Antianemia agents

Iron
Vit B12
Folic acid
Copper
Pyridoxine,riboflavine

Iron
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 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

Erythropoietin
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 /week

Obat anti anemia

1.
2.
3.

Besi
Vitamin B12
Asam folat

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 posologi

Oral Fe-sulfat, Fe-fumarat,Fe glukonat)
Parenteral Iron dextran(imferon)----50mg/ml
Dosis R/ berat anemia

Vitamin 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 folat
Carrier single carbon unit
Bentuk aktif: folinic acid
= asam tetrahidrofolat
Fungsi sbg carrier carbon utk sintesis purinpirimidin 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

Erythropoietin
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