APLASTIC ANEMIA

TREATMENT
Treatment includes therapies that reverse the underlying
marrow failure and supportive care of the pancytopenic
patient.
Bone Marrow Transplantation This is the best therapy for
the young patient with a fully histocompatible sibling
donor
in transplant candidates, transfusion of blood from family
members should be avoided so as to prevent sensitization
to histocompatability antigens; while transfusions in
general should be minimized, limited numbers of blood
products probably do not seriously affect outcome
 Immunosuppression
Used alone, ALG or antithymocyte globulin (ATG) dose 20
mg/kg bb induces hematologic recovery (independence
from transfusion and a leukocyte count adequate to
prevent infection) in about 50% of patientsThe addition of
cyclosporine to either ALG or ATG has further increased
response rates to about 70 to 80% and especially improved
outcomes for children and for severely neutropenic
patients.
The addition of cyclosporine12-15 m/kg bb to either ALG or
ATG has further increased response rates to about 70 to
80% and especially improved outcomes for children and for
severely neutropenic patients. Combined treatment is now
standard for patients with severe disease. Hematologic
response strongly correlates with survival. Improvement in
granulocyte number is generally apparent within 2 months
of treatment.
 IRON DEFICIENCY ANEMIA
TREATMENT
Oral Iron Therapy In the patient with established iron deficiency
anemia who is asymptomatic, treatment with oral iron is usually
adequate. Multiple preparations are available ranging from simple
iron salts to complex iron compounds designed for sustained
release throughout the small intestine
Some come with other compounds designed to enhance iron
absorption, such as citric acid. It is not clear whether the benefits of
such compounds justify their costs. Typically, for iron replacement
therapy up to 300 mg of elemental iron per day is given, usually as
three or four iron tablets (each containing 50 to 65 mg elemental
iron) given over the course of the day. Ideally, oral iron preparations
should be taken on an empty stomach, since foods may inhibit iron
absorption.
 Parenteral Iron Therapy Intramuscular or intravenous iron
can be given to patients who are unable to tolerate oral
iron, whose needs are relatively acute, or who need iron on
an ongoing basis, usually due to persistent gastrointestinal
blood loss
There are two approaches to the use of parenteral iron:
one is to administer the total dose of iron required to
correct the hemoglobin deficit and provide the patient with
at least 500 mg of iron stores; the second is to give
repeated small doses of parenteral iron over a protracted
period. The latter approach is common in dialysis centers,
where it is not unusual for 100 mg of elemental iron to be
given weekly for 10 weeks to augment the erythropoietic
response to recombinant erythropoietin therapy

The amount of iron needed by an individual patient is

calculated by the following formula: body weight (kg) 2.3
(15 - patient's hemoglobin, g/dL) + 500 or 1000 mg
 HEMOLYTIC ANEMIAS
Treatment
Splenectomy reliably corrects the anemia, although the
RBC defect and its consequent morphology persist. The
operative risk is low. RBC survival after splenectomy is
normal or nearly so; if it is not, an accessory spleen or
another diagnosis should be sought
plenectomy in children should be postponed until age
4, if possible, to minimize the risk of severe infections
with gram-positive encapsulated organisms. Polyvalent
pneumococcal vaccine should be administered at least
2 weeks before splenectomy. In patients with severe
hemolysis, folic acid (1 mg/d) should be administered
prophylacticall
 Cobalamin Deficiency
TREATMENT
Apart from specific therapy related to the underlying
disorder (e.g., antibiotics for intestinal overgrowth with
bacteria), the mainstay of treatment for cobalamin
deficiency is replacement therapy. Because the defect is
nearly always malabsorption, patients are generally given
parenteral treatment, specifically in the form of
intramuscular cyanocobalamin. Parenteral treatment
begins with 1000 ug cobalamin per week for 8 weeks,
followed by 1000 ug cyanocobalamin intramuscularly every
month for the rest of the patient's life. However, cobalamin
deficiency can also be managed very effectively by oral
replacement therapy with 2 mg crystalline B12 per day.
 Folic Acid Deficienci
acid Folic 5mg every day during 4 months at
people of anemia cronik hemolitic must
therapy for a lifetime.