Anemia Farmako

Drugs for prevention and treatment anemia

azalia arif

Anemia occurs when blood does not have enough rbc or when rbs does not have enoogh Hb

hemoglobin is oxygen-carrying pigment found in rbc

anemia can be life threatening

there are 400 different forms of anemia 3 most common : iron deficiency anemia vitamin B12 deficiency anemia folic acid deficiency anemia

Hematopoesis the production from undifferentiated stem cells of circulating erythrocytes, platelets, leucocytes produces over 200 billion new blood cells per day in normal person resides primarily in bone marrowrequires constant supply of iron vitamin B12 folic acid

Anemiadeficiency in oxygen-carrying erythrocytesis the most common and eazily to treat thrombocytopenia and neutropenia are not rare and are amenable to drug therapy due to deficiency of iron, vitamin B12, folic acidThe use of hematopoetic growth factors to combat anemia, thrombocytopenia, neutropenia and to support stem cell transplantation

Worked up of anemia

evaluate conjunctiva and mucous membrane for paleness cardiovascular system for murmur liver spleen nodes look for jaundice or purpura

Worked up

laboratory

complete blood count with diffrerential and platelet evaluation of smear with the rbc indices reticulocyte count

Approach to anemia

Smear indicesHypochromicnormocyticNormochromicnormocyticmacrocytic

Gbr hypochromic

Hypochromic microcytic anemia

appearance weakly in staning small in size

mechanism decreased in Hb synthesis secondary to decreased heme synthesis

causes : iron deficiency thalassemia lead poisoning

Hypochromic microcytic anemia

iron deficiency mechanism decreased in Hb synthesis secondary to heme synthesis

major differential D/- beta thalassemia minor- incidence 3-24% of children aged 6 -24 months

Iron deficiency anemia

causes lack of adequate iron at birth- low birth weight- low Hb at birth poor iron intake loss of iron (G.I bleeding)

symptoms irritability anorexia with poor weight gain behavioral changes

D/ and test

Hb and MCV are decreased ferritin decreased TBIC decreased

T/ elemented iron 4-6 mg/kg/day in a 1-2 year old with poor diet T/ may with empiric course of oral iron immediately Hb starts to rise at 1 week once normalized continue Fe T/ for 1-2 months to replace Fe stores in marrow

Iron deficiency anemia too little iron in the body to make sufficient Hb three causes of iron deficieny anemia loss of iron at a greater rate than normal (blood loss) usually the result of persistent bleeding??????????????

Iron and vitamin deficiency anemia

microcytic hypochromic anemia iron deficiency the most common

megaloblastic anemia deficiency vit.B12 or folic acid, cofactors for maturation of rbc

pernicious anemia the most common type of B12 deficiency caused by a defect in the synthesis of intrinsic factor

normochromicnormocytic anemiaDecresed reticulocyteIncreased reticulocytemalignancyHypoproliferativeanemiaCOOMB +COOMBS -intracorpuscularextracorpuscularAntibody mediatedAcute blood lossAbnormalHbMembranedeficiencyEnzymedeficiency

The main causes of iron deficiency anemia :

chronic blood loss desease of git drug-induced menstrual (>80 mL/cycle = 46 mg) recurrent hemoptysis increased requirements pregnancy treatment of megaloblastic anemia

malabsorption malabsorption syndrome postgastrectomy

dietary deficiency

Iron deficiency anemia leads to pallor, dizziness,dyspnea, and tissue hypoxia

CV adaptations to chronic anemia : tachycardia, c.o, vasodilation worsen the condition of patients with underlying CV desease

Treatment of iron-deficiency anemia

recommend iron-rich food (liver, seafood, dried fruits, lima beans, whole grains, green leafy vegetables or iron pills

in the more severe cases: anemia cause by blood loss, surgery blood transfusion

Anemia deficiency vitamin 12

impaired ability of digestive tract to absorb the B12

B12 is essential for the production of rbc

maintenance of nervous system

found in food of animal origin such as meat, fish and diary products

Causes of B12 deficiency

failure of the stomach lining to produce intrinsic factor, due to autoimmune disorder intrinsic factor is block

removal of small intestine where vit B12 is absorb

Cronhs disease a chronic inflammatory disease that affects any part of the g.i.t

eating a vegan diet which excludes eggs, diary products, meat and eggs

The symptoms of B12 deficiency anemia are similar to those of iron deficiency, also caused:

jaundice numbness and tingling in the hands and feet equilibriaum diffuculties confusion personality changes and depression

Treatment of B12 deficiencycurrent treatment lifelong treatment of monthly B12 injections

Folic acid deficiencysymptoms of folic acid deficiency are similar tovitamin B12 anemia

symptoms of anemia may also include : black, maroon or bloody stool abdominal pain weight loss fatigue chest pain

Treatment of folic acid deficiency

dietary correction

main sources of lolic acid : meat, poultry, cheese, milk, eggs, liver etc

folic acis tablet

injections in rare instances

Overall treatment considerations

other therapies for anemia may include oxygen, fluids, fresh frozen plasma, platelet replacement and vasopressor to elevate blood pressure this depend upon the underlying cause of the anemia

Prevention of anemiaconsumption of healthy diet including iron-containing foods and those with B-complex vitamin is essential to developing and maintaining satisfactory blood count

Lead poisoning anemia

block placement of Fe into heme

may cause neurological damage and anemia

usually related to lead-base paints and industrial exposure

test for serum lead level

T/ chelation of deferoxamin

Thalassemia

genetically determined, often familial defects in production of Hb victim of this heriditary anemia produce very little functional Hb cells are also prone to rupture two peocesses involved

decreased production of Hb imbalance of globin chain production

The end