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Anemias Pharmacotherapy
Anemias Pharmacotherapy
classification
Anemia can be classified on the basis of the morphology of the RBCs,
etiology, or pathophysiology
I. Morphology
Macrocytic anemias
Megaloblastic anemias
II. Etiology
Deficiency
Iron
Vitamin B12
Folic acid
Pyridoxine
Peripheral
Bleeding (hemorrhage)
Hemolysis (hemolytic anemias)
III. Pathophysiology
Excessive blood loss : Recent hemorrhage;
ulcer; Gastritis; Hemorrhoids
Trauma;
Peptic
Chronic hemorrhage : Vaginal bleeding; Peptic ulcer; Intestinal parasites; Aspirin and
other nonsteroidal antiinflammatory agents
Excessive RBC destruction : Extracorpuscular (outside the cell) factors (RBC
antibodies; Drugs; Physical trauma to RBC (artificial valves); Excessive sequestration
in the spleen); Intracorpuscular factors (Heredity; Disorders of hemoglobin synthesis)
Inadequate production of mature RBCs : Deficiency of nutrients (B 12, folic acid, iron,
protein); Deficiency of erythroblasts(Aplastic anemia; Isolated (often transient);
erythroblastopenia; Folic acid antagonists; Antibodies)
Conditions with infiltration of bone
marrow: Lymphoma; Leukemia;
Endocrine abnormalities:
insufficiency
Myelofibrosis;
Hypothyroidism;
Carcinoma
Adrenal insufficiency;
Pituitary
Epidemiology
In the United States approximately 3.5 million Americans have anemia
based on self-reported data from the National Center for Health
Statistics. It is estimated that millions of people are unaware they have
anemia, making it one of the most underdiagnosed conditions in the
United States. Iron deficiency is considered to be the leading cause of
anemia worldwide, accounting for as many as 50% of cases
Data from the National Health and Nutrition Examination Survey
(NHANES) indicates the prevalence of IDA in young children and women
of childbearing age is 1.2% and 4.5%, respectively. 2 The normal ranges for
Hb and Hct are so wide that a patient may lose up to 15% of RBC mass
and still have a Hct within the normal range. Therefore, iron deficiency
may precede the appearance of anemia.
Vertigo
Shortness of breath
Chest pain
Neurologic symptoms in vitamin B 12 deficiency
Goal
The severity and cause of IDA determines the approach to treatment. Treatment is focused on
replenishing iron stores. Because iron deficiency can be an early sign of other illnesses,
treatment of the underlying disease may aid in the correction of iron deficiency.
Primary prevention of IDA in infants, children, and adolescents is the most appropriate goal
because delays in mental and motor development are potentially irreversible
The goals of treatment for vitamin B12 deficiency include reversal of hematologic
manifestations, replacement of body stores, and prevention or resolution of neurologic
manifestations
Therapy for folic acid deficiency consists of administration of exogenous folic acid to induce
hematologic remission, replace body stores, and resolve signs and symptoms
Treatment of ACD depends on the underlying etiology
Patients with anemia of critical illness require the necessary substrates of iron, folic acid, and
vitamin B12 for RBC production. Parenteral iron is generally preferred in this population
because patients often are undergoing enteral therapy or because of concerns regarding
inadequate iron absorption. The disadvantage of parenteral therapy is the theoretical risk of
infection.
Treatment
Dietary Supplementation and Oral Iron Preparations
Parenteral Iron Therapy
Transfusions
Most patients respond rapidly to vitamin B12 therapy. The typical patient
will experience an improvement in strength and well-being within a few
days. Bone marrow begins to become normoblastic in 2 to 3 days.
Reticulocytosis is evident in 3 to 5 days. Hb begins to rise after the first
week and should normalize in 1 to 2 months. CBC count and serum
cobalamin levels usually are drawn 1 to 2 months after initiation of
therapy and 3 to 6 months thereafter for surveillance monitoring.
Homocysteine and MMA levels should be repeated 2 to 3 months after
initiation of replacement therapy to evaluate for normalization of levels,
although levels begin to decrease in 1 to 2 weeks. Neuropsychiatric signs
and symptoms can be reversible if treated early. If permanent neurologic
damage has resulted, progression should cease with replacement
therapy. Slow response to therapy or failure to observe normalization of
laboratory results may suggest the presence of an additional abnormality
such as iron deficiency, thalassemia trait, infection, malignancy,
nonadherence, or misdiagnosis.