Anemia is a below-normal concentration of hemoglobin in the blood, caused by a decreased number of red blood cells. Common symptoms include fatigue, rapid heartbeat, shortness of breath, and pale skin. Treatments for anemia include supplements like iron, cyanocobalamin (vitamin B12), folic acid, and medications like erythropoietin and darbepoetin. Iron deficiency is a common cause of anemia and can cause complications if left untreated. Sickle cell anemia can be treated with hydroxyurea or pentoxifylline to reduce painful crises.

1. ANEMIA
Submitted to: Mrs. Manisha Mistri Ma’m
Medical surgical DPT, Nursing Teacher
of Scon
Submitted By:
Bhagyashri P.
PBBsc 1st year Scon.

2. Introduction
 Anemia is defined as a below-normal plasma hemoglobin
concentration resulting from a decreased number of
circulating red blood cells.

3. GENERAL SIGNS AND
SYMPTOMS
 Fatigue
 Rapid heartbeat
 Shortness of breath
 Pale skin
 Dizziness
 Insomnia

4. DRUGS FOR TREATMENT OF ANEMIA
TREATMENT OF ANEMIA
Cyanocobalamin (B12)
Darbepoetin
Epoetin alfa
Folic acid
Iron
TREATMENT OF NEUTROPENIA
Filgrastim
Peglgrastim
Sargramostim
Tbo-lgrastim
TREATMENT OF SICKLE CELLANEMIA
Hydroxyurea
Pentoxifylline

5. IRON
 Iron is stored in the intestinal mucosal
cells, liver, spleen, and bone marrow as
ferritin (an iron–protein complex) until
needed by the body.
 Iron is delivered to the marrow for
hemoglobin production by a transport
protein, namely transferrin.

6. IMPACT OF IRON DEFICIENCY
ANEMIA
 Acute or chronic blood loss,
 From insufficient intake during periods of accelerated
growth in children, and in
 Heavily menstruating or pregnant women

7. Iron deficiency anemia may cause:
 Pica (hunger for ice, dirt, paper, etc.)
 Koilonychias (upward curvature of the finger and toe nails)
 Soreness and cracking at the corners of the mouth
 Acidic conditions in the stomach keep iron in the reduced
ferrous form, which is the more soluble form. Iron is then
absorbed in the duodenum
 Daily iron requirements in patient with iron deficiency
anemia is 150 -180 mg /day

8. ORAL PREPARATIONS PARENTERAL
PREPARATIONS
Ferrous sulfate Iron dextran
Ferrous fumarate Sodium ferric gluconate
Ferrous gluconate Iron sucrose
Polysaccharide–iron complex
Carbonyl iron formulations

9.  Abdominal pain, constipation, diarrhea and dark stools
are the most common adverse effects of oral iron
supplements.
 Fatal hypersensitivity and anaphylactoid reactions can
occur in patients receiving parenteral iron (mainly iron
dextran formulations).
 Excessive iron can cause toxicities that can be reversed
using chelators such as deferoxamine

10. FOLIC ACID (FOLATE)
Folate deficiency may be caused by
 Increased demand (for example, pregnancy and lactation
 Poor absorption caused by pathology of the small intestine
 Alcoholism
 Treatment with drugs that are dihydrofolate reductase inhibitors (for
example, methotrexate, pyrimethamine, and trimethoprim) & treated
by folinic acid
 Reduced or active form of the vitamin (folinic acid—also known as
leucovorin calcium—available as oral and parenteral formulations)

11. Content
 A primary result of folic acid deficiency is megaloblastic
anemia (large-sized red blood cells)
 Folic acid is well absorbed in the jejunum unless pathology is
present.
 If excessive amounts of the vitamin are ingested, they are
excreted in the urine and feces. Oral folic acid administration is
nontoxic

12. CYANOCOBALAMIN &
HYDROXOCOBALAMIN (VITAMIN B12)
 Deficiencies of vitamin B12 can result from either low
dietary levels
 Poor absorption of the vitamin due to the failure of
gastric parietal cells to produce intrinsic factor (as in
pernicious anemia), which is required for vitamin B12
absorption.

13. SIGNS AND SYMPTOMS
 May cause tingling (pins and needles) in the
hands and feet,
 Difficulty Walking
 Dementia
 In extreme cases, hallucinations, paranoia, or
schizophrenia.

14. Undiagnosed or untreated iron-deficiency
anemia may cause the following
complications:
 Depression.
 Heart problems. ...
 Increased risk of infections.
 Motor or cognitive development delays in children.
 Pregnancy complications, such as preterm
delivery or giving birth to a baby with low birth
weight

15. Content
 The vitamin may be administered orally (for dietary
deficiencies), intramuscularly, or deep subcutaneously (for
pernicious anemia)
 Folic acid administration alone reverses the hematologic
abnormality and, thus, masks the vitamin B12 deficiency,
which can then proceed to severe neurologic dysfunction and
disease
 Therefore, megaloblastic anemia should not be treated with
folic acid alone but, rather, with a combination of folate and
vitamin B12.
 Therapy must be continued for the remainder of the life of a
patient suffering from pernicious anemia

16. Content
 In patients with bariatric surgery (surgical treatment for
obesity), vitamin B12 supplementation as cyanocobalamin is
required in large oral doses, sublingually or once a month by
the parenteral route.
 Intramuscular hydroxocobalamin is now preferred since it has
a rapid response, is highly protein bound, and maintains longer
plasma levels.

17. ERYTHROPOIETIN AND
DARBEPOETIN
 Peritubular cells in the kidneys work as sensors that respond to
hypoxia and mediate synthesis and release of erythropoietin
 Erythropoietin stimulates stem cells to differentiate into
proerythroblasts and promotes the release of reticulocytes from
the marrow and initiation of hemoglobin formation
 Erythropoietin thus, regulates red blood cell proliferation and
differentiation in bone marrow

18. Content
 Human erythropoietin (epoetin alfa), produced by recombinant
DNA technology
Effective in the treatment of anemia caused by
 End-stage renal disease,
 Anemia associated with HIV
 Anemia in bone marrow disorders,
 Anemias in some cancer patients.

19. Content
 Darbepoetin is a long-acting version of erythropoietin
 It differs from erythropoietin by the addition of two
carbohydrate chains, which improves its biologic activity.
 Darbepoetin has decreased clearance and has a half-life about
three times that of epoetin alfa.

20. ADVERSE EFFECT
ERYTHROPOIETIN/EPOET
IN
ALFA
DARBEPOETIN ALFA
Edema Edema
Thrombosis Thrombosis
Nausea/Vomiting Dyspnea
Hypertension cerebrovascular accident
Pruritus Hypertension
cerebrovascular accident

21. AGENTS USED FOR
NEUTROPENIA
Myeloid growth factors or granulocyte colony stimulating factors
(G-CSF)
 Filgrastim
 Tbo-filgrastim
 Pegfilgrastim
Granulocyte–macrophage colony–stimulating factors (GM-CSF)
 Sargramostim

22. Content
 Stimulate granulocyte production in the marrow to increase the
neutrophil counts and reduce the duration of severe neutropenia.
 They are typically used prophylactically to reduce risk of neutropenia
following chemotherapy and bone marrow transplantation.
 Filgrastim and sargramostim can be dosed either subcutaneously or
intravenously,
 Tbo-filgrastim and pegfilgrastim are dosed subcutaneously only

23. SICKLE CELLANEMIA
 Hydroxyurea can reduce the frequency of painful sickle cell crises
 Hydroxyurea is also used off-label to treat chronic myelogenous
leukemia and polycythemia vera.
 In sickle cell disease, the drug apparently increases fetal hemoglobin
levels, thus diluting the abnormal hemoglobin S (HBS). This process
takes several months
 Polymerization of HBS is delayed in treated patients, so that painful
crises are not caused by sickled cells blocking capillaries and causing
tissue anoxia.
 Side effects include bone marrow suppression and cutaneous vasculitis

24. Content
 Pentoxifylline increases the deformability of red blood cells
(improves erythrocyte flexibility) and reduces the viscosity of
blood.
 This decreases total systemic vascular resistance, improves
blood flow, and enhances tissue oxygenation in patients with
peripheral vascular disease
 It is available in extended-release tablets and is taken three
times a day with food.
 Adverse reactions are mainly GI in nature and are lessened by
administration with food

25. THANK YOU