Drugs for Deficiency Anemia

Hematinic Agents NSG 220

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Anemia (Overview)

Deficiency in the number of red blood cells or in the quality and amount of the hemoglobin. Low hemoglobin level decrease oxygen-carrying capacity to mee the physiologic needs of the body.


Decreased number, size or hemoglobin RBCs.

Loss of blood (acute or chronic)

Hemolysis- destruction of RBC’s

Poor dietary intake of iron, Vit. B, folic acid


bone marrow dysfunction or deficiency of substances for RBC production or maturation.



Most common type of anemia

Cause: Slow, chronic blood loss (GI bleeding, peptic ulcers, heavy menstrual bleeding, etc.), impaired absorption of iron, diet (lack of)

Drug Treatment

Ferrous Sulfate

IV Dextran

Ferrous fumarate

Ferrous succinate

Administered: IV, PO

Action: Used to treated the production of normal hemoglobin and the RBCs for transportation and utilization of oxygen

Iron Supplements

Adverse Effect- GI related- constipation*, nausea*, diarrhea, dark green to black stools, teeth staining (liquid preparations)

Can be toxic if given in large doses (accidental or intentional)

Patient Teaching:

Take with Vitamin C (ascorbic acid) to promote the absorption of iron*

Do not give with antiacids or tetracyclines*

Liquid preparations can stain teeth (dilute with a liquid, rinse mouth afterwards)

Encourage to eat food rich in iron- liver, eggs, meat, fish


Vitamin B12 Deficiency


Impaired Absorption

Pernicious Anemia

Megaloblastic Anemia

Neurological Damage

GI disturbances

Severe B12 anemia

Mortality due to hypoxia to peripheral and cerebral hypoxiaHF and dysrhythmia

Drug Treatment

Vitamin B12 (Cyanocobalamin)



Administered: intranasal, subQ, or PO –never IV

Nursing Implications

Treatment duration is usually life long

Use with caution in patients who receive folic acid.

Hypokalemia can develop during early therapy.

Monitor serum potassium levels

Teach patient s/s of hypokalemia and instruct them to contact provider immediate.

Vitamin B12 is essential for the synthesis of DNA- required for the growth and division of cells.

Lack of Vit B12 causes anemia and injury to the nervous system.

Causes of B12 anemia is due to impaired absorption and rarely due to diet. Pernicious anemia (due to absence of intrinsic factors) is one you may remember in pathophysiology. Megaloblastic Anemia due to oversized erythroblasts (megaloblasts) and oversized erythrocytes (macrocytes) due to impaired DNA synthesis. I can also be cause by neurologic damage –when there is demyelination (damage) to the neurons of the spinal cord and brain. GI disturbances – autoimmune diseases such as Chron’s where uncontrolled inflammation if the terminal ileum can lead to this deficiency.


Folic Acid Deficiency

Required for DNA synthesis. Identical to vitamin B12 deficiencies.


Poor diet*


Sprue- intestinal disease which decreases folic acid uptake

ETOH use (acute or chronic)*


Prophylactic- pregnancy women

Severe deficiency – Megaloblastic anemia.

Treatment: Folic Acid

Administered: IV,PO, subQ and IM* (only for patients with impaired GI absorption only)

Identical to Vitamin B12 deficiencies. Megaloblastic anemia is the most common. However, the provider must determine which one is he cause- Vitamin B12 deficiency or Folic Acid deficiency.

"lack of folic acid may result in leukopenia, thrombocytopenia, and injury to the oral and GI mucosa. It can also case neural tube defects in early pregnancy which is many women are encouraged to take during pregnancy.


Hematopoietic Agents

Hematopoiesis is the process by which our bodies make red blood cells, white blood cells, and platelets.

RBC production occurs in the bone marrow

The actual process “erythropoiesis occurs in the bone marrow”

Erythropoietin “hormone” is produced and secreted in the proximal tubules of the kidney (& liver). It stimulates RBC production

See process below

When there is anemia or hypoxia, levels of erythropoietin rise and trigger increase of erythrocytes synthesis (erythropoiesis= production of red blood cells)

Bone Marrow is the site of hematopoiesis- hemato means “blood” and poiesis means “to make”.

Erythropoietin is a hormone that is produced predominantly in the kidneys. Erythropoietin is made to protect RBCs from destruction. They also stimulate stem cell of the bone marrow to increase RBC production.

When there is sufficient oxygen in the blood circulation, the production of erythropoietin is reduced, but when oxygen levels go down, the production of erythropoietin goes up.


Erythropoietin Alfa

MOA: Stimulate RBC production in bone marrow and erythropoietin in the kidneys


Anemia due to chronic renal failure


HIV patietns and takig zidovudine (Retrovir)


Erythropoietin alfa*

Darbepoetin alfa (Aranesp)


Administered: IV or subQ

Nursing implications:

Monitor H&H as well as iron levels

Monitor blood pressure before therapy

Due to increase hematocrit

Do not administer if hemoglobin >11 gm/dL (twice a week)

Do not agitate (shake) the vial

When there isn’t’ enough of red blood cells then medications are prescribed to increase the production of red blood cells. Remember red blood cells are produced in the marrow, the kidneys produce erythropoietin to protect the RBCs. When there isn’t enough RBC’

Increased risk of DVTs, CVA (strokes) or myocardial infarctions (MI)

Can cause HTN**Monitor blood pressure before therapy due to increase hematocrit

In order for erythropoietin to produce, there must be adequate store of iron, folic acid and vitamin B12 available.


High risk populations

Cancer Patients- accelerate tumor progression

Postoperative patients not given an anticoaugulant- increased risk of developing DVT’s

Dialysis patients- increased risk of cardiovascular events.

Monitor h & h – do not give for hemoglobin levels higher than 10 to 11 mg/dl


MOA: Stimulate neutrophil production kidneys reduce neutropenia


Chemotherapy – myelosuppressive reduce risk of infections

Patients undergoing bone marrow transplantation

Severe chronic neutropenia

Administered: IV or subQ

Can not be taken orally due

Adverse Effects

Bone pain


Nursing implications:

“Filgrastim is given to reduce the risk of infection in patients undergoing cancer chemotherapy. Many anticancer drugs act on the bone marrow to suppress production of neutrophils, greatly increasing the risk of infection. By stimulating neutrophil production, filgrastim can decrease infection risk.

Increased risk of DVTs, CVA (strokes) or myocardial infarctions (MI)

Can cause HTN**Monitor blood pressure before therapy due to increase hematocrit

In order for erythropoietin to produce, there must be adequate store of iron, folic acid and vitamin B12 available.



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