Antianemia agentsIronVit B12Folic acidCopperPyridoxine,riboflavine

IronIron-porphyrin ring hemeEssential and non essential ironAbsorbed in duodenum,prox jejenum(ferrous iron)Normal indiv:0,5-1mg dailyAbsorption : vit c,HCl,co,inosin,etioninAbsorption: phosphate,antacid, presence of chelator or complexing agents

Transported in the plasma bound to transferrin(specific for ferric iron) developing erythroid cells in bone marrowStorage: ferritin , hemosiderin RE cellsElimination: skin epithelial cells,exfoliation of intestinal mucosal cells, bile, urine,nail, hairSide 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 preparationsOral iron corrects the def just as rapidly and completely as paranteral iron

Oral prep:- ferrous sulfate - ferrous gluconate - ferrous fumarate200-400 mg daily for 3-6 monthsParanteral 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+ folic acid intracellular metabA def of either vit B12 or folic acid defective synthesis of DNA in any cell megaloblastic anemiaVit 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 hormoneDef B12 neurological disordersFA carrier of single carbon unit purine, pirimidine,amino acids interconversionFA 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/ monthR/ 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

ErythropoietinFirst human hematopoietic growth factorStimulates erythroid prolif and different interacting w/ specific epo receptorProduced using recombinant DNA technologyInd: CRF w/ severe anemiaDose: 50-150 IU, 3x /week

Obat anti anemiaBesiVitamin B12Asam folat

Besi(Fe)Esensial dan non esensial(cadangan)Absorpsi bentuk fero Absorpsi :Co, inosin, etionin,Hcl, dan senyawa asamAbsorpsi : fosfat, antasida

Cadangan: feritin(60%) dan hemosiderin(40%) sel sel REEkskresi desquamasi sel-sel epitel, kerigat, kuku, rambut,urin, fecesEfek samping intoleransi sediaan oral: - mual dan nyeri lambung - konstipasi - diare dan kolik intestinal

Sediaan dan posologiOral Fe-sulfat, Fe-fumarat,Fe glukonat)Parenteral Iron dextran(imferon)----- 50mg/mlDosis R/ berat anemia

Vitamin B12Cianokobalamin dan hidroksokobalaminBentuk aktif: metilkobalamin dan 5-deoksi adenosilkobalaminFungsi :metabolisme intra selAbsorpsi memerlukan FIC(Faktor Intrinsik Castle)Defisiensi gangguan metabolisme intra sel asam folat & neurologic disorders

Dosis terapi tergantung berat anemiaAwal 100 mic/hr selama 5-10 hr (IM) penunjang 100-200 mic/bln sampai remisi lengkap

Asam folatCarrier single carbon unitBentuk aktif: folinic acid = asam tetrahidrofolatFungsi sbg carrier carbon utk sintesis purin-pirimidin dan interkonversi asam2 aminoDefisiensi folat transfer carbonunit terganggusisntesis protein terganggusintesis purin-pirimidin DNA mitosis anemia megaloblastik

Defisiensi folat tidak disertai ggn neurologikSediaan: tablet dan injeksi(sk,im)Dosis R/ awal 0,5-1mg/hr selama 10 hr penunjang 0,1-0,5 mg/hr

ErythropoietinFirst human hematopoietic growth factorStimulates erythroid prolif and different interacting w/ specific epo receptorProduced using recombinant DNA technologyInd: CRF w/ severe anemiaDose: 50-150 IU, 3x a week