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Drugs for prevention and treatment anemia

azalia arif

Anemia occurs when blood does not have enough rbc or when rbs does not have enoogh Hb

hemoglobin is oxygen-carrying pigment found in rbc

anemia can be life threatening there are 400 different forms of anemia 3 most common : iron deficiency anemia vitamin B12 deficiency anemia folic acid deficiency anemia 3

Hematopoesis the production from undifferentiated stem cells of circulating erythrocytes, platelets, leucocytes produces over 200 billion new blood cells per day in normal person resides primarily in bone marrow requires constant supply of iron vitamin B12 folic acid
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Anemia deficiency in oxygen-carrying erythrocytes is the most common and eazily to treat thrombocytopenia and neutropenia are not rare and are amenable to drug therapy due to deficiency of iron, vitamin B12, folic acid The use of hematopoetic growth factors to combat anemia, thrombocytopenia, neutropenia and to support stem cell transplantation
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Worked up of anemia evaluate conjunctiva and mucous membrane for paleness cardiovascular system for murmur liver spleen nodes look for jaundice or purpura

Worked up laboratory

complete blood count with diffrerential and platelet evaluation of smear with the rbc indices reticulocyte count

Approach to anemia

Smear indices

Hypochromic normocytic
Normochromic normocytic

macrocytic

Gbr hypochromic

Hypochromic microcytic anemia appearance weakly in staning small in size mechanism decreased in Hb synthesis secondary to decreased heme synthesis causes : iron deficiency thalassemia lead poisoning
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Hypochromic microcytic anemia iron deficiency mechanism decreased in Hb synthesis secondary to heme synthesis major differential D/ - beta thalassemia minor - incidence 3-24% of children aged 6 - 24 months

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Iron deficiency anemia causes lack of adequate iron at birth - low birth weight - low Hb at birth poor iron intake loss of iron (G.I bleeding) symptoms irritability anorexia with poor weight gain behavioral changes

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D/ and test

Hb and MCV are decreased ferritin decreased TBIC decreased

T/ elemented iron 4-6 mg/kg/day in a 1-2 year old with poor diet T/ may with empiric course of oral iron immediately Hb starts to rise at 1 week once normalized continue Fe T/ for 1-2 months to replace Fe stores in marrow

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Iron deficiency anemia too little iron in the body to make sufficient Hb three causes of iron deficieny anemia loss of iron at a greater rate than normal (blood loss) usually the result of persistent bleeding ??????????????

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Iron and vitamin deficiency anemia microcytic hypochromic anemia iron deficiency the most common

megaloblastic anemia deficiency vit.B12 or folic acid, cofactors for maturation of rbc
pernicious anemia the most common type of B12 deficiency caused by a defect in the synthesis of intrinsic factor

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normochromic normocytic anemia

Decresed reticulocyte

Increased reticulocyte

Acute blood loss

malignancy

Hypoproliferative anemia

COOMB +

COOMBS -

intracorpuscular

extracorpuscular

Antibody mediated

Abnormal Hb

Membrane deficiency

Enzyme deficiency
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The main causes of iron deficiency anemia : chronic blood loss desease of git drug-induced menstrual (>80 mL/cycle = 46 mg) recurrent hemoptysis increased requirements pregnancy treatment of megaloblastic anemia
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malabsorption malabsorption syndrome postgastrectomy

dietary deficiency

Iron deficiency anemia leads to pallor, dizziness, dyspnea, and tissue hypoxia

CV adaptations to chronic anemia : tachycardia, c.o, vasodilation worsen the condition of patients with underlying CV desease
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Treatment of iron-deficiency anemia recommend iron-rich food (liver, seafood, dried fruits, lima beans, whole grains, green leafy vegetables or iron pills in the more severe cases: anemia cause by blood loss, surgery blood transfusion

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Anemia deficiency vitamin 12 impaired ability of digestive tract to absorb the B12

B12 is essential for the production of rbc

maintenance of nervous system

found in food of animal origin such as meat, fish and diary products

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Causes of B12 deficiency failure of the stomach lining to produce intrinsic factor, due to autoimmune disorder intrinsic factor is block removal of small intestine where vit B12 is absorb Cronhs disease a chronic inflammatory disease that affects any part of the g.i.t eating a vegan diet which excludes eggs, diary products, meat and eggs
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The symptoms of B12 deficiency anemia are similar to those of iron deficiency, also caused: jaundice numbness and tingling in the hands and feet equilibriaum diffuculties confusion personality changes and depression

Treatment of B12 deficiency current treatment lifelong treatment of monthly B12 injections
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Folic acid deficiency symptoms of folic acid deficiency are similar to vitamin B12 anemia symptoms of anemia may also include : black, maroon or bloody stool abdominal pain weight loss fatigue chest pain
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Treatment of folic acid deficiency dietary correction main sources of lolic acid : meat, poultry, cheese, milk, eggs, liver etc folic acis tablet injections in rare instances

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Overall treatment considerations other therapies for anemia may include oxygen, fluids, fresh frozen plasma, platelet replacement and vasopressor to elevate blood pressure this depend upon the underlying cause of the anemia Prevention of anemia consumption of healthy diet including ironcontaining foods and those with B-complex vitamin is essential to developing and maintaining satisfactory blood count 25

Lead poisoning anemia block placement of Fe into heme may cause neurological damage and anemia usually related to lead-base paints and industrial exposure

test for serum lead level

T/ chelation of deferoxamin

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Thalassemia genetically determined, often familial defects in production of Hb victim of this heriditary anemia produce very little functional Hb cells are also prone to rupture two peocesses involved decreased production of Hb imbalance of globin chain production
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