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 Antianemia agents Antianemia agents•IronIron

•Vit B12Vit B12

•Folic acidFolic acid

•Copper Copper 

•Pyridoxine,riboflavinePyridoxine,riboflavine

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IronIron

• Ironporp!yrin ring !eme

• "ssential and non essential iron

•  Absorbed in d#oden#m,prox $e$en#m%ferro#s iron&

• 'ormal indiv(),*1mg daily

•  Absorption ( vit c,+Cl,co,inosin,etionin•  Absorption( p!osp!ate,antacid, presence

of c!elator or complexing agents

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• -ransported in t!e plasma bo#nd to

transferrin%specific for ferric iron& 

developing eryt!roid cells in bone marro.

• /torage( ferritin , !emosiderin  0" cells

• "limination( sin epit!elial cells,exfoliation

of intestinal m#cosal cells, bile, #rine,nail,!air 

• /ide effect%intolerance to oral prep&(

  na#sea, epigastric discomf, abd cramps,

constipation, diarr!ea

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• Indication ( treatmentprevent of iron

deficiency anemia3

• 4ef  infants, rapid gro.t! c!ild, pregnancy,

lactating, post gastrectomy, severe small

bo.el disease%malabsorpt&, blood loss%ad#lt&

• -reatment( oral iron preparations

  parenteral iron preparations

• 5ral iron corrects t!e def $#st as rapidly and

completely as paranteral iron

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• 5ral prep( ferro#s s#lfate

  ferro#s gl#conate

ferro#s f#marate

• 2))6)) mg daily for 78 mont!s

• Paranteral prep( Iron 4extran

 *) mgelemental ironml sol#tion

'ote( 'ormal range of iron ser#m( 8)18)  mcgrdl

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Vit B12 and Folic acidVit B12 and Folic acid

• Vit B129 folic acid intracell#lar metab

•  A def of eit!er vit B12 or folic acid defective

synt!esis of 4'A in any cell megaloblastic

anemia

• Vit B12 cyanocobalamin and

!ydroxocobalamin%t!erape#tic #se&

•  Active forms in !#man( met!ylcobalamin anddeoxyadenosilcobalamin en:ymatic reactions

•  

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•  Absorption %oral& of B12 intrinsic factor

of castle• IF !istamine, c!olinergic, corticosteroid,

 AC-+, t!yroid !ormone

• 4ef B12 ne#rological disorders• FA carrier of single carbon #nit p#rine,

pirimidine,amino acids interconversion

• FA def( c!ronic alco!olism, oralcontraceptives, anti conv#lsants,

maln#trition, malabsorption, cytotoxic dr#g

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• 0 vit B12 def(

initial dose( 1)) mcgr I;*1) days,

t!en 1))2)) mcgr I; mont!

• 0 FA def(

  initial dose( ),*1mgday

 1) days,  ),1),*mgday

  %in$ *mgml&

• 'ote( Vit B12( ),71ngrml, FA( 62*ngrml

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"ryt!ropoietin"ryt!ropoietin

• First !#man !ematopoietic gro.t! factor 

• /tim#lates eryt!roid prolif and different

  interacting . specific epo receptor • Prod#ced #sing recombinant 4'A

tec!nology

• Ind( C0F . severe anemia• 4ose( *)1*) I<, 7x .ee

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5bat anti anemia5bat anti anemia

1313 BesiBesi2323 Vitamin B12Vitamin B12

7373  Asam folat Asam folat

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Besi%Fe&Besi%Fe&

• "sensial dan non esensial%cadangan&

•  Absorpsi bent# fero

•  Absorpsi (Co, inosin, etionin,+cl, dansenya.a asam

•  Absorpsi ( fosfat, antasida

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• Cadangan( feritin%8)=& dan

!emosiderin%6)=& sel sel 0"• "sresi des>#amasi selsel epitel,

erigat, ##, ramb#t,#rin, feces

• "fe samping  intoleransi sediaan oral(  m#al dan nyeri lamb#ng

  onstipasi

  diare dan oli intestinal

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/ediaan dan posologi/ediaan dan posologi

• 5ral Fes#lfat, Fef#marat,Fe gl#onat&

• Parenteral Iron dextran%imferon&

*)mgml

• 4osis 0 berat anemia

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Vitamin B12Vitamin B12

• Cianoobalamin dan !idrosoobalamin

• Bent# atif( metilobalamin dan *deosi

adenosilobalamin

• F#ngsi (metabolisme intra sel

•  Absorpsi memerl#an FIC%Fator Intrinsi

Castle&• 4efisiensi gangg#an metabolisme intra

sel asam folat ? ne#rologic disorders

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• 4osis terapi tergant#ng berat anemia

•  A.al 1)) mic!r selama *1) !r %I;&  pen#n$ang 1))2)) micbln sampai

remisi lengap

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 Asam folat Asam folat

• Carrier single carbon #nit• Bent# atif( folinic acid

  @ asam tetra!idrofolat

• F#ngsi sbg carrier carbon #t sintesis p#rinpirimidin dan interonversi asam2 amino

• 4efisiensi folat transfer carbon#nit

tergangg#

sisntesis proteintergangg#sintesis p#rinpirimidin 4'A

 mitosis  anemia megaloblasti

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• 4efisiensi folat tida disertai ggn

ne#rologi• /ediaan( tablet dan in$esi%s,im&

• 4osis 0 a.al ),*1mg!r selama 1) !r 

  pen#n$ang ),1),* mg!r 

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"ryt!ropoietin"ryt!ropoietin

• First !#man !ematopoietic gro.t! factor 

• /tim#lates eryt!roid prolif and different

  interacting . specific epo receptor • Prod#ced #sing recombinant 4'A

tec!nology

• Ind( C0F . severe anemia• 4ose( *)1*) I<, 7x a .ee