1. Agents Used to Treat Anemias

2. Anemia Decreased number of circulating red blood cells Decreased hemoglobin = decreased oxygen capacity Many causes. 22 - 2

3. Iron-Deficiency Anemia Blood loss  Number one cause  Nutritional deficit  2 nd most common cause  Clients with:  Bleeding disorders  Menses  Pregnant women  Infants  Blood donors 22 - 3

4. Treatment for Iron Deficiency Anemia  Correct the cause of blood loss if possible  Iron therapy: usually oral  Absorption: proximal portion of the small intestine  5-10% usually absorbed may be as high as 20-30% if seriously depleted. 22 - 4

5. Treatment for Iron Deficiency Anemia  Three iron salts most commonly used are ferrous sulfate, ferrous fumarate, ferrous gluconate  Ferrous sulfate more readily absorbed  Contains different proportions of elemental iron Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 22 - 5

6. Treatment for Iron Deficiency Anemia Elemental iron: 200mg daily Therapy should be continued for 6 months Iron should be taken on an empty stomach 22 - 6

7. Treatment for Iron Deficiency Anemia Concurrent use of Vitamin C can help increase absorption: give with orange juice Iron should be given in divided doses Parental therapy may be indicated 22 - 7

8. Therapeutic Agents Iron salts Ferrous sulfate Ferrous fumarate Ferrous gluconate Side effects Gastrointestinal upset Constipation and dark stools IM, IV 22 - 8

9. Antianemia medications Chemotherapy-induced anemia occurs in 7 out of 10 patients damages the normal blood cells Does not differentiate cancer cells from normal cells Radiation therapy, certain drugs used to treat HIV/AIDs, and chronic renal failure can result in anemia Examples: Epogen, Eprex and Procit 22 - 9

10. Epogen or Procrit Synthetic products Generic: epoetin alfa recombinant Erythropoietin Synthesized by the kidneys Stimulates red blood cells 22 - 10

11. Nursing Considerations Low dose may be lethal for children Educate patients to store iron out of children’s reach Remind patients that iron may cause black stools Need to educate patients on the necessity of taking iron on a long-term basis Remind to take with vitamin C source

12. Megaloblastic Anemias Large red blood cells Neutrophil and platelet changes Treated with vitamin B 12 Intramuscular 22 - 12

13. Vitamin B12 Deficiency  Normally Vitamin B12 is chemically combined with intrinsic factor and then absorbed in the blood at the terminal ileum  Vitamin B12 deficiency can be caused by  Gastrectomy  pernicious anemia  chronic use of drugs that decrease Vitamin B12 absorption 22 - 13

14. Vitamin B12 Deficiency (cont’d)  Anemia develops when total-body B12 content falls below 200 mcg  Symptoms may take years to develop 22 - 14

15. Vitamin B12 Deficiency  Symptoms  -weakness  -sore tongue  -numbing or tingling of the extremities  -anorexia  -shortness of breath  -yellow complexion  If untreated, may lead to spasticity, emotional disturbances 22 - 15

16. B12 deficiency: treatment Need to replenish stores as well as meet daily requirements Parental therapy by intramuscular (IM) injection May need maintenance therapy for life 22 - 16

17. Folic acid deficiency The average daily diet contains 200 mcg of folic acid Folic acid deficiency can occur in: pregnancy alcoholics nutritionally deprived patients patients using drugs that increase need for folic acid 22 - 17

18. Folic Acid Deficiency FDA requires addition of folic acid to flours enriched breads cornmeals, pasta, and rice Folic acid deficiencies related to neural tube defects in the developing fetus Most vitamin products contain 0.4mg of folic acid

19. Nursing Considerations Assess the symptoms and effectiveness of the treatment Vitamin B12 supplement should not be stopped; can cause neurological problems 22 - 19

20. Nursing Considerations Encourage pregnant women or those planning to become pregnant to take folic acid supplements Provide nutritional education Assess for constipation Encourage appropriate follow-up with provider Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 22 - 20