1. Anti-Anemia Agents Broyles Chapter 22 Lehmkuhl, 2009

2. Anemia Not a disease but symptom of underlying cause Four- million people <65 yrs affected Women more than men are affected Possible causes see BOX 22-1 pg 527

3. Hemoglobin Hemoglobin is the most important component of red blood cells. It is composed of a protein called heme, which binds oxygen. In the lungs, oxygen is exchanged for carbon dioxide. Abnormalities of an individual's hemoglobin value can indicate defects in the normal balance between red blood cell production and destruction. Both low and high values can indicate disease states.

4. Anemia Anemia classification by cause or appearance on the RBC –Hypochromatic (microcytic)- small, pale red cells assoc with IDA –Normocytic-RBC normal appearance –Macrocytic- enlarged RBCs often D/T B12 deficiency Symptoms are similar pallor, malaise, and lethargic in all anemia's

5. Red Blood Cells, IDA Microcytic, Hypochromic These abnormal red blood cells (RBCs) are seen in association with some forms of anemia, and following the removal of the spleen (splenectomy). Small, pale RBC’s

6. Megaloblastic Anemia - View of Red Blood Cells This picture shows large, dense, oversized, red blood cells (RBCs) that are seen in megaloblastic anemia. Megaloblastic anemia can occur when there is a deficiency of vitamin B-12.

7. Iron-Deficiency Anemia Anemia is a decrease in RBCs, decrease in the amount of hemoglobin in the RBCs, or both Iron deficiency anemia is the most common type of anemia When the body does not have enough iron to supply the body’s needs IDA results Dx: hypchromatic (microcytic) RBC’s. Nutritional deficit –Common cause Clients with: –Bleeding disorders –Menses –Pregnant women –Infants –Blood donors

8. Anti-Anemic Agents Loss of iron is greater than the available iron stored in the body Tx- underlying cause r/t bleeding and iron replacement PO tx safe, economical and convenient take on an empty stomach (no food). Small intestine is the major site of Fe absorption. Treatment is iron salts Iron Dextran is given IM by Z track method Iron Dextran can exacerbate joint pain in RA Oral iron solutions need to be given with a straw and may stain teeth black

9. Anti-Anemic Agents IDA Iron is constipating, and stains the stool black or green (tarry), nausea is common. Vitamin C increases the absorption of Iron. Take in divided doses between meals to improve absorption. Take as prescribed OD leads to poorer Fe absorption in adults. Antacids, Vit E., Tetracyclines, PCN, and Fluroquinolones decrease absorption of iron Anemia may occur in patients with CRF due to decreased production of erythropoietin and long term dialysis. Procrit, Eprex and Epogen (epoetin) are used to tx anemia of CRF and stimulate bone marrow to make RBCs Most common s/e HTN (monitor b/p carefully). Treatment 3-6 months p hemoglobin levels return to normal.

10. Folic Acid Deficiency Megaloblastic Anemias Most common causes are: Folic acid deficiency anemia and Pernicious anemia (B-12) RBC’s are macrocytitic. Folic acid is required for the manufacture of RBCs Folic acid deficiency may result in neural defects during pregnancy. Folvite and Leucovorin are used to tx folic acid deficiency RDA of folate in pregnancy is 0.4 mg/d RDA of folate in lactation is 0.8 mg/d Enc foods enriched w/ folic acid (e.g. flours, bread, cornmeals, pasta, rice).

11. FOLIC ACID DEFICIENCY

12. PERNICIOUS ANEMIA

13. Pernicious Anemia Megaloblastic Anemias Pernicious anemia is a megaloblastic (macrocytic) anemia caused by a deficiency of vitamin B12 A deficiency of this vitamin is rare when caused by low dietary intake (meat, milk, eggs, and cheese) but may occur in strict vegetarians S/S weakness, sore tongue, tingling of the extremities Intrinsic factor produced by parietal cells in the stomach is needed for absorption of B12 Causes maybe congenital, gastric and intestinal disorders, gastrectomy, chronic use of potassium supplements, pernicious anemia B12 deficiency may cause lesions of the spinal cord

14. Anti-Anemic Agents Pernicious anemia is treated with B12 injections (cyanocobalamin) B12 in contraindicated in persons allergic to COBALT B12 is given IM because the vitamin is ineffective when given orally due to absence of intrinsic factor Lifetime therapy with B12 injections is required Instruct patient to eat a balanced diet that includes seafood, eggs, meats, and dairy products. Avoid contact with infections and report any signs of infection because dose increase maybe necessary