Anti-Anemia & Anticoagulation Overview

Anti-Anemia & Anticoagulation

• Iron Replacement:

  • Ferrous sulfate (Feosol) is a common iron replacement drug.
  • Iron is essential for red blood cell (RBC) oxygen-carrying capacity.
  • Absorption is about 15% if body iron stores are low, and only 2-3% if high. Absorption is aided by vitamin C.
  • Excretion is primarily through normal body processes (bowel, kidney, sweat).
  • Adults typically take 325 mg daily or more, children 3-6 mg Fe/kg/day (3 doses), adjusted to anemia severity.
  • Stool discoloration (black or green) is a common side effect.
  • Do not take with antacids.

• Vitamin B12:

  • Necessary for red blood cell formation.
  • Oral absorption is poor (1-2%).
  • Intramuscular (IM) or subcutaneous (subcu) administration is more effective.
  • Dosage: 100-200 mcg IM or subcu monthly (or weekly or biweekly).
  • Patients with intrinsic factor deficiency require higher oral doses.

• Folic Acid:

  • Essential for DNA production and red blood cell maturation (macrocytic RBC).
  • Good oral absorption; large doses effective for malabsorption cases.
  • Commonly found in green leafy vegetables, milk, and eggs.
  • Dosage: 0.4-1 mg/day, adjusted to adequacy based on deficiency.
  • Important for neural tube development in fetuses.

• Erythropoietin (EPO):

  • Mimics naturally produced EPO, enhancing RBC production.
  • Given parenterally (IV or subcu).
  • Monitor hematocrit (Hct) closely and adjust dosage.
  • Adequate iron supplementation is necessary.
  • Indications include chronic renal failure, HIV/AIDS, and cancer chemotherapy.
  • Potential side effects include hypertension, nausea, vomiting, diarrhea, fatigue, and others.

• Heparin (unfractionated):

  • Inhibits conversion of fibrinogen to fibrin.
  • Given parenterally (IV) for immediate onset.
  • Overdose can cause serious bleeding (hematoma, etc.).
  • High-risk patients require frequent monitoring (PTT/APTT - partial thromboplastin time) to adjust dosage.
  • The antidote is protamine sulfate.

• Low Molecular Weight Heparin (LMWH) (Enoxaparin):

  • Similar action to heparin, but preferentially inhibits factor Xa over thrombin.
  • Given subcutaneously.
  • Less risk of bleeding complications, than unfractionated heparin.
  • Daily or twice daily doses.

• Protamine Sulfate:

  • Anticoagulant antidote for heparin.
  • Inactivates heparin's anticoagulant activity.
  • Given slowly to minimize adverse effects.

• Anti-coagulant Therapy (Rivaroxaban):

  • Prevents thrombin formation by inhibiting factor Xa.
  • Taken orally.
  • Important to avoid in patients with significant bleeding risk.

• Thrombolytics (Tenecteplase):

  • Enzyme that dissolves blood clots by converting plasminogen to plasmin.
  • Given intravenously (IV).
  • Indicated in cases of acute myocardial infarction (AMI) and stroke (CVA).
  • Should be administered within hours of symptom onset.
  • Contraindicated in cases of active bleeding and stroke.

• Aminocaproic Acid (Amicar):

  • An inhibitor of plasminogen activation.
  • Used for stopping bleeding.
  • Oral and intravenous (IV) administration.
  • Adverse effects include headache, dizziness, nausea, etc.

• Filgrastim:

  • Granulocyte colony-stimulating factor.
  • Stimulates neutrophil production in bone marrow.
  • Used to treat reduced neutrophil counts (e.g., after chemo).
  • Subcutaneous injection; monitoring is key to avoiding complications.