PRACTICAL APPLICATIONS OF THE BLOOD MEDICATION

I. THEORETICAL PART

ANTIANEMIA AGENTS

GENERAL PRINCIPLES OF ADMINISTRATION

1. Oral iron preparations are the treatment of choice for iron deficiency anemia,
administered for at least 6 months.
2. The average dose for the treatment of iron-deficiency anemia is 2-3 mg iron/kg/day,
divided into three equal portions. Vitamin C administered at the same time increases
the iron absorption.
3. The effectiveness of iron therapy is evaluated by tracking the reticulocyte count
(increases after 4-7 days) and the rise of hemoglobin (2 g/dl) or hematocrit.
4. The creation of iron stores requires many months of oral therapy.
5. If the response to oral iron therapy is inadequate, the diagnosis must be reconsidered.
6. If oral iron therapy fails (because of malabsorption or severe intolerance), parenteral
iron administration (IV or IM) may be an alternative.
7. Parenteral iron therapy can cause hypersensitivity, including anaphylactic shock
reactions, which may be fatal despite treatment. Always use a test dose of 25 mg of
iron before parenteral iron administration. If hypersensitivity symptoms occurs,
parenteral iron therapy must be abandoned.
8. The required dose of iron for parenteral administration is calculated through the
Ganzoni formula:

Iron req. (mg) = Body weight (kg) x (target Hb – current Hb) x 2.4 + Iron stores (mg)

Iron stores
Children < 35 kg = 15 mg/kg
Women = 500 mg
Men = 700 – 900 mg
Normal Hb
Women = 11 - 15 g/100 ml
Men = 13 – 16 g/100 ml

9. Vitamin B12 is indicated in megaloblastic anemia, intramuscular or subcutaneous.

10. The administration of Vitamin B12:

2 vials of 50 mcg/day for 2 weeks, continued with

2 vials of 50 mcg/week for 1 month, continued with
2 vials of 50 mcg/month for the whole life

11. Folic acid can be associated in megaloblastic anemia, 3 dj./day.

Generic drug Brand name Route of Pharmaceutical dosage form

administratio
n
Ferrous sulphate Ferrogradumet p.o. Tab with 105 mg Fe2+
Ferrous Ferronat p.o. Suspension 3% with 45 mg Fe2+/5mL
fumarate
 Ferrous Ascofer p.o. Tab 40 mg Fe2+ + 100 mg Vitamin C
gluconate
Iron sucrose Venofer IV Vials 100 mg/5 ml
Cyanocobalamin Vitamin B12 IM, SC Vial 50 μg/mL, 1000 μg/mL
Folic acid Acifol p.o. Dj 5 mg
Erythropoetin Eprex IV, SC Vial 2 000, 4 000 or 10 000 UI/mL

ANTITHROMBOTICS

GENERAL PRINCIPLES OF ADMINISTRATION

1. The parenteral (IV, SC) dose of unfractionated heparin should be calculated according
to the aPTT, which should be maintained at levels of 1.5-2.5 times higher than normal.
2. The treatment with heparin should never be stopped suddenly, because of the
hypercoagulation risk.
3. Low molecular weight heparins are administered always SC, once or twice daily.
There is no need for aPTT monitoring.
4. Antivitamin K anticoagulants are administred orally, ½-1 tablet/day, according to the
INR value (should be maintained between 2-3). The duration of treatment can be for
4-6 weeks in patients with low risk (young adults), for 6 months in those with medium
risk (AMI, heart failure, venous thrombosis) and for life in case of high risk patients
(elderly, chronic atrial fibrillation, cancer).
5. During the treatment with antivitamin K drugs, surgical procedures are forbidden.
6. The treatment with fibrinolytics should be initiated as soon as possible after the
ischemic event, for a short period of time (maximum 2-3 days, according to the type of
drug) and only if thrombin time checking is possible.
7. 250 mg of Hydrocortisone hemisuccinate should be administered before starting the
Streptokinase treatment, to prevent an allergic reaction.

Generic drug Brand name Route of Pharmaceutical dosage form

administration
Unfractionated Heparine IV Vial 5 ml, 5000 IU/ml; Initial 50
heparin sodique IU/Kg bolus, then 20 IU/Kg/h
panpharma according to APTT
Heparina IV Vial 1 ml, 5000 IU/ml; Initial 10,000
IU then 5000-10,000 IU every 4-6 h
Lioton gel local Tube 100 g, 1000 IU/g, apply 3x1
/day
AntiflebiticMK local Tube 25 g, 45 g, 50,000 IU heparin +
Gel, Alle gel 1g diclofenac /100 g; apply 3x1 day
Hepatrombin local Tube 40 g with 50,000IU/100 g or
30,000 IU/100 g; apply 3x1/day
Calciparine SC Vial 1 ml, 0.5 ml with 25,000 IU/ml ;
prefilled syringe of 5000 IU (0.2 ml).
SC 250 IU/kg every 12 h
Enoxaparin Clexane SC Prefilled syringe with 20 mg (2000 IU
anti-Xa)/0.2 ml, 40 mg (4000 IU anti-
Xa)/0.4 ml, 60 mg (6000 IU anti-
Xa)/0.6 ml; 2000 IU anti-Xa every 12
h or 4000 IUanti-Xa every 24 h.
Dalteparin Fragmin SC Prefilled syringe with 10,000 IU anti-
 Xa/0,4 ml;  10,000 IU anti-Xa/ml;
12,500 IU anti-Xa/0,5 ml; 18,000 IU
anti-Xa/0,72 ml;  2,500 IU anti-
Xa/0.2 ml; 25,000 IU anti-Xa/ml;
5000 IU anti-Xa/0.2 ml; 7500 IU anti-
Xa/0.3 ml; 15,000 IU anti-Xa/0.6 ml
200 IU anti-Xa/kg every 12 h or 24 h.
Nadroparin Fraxiparine SC Prefilled syringe with 2850 IU anti-
Xa/0.3 ml; 3800 IU anti-Xa/0.4 ml; 
5700 IU anti-Xa/0.6 ml; 7600 IU
anti-Xa/0.8 ml; 9500 IUanti-Xa/1 ml
38 IU anti-Xa/kg every 12 h.
Reviparin Clivarine SC Prefilled syringe with 1432 IU anti –
Xa/0.25 ml; 3436 IU anti – Xa/0.60
ml
One syringe of 0.25 ml or 0.6 ml
every 24 h.
Tinzaparin Innohep SC Prefilled syringe with 3500 IU anti-
Xa/0.35 ml; 4500 IU anti-Xa/0.45 ml
175 IU anti-Xa/kg every 24 h.
Fondaparinux Arixtra SC Prefilled syringe with 2.5 mg/1 ml
2.5 mg/day
Lepirudin Refludan IV Vial 20 mg; initial 0.4 mg/kg in bolus
then 0.15 mg/kg IV cont. 2-10 days
Bivalirudin Angiox IV Vial 250 mg; initial 0.75 mg/kg in
bolus then 1.75 mg/kg and h IV cont.,
maximum 4 h
Acenocumarol Sintrom p.o. Tab 4 mg; 1-8 mg/day
Trombostop p.o. Tab 2 mg; 1-8 mg/day
Warfarin Coumadin p.o. Tab 2.5 mg, 3 mg, 5 mg; 2-10 mg/day

Streptokinase Streptase IV drip Vials 250,000 IU, 750,000 IU,

1,500,000 IU; initial 250,000 IU in IV
DRIP for 30 min, then 100,000 IU/h
Alteplase Actilyse IV, IV drip Vials 50 mg; 15 mg IV in bolus then
50 mg in IV drip 30 min, then 35 mg
in IV drip 60 min until max. 100 mg
Reteplase Rapilysin IV, IV drip Vials 10 IU; 10 IU IV bolus, wait 30
min then 10 IU in the second bolus
Tenecteplase Metalyse IV Vials 8000 IU; one bolus of 100
IU/kg

Aspirin Aspenter, p.o. Tab. 75 mg, 150 mg; 75-150 mg/day,

Santepirin, after lunch
Ticlopidin Ticlodin p.o. Tab. 250 mg; 2x1 tab./day, after meal
Clopidogrel Clopidogrel p.o. Tab. 75 mg; 1 tab./day
Dipiridamol Dipiridamol p.o., IV Tab. 25 mg, 75 mg, vials 10 mg/2 ml;
75-100 mg/day 4 times/day between
meals; IV for CV stress test
Abciximab ReoPro IV, IV drip Vials 5 ml with 2 mg/ml; 0.25 mg/kg
IV bolus, then IV drip 0.125
mg/kg/min for 12 h
Tirofiban Aggrastat IV IV drip Vials 50 ml with 0.25 mg/ml; bolus
IV 0.4 mg/kg/min for 30 min then IV
drip 0.1 mg/kg/min
Eptifibatide Integrilin IV, IV drip Vials 2 mg/ml, 0.75 mg/ml; initial
bolus of 0.18 mg/kg then 0.002
mg/kg/min for 72 h

II. PRACTICAL PART

1. Write a medical prescription to a 45 year old male patient with iron defficiency
anemia, body weight of 80 kg and Hgb = 10 g/dl.
2. Calculate the necessary iron dose and specify the iron preparation and route of
administration for a 50 year old female patient with iron defficiency anemia, body
weight of 90 kg, Hgb = 8 g/dl and intolerance to oral iron therapy.
3. Write a medical prescription to a 60 year old patient with megaloblastic anemia and
gastric cancer, after total gastrectomy, in the first 2 weeks of treatment.
4. Write a medical prescription to a patient with chronic atrial fibrillation.