very low. The doctor told me that she is suffering from anaemia and prescribed Oroferr xt for 3 months. She has been taking the tablet for the last 45 days but sometimes her nose starts bleeding suddenly. How to stop nasal bleeding? How to increase her weight and height?

A:Your sister is likely having anaemia secondary to chronic blood loss from her nose. For this, you need to consult a good ENT surgeon who can examine her and exclude a nasal problem. In case there the ENT examination are normal, please consult a hematologist who would exclude the possibility of a primary bleeding disorder. The anaemia will keep recurring unless the primary condition is treated. For iron deficiency anaemia, she will need iron supplementation. The iron preparation you give should contain between 30-100 mg elemental iron. Avoid enteric-coated or prolonged-release preparations. The dose should be sufficient to provide between 150-200 mg elemental iron per day and the tablet may be taken 2 to 3 times a day about 1 hour before meals. Though ferrous sulphate is recommended to treat iron deficiency, often patients complain of gastrointestinal discomfort, bloating and other distress. Ferrous gluconate, which is roughly equivalent in cost, produces fewer problems, and is preferable as the initial treatment of iron deficiency. Taking fruit juice along with it enhances iron absorption. Add meat and eggs to her diet as also green leafy vegetables and fruits.