1. Chapter 22 Agents Used to Treat Anemias

2. Anemia p526 Decrease in hemoglobin or decrease in RBCs Many causes of anemia – Iron deficiency anemia – Chemotherapy induced anemia – Megaloblastic anemias B12 Folic acid deficiency

3. Iron-Deficiency Anemia p527 Iron deficiency anemia is most common form of anemia Clients at risk for iron deficiency anemia: – Bleeding disorders – Menses – Pregnant women – Infants – Blood donors

4. Symptoms of anemia p 532 Fatigue Malaise Lack of energy Tachycardia Pallor

5. Therapeutic Agents for Fe deficiency anemia p527 Table 22-1 p 529 Iron salts – Ferrous sulfate – Ferrous fumarate – Ferrous gluconate Side effects – Gastrointestinal upset – Constipation – Dark, tarry stools Oral, intramuscular, and intravenous routes of administration

6. Oral route of iron administration p528 Only 5-10% of oral iron is absorbed Absorption increased: – with vitamin C – when taken in divided doses throughout the day (at least 4 hours apart) – on an empty stomach, but can be given with food to decrease GI upset. Liquid iron preparations: – diluted in water or juice – taken through a straw to minimize staining of teeth. Avoid iron administration with milk or antacids

7. Adverse effects of oral iron therapy p528 GI upset Anorexia Nausea Constipation and/or diarrhea – Encourage fluids and fiber to treat constipation Dark, tarry stools Overdose of iron is treated with deferoxamine mesylate (pg 533)

8. Dietary sources of iron p533 Meats, including organ meats Eggs Poultry Leafy green vegetables

9. Epogen or Procrit p528 Generic name: epoetin alfa recombinant Erythropoietin – Stimulates RBC production by hematopoietic stem cells in red bone marrow Uses: patients receiving chemotherapy, patients in renal failure Contraindicated in uncontrolled HTN Parenteral administration. Do not shake bottle!

10. Megaloblastic Anemias p529 Results in macrocytic RBCs – Large red blood cells Caused by Vit B12 or Folic Acid deficiency, or both

11. Vitamin B12 deficiency p530 Dietary B12 has to be combined with intrinsic factor to be absorbed Vit B12 deficiency can result from: – Gastrectomy – Pernicious anemia – Slow release potassium chloride tablets Anemia = B12 < 200mcg

12. Vit B12 deficiency cont Symptoms of B12 deficiency – Weakness – sore tongue – numbness or tingling of extremities – anorexia – SOB – yellowed complexion – Neurological symptoms: spasticity and emotional disturbances from degeneration of white matter in brain and spinal cord

13. Dietary sources of vitamin B12 p536 Lean meat Organ meat Milk Oysters Saltwater fish Strict vegetarians (vegans) may develop this anemia 22 - 13

14. Folic Acid Deficiency p531 Needed for proper neural tube development in the embryo/fetus Products enriched with folate per FDA guidelines – Grain products Dietary sources of folic acid – Meat, eggs, leafy green vegetables, yeast products.

15. Folic acid deficiency cont p531 Folic acid deficiency is most likely in – Pregnant women – Alcoholics – Nutritionally deprived clients – Pt on oral contraceptives – Pt on long term anticonvulsant treatment Phenytoin (Dilantin)