Agents Used to Treat Anemias

AnemiaDecreased number of circulating red blood cellsDecreased hemoglobin = decreased oxygen capacity

Many causes

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Iron-Deficiency AnemiaBlood loss

Number one cause Nutritional deficit

2nd most common cause Clients with:

Bleeding disordersMensesPregnant womenInfants Blood donors

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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

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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

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Treatment for Iron Deficiency Anemia

Elemental iron: 200mg dailyTherapy should be continued for 6 months

Iron should be taken on an empty stomach

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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

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Therapeutic AgentsIron salts

Ferrous sulfateFerrous fumarateFerrous gluconate

Side effectsGastrointestinal upsetConstipation and dark stools

IM, IV

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Antianemia medicationsChemotherapy-induced anemia

occurs in 7 out of 10 patients damages the normal blood cellsDoes 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

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Epogen or Procrit

Synthetic productsGeneric: epoetin alfa recombinant

ErythropoietinSynthesized by the kidneysStimulates red blood cells

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Nursing ConsiderationsLow dose may be lethal for childrenEducate patients to store iron out of

children’s reachRemind patients that iron may cause

black stoolsNeed to educate patients on the

necessity of taking iron on a long-term basis

Remind to take with vitamin C source

Megaloblastic Anemias

Large red blood cellsNeutrophil and platelet changes

Treated with vitamin B12

Intramuscular

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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

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Vitamin B12 Deficiency(cont’d)

Anemia develops when total-body B12 content falls below 200 mcg

Symptoms may take years to develop

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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

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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

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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

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Folic Acid DeficiencyFDA requires addition of folic acid to flours enriched breads cornmeals, pasta, and riceFolic acid deficiencies related to neural tube defects in the developing fetus

Most vitamin products contain 0.4mg of folic acid

Nursing Considerations

Assess the symptoms and effectiveness of the treatment

Vitamin B12 supplement should not be stopped; can cause neurological problems

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Nursing ConsiderationsEncourage pregnant women or those planning to become pregnant to take folic acid supplements

Provide nutritional educationAssess for constipationEncourage appropriate follow-up with provider

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