IB Anemia and its Management PDF

Learning Objectives Anemia and its Management - 2 Pharmacotherapeutics III Dr. Abdul Salam Nazmi • Upon completion, the students will be able to: • Identify common causes, signs and symptoms of anemia. • Describe diagnostic evaluation to determine the etiology. • Develop a treatment regimen consi...

Learning Objectives Anemia and its Management - 2 Pharmacotherapeutics III Dr. Abdul Salam Nazmi • Upon completion, the students will be able to: • Identify common causes, signs and symptoms of anemia. • Describe diagnostic evaluation to determine the etiology. • Develop a treatment regimen considering the underlying cause. • Compare and contrast oral and parenteral iron preparations. • Explain the of folic acid and vitamin B12 in macrocytic anemia. • Evaluate the use of epoetin and darbepoetin in anemia patients. • Develop a plan to monitor the outcomes of pharmacotherapy. Treatment • Goal of anemia therapy: • The anemia evaluation process. • to increase Hgb levels. • Assessment primarily: by the resolution of clinical symptoms (shortness of breath, tachycardia, fatigue, dizziness) • No aggressive therapy. tachycardia p • Hypoxia and cardiovascular sequelae due to anemia can be avoided if Hgb levels are greater than 7.0 g/dL. Nonpharmacologic Therapy meatlived ironsupplementsvite Pharmacologic Therapy: Iron Deficiency Anemia teacurteacheese.mil ifinnmmbelhoro S.im avemedicato1PRBCGacvedrec • The nonpharmacologic treatment is transfusion of RBCs: ideals Salt Form • Safety concerns, cost, and the availability. Ferrous sulfate • If free of serious cardiac disease • “Restrictive Transfusion Triggers” incaseoracs give moremanentsive if um FeroSul, Fer-In-Sol, Slow Fe Ferrous sulfate, N/A anhydrous Ferrous glucona Ferate te Ferrous fumarat Ferretts Ferrimin e commtbtotan Hemocyte Polysaccharide– Niferex, Ferrex, iron complex NovaFerrum d • Hgb is 7.0 g/dL. mm m • If acute symptoms (dyspnea, chest pain) • Hgb is 7.0 to 9.0 g/dL. • Yes - transfusion pituaycouosa.name Tommie • If > 30% blood loss - Yes. bananas Oral Iron supplementation effect • Reticulocytosis - occur in 7 to 10 days. s peak • Hgb values should rise by about 1.0 g/dL per week. • Reassessment: if Hgb does not increase by 2.0 g/dL in 3 weeks. Iz sinceinnsurabeltrinairedineabilenbamaen • If GIT - S/Es (ie, heartburn, nausea, bloating) on an empty stomach - advised to take with meals (or Enteric coated) • Lower doses and less frequent dosing may improve the amount of iron absorbed. • Common toxicities on oral iron: • Abdominal pain, nausea, heartburn, constipation, and dark stools. aastfs oonsinaau.avenztsiag Brand Name(s) Formulation Types m m Elixir, liquid, solution, Tabletsslow and extended release Tablet Tablets Tablets Liquid, Capsule iron done seems r.mn batmosome Oral Iron supplementation ..2 • Drug–drug interactions: thrombopoetin agonist receptor EE • ↓ absorption of drugs: Fluoroquinolones, tetracyclines, eltrombopag, and mycophenolate mofetil. Linnutabarpmenann MAP • ↓ absorption of iron with: Antacids, proton pump inhibitors, and H2-blockers • Stagger the use • Diseases that ↓ the absorption of iron: • Celiac disease, inflammatory bowel disease • Patients with gastric surgeries. iron 6monthstoreslinm Ii igI I Parenteral iron therapy Iron dextran • The dose calculation: When: cannot tolerate, have ↓ intestinal absorption, or are noncompliant. anamicininianatreanan.in Product Iron dextran Sodium ferric gluconate Iron sucrose Ferumoxytol Ferric carboxymaltose At got Max dose Test dose Premedication Box warning 100 125 Yes yes Yes-TDI Yes-TDI Yes yes 200 510 750 No No No No yes No No No No Acute Iron Poisoning • Manifestations: • Dose (mL) = 0.0442 (desired Hgb − observed Hgb) × body weight + (0.26 × body weight). oata minicasez eaniad • 50 mg of elemental iron per ml. imy no • A test dose of 0.5 mL over at least 30 seconds. • Monitor for signs of anaphylaxis for 1 hour before administering the remaining total dose. • Other adverse effects: • Arthralgias, Arrhythmias, hypotension, flushing, and pruritus. anuran Hemochromatosis me allow daily RDA required Vitamin B12 Anemia g m.mm.my d • Oral therapy: vitamin B12 is absorbed poorly PrDaily rewraleralwmcat.ie regiments • Dietary deficiency or reversible malabsorption syndrome • 1000 to 2000 mcg/day • Abdominal pain, V/D, haematemesis • Cyanosis, Acidosis, Convulsions • Shock, cardiovascular collapse and death CAS • IM Cyanocobalamin: absorbed completely • in severe neurological signs or CNS symptoms • 1000 mcg/day for 1 week, followed by 1000 mcg/week for a month or until the Hgb normalizes. • Pernicious anemia: Lifelong maintenance - 1000 mcg/month. r • Treatment: should be prompt • Prevent further absorption: • Sodium bicarbonate: Vomiting or gastric lavage wheni atonal sinensis.com.ve • Egg yolk and milk orally • Vitamin B12 is well tolerated • Antidote: • Desferrioxamine 5-I0 gm in 100 ml saline • Alternatively : Calcium edetate • Lean body weight for adults and children weighing more than 15 kg and • Actual body weight for children weighing 5 to 15 kg. • The dose in milligrams: standard concentration is i i • The body weight: MYtIi • reported A/E - injection-site pain, pruritus, and rash. 11 testvitB12 Schilingtestfor 100moldydarknet a Anemia of Chronic Disease Folic acid Anemia a • Effective dose of folic acid is 1 mg/day orally and absorption is rapid and complete. • Patients with malabsorption or short gut syndrome forsevercases 8 • ACD treated with the EPO stimulating agent (ESAs) I • Decreases RBC transfusion requirements in ifnotsmggives.mg • require doses up to 5 mg/day and longer day therapy durations. women pregnant Este • Reticulocytosis occurs within days of commencing therapy. • Hgb start to rise after 2 weeks of therapy and normalize after 2 to 4 months. • Folic acid is well tolerated • Cancer/Chemotherapy, • CKD, and • Zidovudine/HIV Infection • Erythropoietin: • Peritubular cells of the kidney • Functions: • Stimulates proliferation of erythroid cells • Induces haemoglobin formation • Releases reticutocytes in circulation at • Nonspecific A/E: allergic reactions, flushing, and rash. mm EPO stimulating agent (ESAs) • EPO Preparations: IV or SC May • Human recombinant EPO: Epoetin α, β, • Darbepoietin: longer half-lifeelenf.TT r.tadesiraton • Methoxy polyethylene glycol–epoetin beta Ein Georges Nakhoul, and James F. Simon CCJM 2016;83:613624 Copyright © 2016 The Cleveland Clinic Foundation. All Rights Reserved. oonBaehBoxifT • Side É effects: Hypertension and Thrombotic events T.at • Clinical Uses: m • Anemia of Chronic renal failure • Also effective in Anemia of: • Primary bone marrow disorders • Anemaia of HIV and chemotherapy treatment • Bone marrow transplantation