Anti-Anemia & Anticoagulation Overview

Study Notes

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.