Drug Therapy for Anemia

Drugs can negatively impact blood cells, hemoglobin production, and erythropoietic organs, leading to anemia.

Anemia is a condition where the blood's hemoglobin concentration is lower than normal, due to a reduced number of red blood cells, or abnormally low hemoglobin content.
Common signs and symptoms include fatigue, palpitations, shortness of breath, pallor, dizziness, and insomnia.
Causes of anemia include chronic blood loss, bone marrow abnormalities, hemolysis, infections, malignancy, endocrine deficiencies, and renal failure.
Nutritional deficiencies (iron, folic acid, vitamin B12) can also cause anemia.

Anemia treatment: Cyanocobalamin (B12), Darbepoetin, Epoetin alfa, Folic acid, Iron supplements (INFED, VENOFER, others) are used to treat anemia.
Treatment of Neutropenia: Filgrastim, Pegfilgrastim, Sargramostim, Tbo-filgrastim.
Treatment of Sickle Cell Anemia: Hydroxyurea.

Iron is stored as ferritin in intestinal mucosal cells, liver, spleen, and bone marrow.
Transferrin transports iron for hemoglobin production.
Iron deficiency is the most common nutritional deficiency, resulting from negative iron balance (low iron stores and/or low intake) , such as chronic blood loss, menstruation, or pregnancy.
Symptoms may include pica (craving non-nutritive substances), koilonychias (spoon-shaped nails), and mouth sores.
Iron supplementation corrects iron deficiency. The recommended daily dosage is 150 to 180mg of elemental iron, administered in divided doses two to three times daily.
Oral iron preparations include ferrous sulfate, ferrous fumarate, ferrous gluconate, polysaccharide-iron complex, and carbonyl iron formulations.
Parenteral iron formulations include iron dextran, sodium ferric gluconate, ferumoxytol, ferric carboxymaltose, and iron sucrose.

Oral iron supplements can cause gastrointestinal (GI) disturbances (abdominal pain, constipation, nausea, diarrhea) and dark stools.
Parenteral iron (especially iron dextran) can cause fatal hypersensitivity or anaphylactoid reactions. A test dose should be given before any iron dextran, and intravenous iron should be used cautiously when active infections are present.

Folic acid is primarily for treating folate deficiency states caused by inadequate levels. This may result from increased demand (pregnancy, lactation), poor absorption (intestinal pathologies), alcohol abuse, and certain medications (dihydrofolate reductase inhibitors, drugs inhibiting DNA synthesis, or drugs reducing folate absorption).
Deficiency leads to megaloblastic anemia (large-sized red blood cells).
Treatment typically involves oral folic acid administration; it's non-toxic in high doses, and excess is excreted.

Vitamin B12 deficiency stems from low dietary intake or impaired absorption. Gastric parietal cells' failure to produce intrinsic factor (as in pernicious anemia) or diminished receptor activity for intestinal uptake are common causes.
Deficiency can cause tingling, walking problems, dementia, and even hallucinations/paranoia/schizophrenia, in addition to anemia symptoms.
It's critical to understand the cause of megaloblastic anemia before treatment with folic acid alone, as it can mask a vitamin B12 deficiency and lead to severe neurological problems. Optimal treatment combines folic acid and vitamin B12. Administration may be oral, intramuscular, or deep subcutaneous, with intramuscular hydroxocobalamin being preferred due to rapid response and sustained plasma levels. High oral doses or monthly parenteral administration may be needed for malabsorption issues. This vitamin is nontoxic, but must continue for life in conditions like pernicious anemia.

Vitamins are organic compounds made by plants or animals while Minerals are inorganic elements from the earth.
Vitamins and minerals are essential for body development and proper functioning.
Fat-soluble vitamins (Vitamins A, D, E, and K) are absorbed with fat and stored in the liver. Water-soluble vitamins (various B vitamins and Vitamin C) must be replaced daily and not stored.

Specific vitamins and their functions are detailed in their respective sections throughout the notes, including Vitamin A, Vitamin D, Vitamin E, Vitamin K, the Vitamin B Complex (including vitamin B6 and B12).

Specific minerals and their functions (eg Calcium, Iron, Potassium,Zinc, Magnesium) are covered in the notes.

Various trace minerals and their functions in bone health, enzyme/antioxidant production, connective tissue, and thyroid hormone synthesis are detailed.