ANEMIA

INTRODUCTION

Decreased or poor maturation of red blood cells

Multiple etiologies

IRON DEFICIENCY ANEMIA

Hypochromic microcytic anemia

Decreased RBC’s and decreased hemoglobin

Decreased oxygen binding

Can cause high output cardiac failure

ETIOLOGY

Blood loss

Inadequate diet or absorption

IRON REPLACEMENT

ORAL THERAPY

Replacement therapy may require 6 months

INTRAMUSCULAR

Z-track administration

Limited daily volume

INTRAVENOUS

Guidelines limit use to 100mg per day

Required for quick iron replacement (pregnancy, ulcerative colitis)

MEGALOBLASTIC ANEMIA

FOLIC ACID OR CYANOCOBALAMIN (VITAMIN B12) DEFICIENCY

REPLACEMENT WITH THE WRONG VITAMIN CAN MASK THE DEFICIENCY

DEFICIENCY COMPARISON

CYANOCOBALAMIN

Irreversible nerve damage

Constipation

Folic Acid

No Nerve Damage

Diarrhea

CYANOCOBALAMIN DEFICIENCY

Poor diet (vegetarian)

Lack of Intrinsic Factor (produced in stomach)

Onset of symptoms - 1 year

Also known as Pernicious Anemia

THERAPY

REPLACEMENT THERAPY

Intramuscular or Subcutaneous

Those that lack intrinsic factor will receive monthly injections

FOLIC ACID DEFICIENCY

Onset of Symptoms: 2 months

ETIOLOGY

Poor diet (e.g. alcoholic)

Drug Interactions

Phenytoin (blocks absorption)

Birth Control Pills

Methotrexate, co-trimoxazole (blocks converting to active form of the vitamin tetrahydrofolate)

Therapy

Oral folic acid supplementation

Leucovorin (active tetrahydrofolate) is utilized to overcome deficiencies associated with methotrexate and co-trimoxazole

NORMOCHROMIC NORMOCYTIC ANEMIA

Associated with chronic disease states

Renal Disease, Cancer, HIV

Erythropoietin

Hormone produced in the kidney to stimulate RBC production in bone marrow

Synthetic genetically engineered hormone is commercially available

Helps avoid the need for transfusions

WBC Deficiency

Associated with cancer chemotherapy

Prone to infections

Example of agents that promote production of granulocytes

Filgastrim (Neupogen®)

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