Antianemia agentsAntianemia agents•IronIron

•Vit B12Vit B12

•Folic acidFolic acid

•CopperCopper

•Pyridoxine,riboflavinePyridoxine,riboflavine

IronIron

• Iron-porphyrin ring heme

• Essential and non essential iron

• Absorbed in duodenum,prox jejenum(ferrous iron)

• Normal indiv:0,5-1mg daily

• Absorption : vit c,HCl,co,inosin,etionin

• Absorption↓: phosphate,antacid, presence of chelator or complexing agents

• Transported in the plasma bound to transferrin(specific for ferric iron) developing erythroid cells in bone marrow

• Storage: ferritin , hemosiderin RE cells

• Elimination: skin epithelial cells,exfoliation of intestinal mucosal cells, bile, urine,nail, hair

• Side effect(intolerance to oral prep):

nausea, epigastric discomf, abd cramps, constipation, diarrhea

• Indication : treatment/prevent of iron deficiency anemia.

• Def infants, rapid growth child, pregnancy, lactating, post gastrectomy, severe small bowel disease(malabsorpt), blood loss(adult)

• Treatment: - oral iron preparations

- parenteral iron preparations• Oral iron corrects the def just as rapidly and

completely as paranteral iron

• Oral prep:- ferrous sulfate

- ferrous gluconate

- ferrous fumarate

• 200-400 mg daily for 3-6 months

• Paranteral prep: Iron Dextran 50 mg elemental iron/ml solution

Note: Normal range of iron serum: 60-160

mcgr/dl

Vit B12 and Folic acidVit B12 and Folic acid

• Vit B12+ folic acid intracellular metab• A def of either vit B12 or folic acid defective

synthesis of DNA in any cell megaloblastic anemia

• Vit B12 cyanocobalamin and hydroxocobalamin(therapeutic use)

• Active forms in human: methylcobalamin and deoxyadenosilcobalamin enzymatic reactions

•

• Absorption (oral) of B12 intrinsic factor of castle

• IF histamine, cholinergic, corticosteroid, ACTH, thyroid hormone

• Def B12 neurological disorders

• FA carrier of single carbon unit purine, pirimidine,amino acids interconversion

• FA def: chronic alcoholism, oral contraceptives, anti convulsants, malnutrition, malabsorption, cytotoxic drug

• R/ vit B12 def:

- initial dose: 100 mcgr IM/5-10 days,

then 100-200 mcgr IM/ month

• R/ FA def:

- initial dose: 0,5-1mg/day 10 days,

0,1-0,5mg/day

(inj 5mg/ml)

• Note: Vit B12: 0,3-1ngr/ml, FA: 4-25ngr/ml

ErythropoietinErythropoietin

• First human hematopoietic growth factor

• Stimulates erythroid prolif and different interacting w/ specific epo receptor

• Produced using recombinant DNA technology

• Ind: CRF w/ severe anemia

• Dose: 50-150 IU, 3x a week

Obat anti anemiaObat anti anemia

1.1. BesiBesi

2.2. Vitamin B12Vitamin B12

3.3. Asam folatAsam folat

Besi(Fe)Besi(Fe)

• Esensial dan non esensial(cadangan)

• Absorpsi bentuk fero

• Absorpsi :Co, inosin, etionin,Hcl, dan

senyawa asam

• Absorpsi : fosfat, antasida

• Cadangan: feritin(60%) dan hemosiderin(40%) sel sel RE

• Ekskresi desquamasi sel-sel epitel, kerigat, kuku, rambut,urin, feces

• Efek samping intoleransi sediaan oral:

- mual dan nyeri lambung

- konstipasi

- diare dan kolik intestinal

Sediaan dan posologiSediaan dan posologi

• Oral Fe-sulfat, Fe-fumarat,Fe glukonat)

• Parenteral Iron dextran(imferon)----- 50mg/ml

• Dosis R/ berat anemia

Vitamin B12Vitamin B12

• Cianokobalamin dan hidroksokobalamin

• Bentuk aktif: metilkobalamin dan 5-deoksi adenosilkobalamin

• Fungsi :metabolisme intra sel

• Absorpsi memerlukan FIC(Faktor Intrinsik Castle)

• Defisiensi gangguan metabolisme intra sel asam folat & neurologic disorders

• Dosis terapi tergantung berat anemia

• Awal 100 mic/hr selama 5-10 hr (IM)

penunjang 100-200 mic/bln sampai remisi lengkap

Asam folatAsam folat

• Carrier single carbon unit

• Bentuk aktif: folinic acid

= asam tetrahidrofolat

• Fungsi sbg carrier carbon utk sintesis purin-pirimidin dan interkonversi asam2 amino

• Defisiensi folat transfer carbonunit terganggusisntesis protein terganggusintesis purin-pirimidin↓ DNA ↓ mitosis ↓ anemia megaloblastik

• Defisiensi folat tidak disertai ggn neurologik

• Sediaan: tablet dan injeksi(sk,im)

• Dosis R/ awal 0,5-1mg/hr selama 10 hr

penunjang 0,1-0,5 mg/hr

ErythropoietinErythropoietin

• First human hematopoietic growth factor

• Stimulates erythroid prolif and different interacting w/ specific epo receptor

• Produced using recombinant DNA technology

• Ind: CRF w/ severe anemia

• Dose: 50-150 IU, 3x a week