Dr. Ave Olivia Rahman, MSc.

Bagian Farmakologi FKIK UNJA

Anemia
 A reduction in red blood cell count or
hemoglobin content, or both.
Disturbance of erythropoiesis
Vitamin B12 (cyanocobalamin)
 Vitamin B12 is produced by bacteria, generated
in the colon.
 Enteral absorption needs “intrinsic factor”
from parietal cells of the stomach  This
complex undergoes endocytosis  Bound to its
transport protein (transcobalamin)  storage
in the liver or uptake into tissues
 The minimal requirement is about 1 μg/day.
Vitamin B12 deficiency
 Symptomp : Megaloblastic anemia, Pernicious
anemia
 Frequent cause is Atrophic gastritis leading to
a lack of intrinsic factor.
 Therapy : parenteral administration of
cyanocobalamin or hydroxycobalamin (vitamin
B12a; exchange of –CN for –OH group).
 Adverse effects : hypersensitivity reactions
Folic Acid (FA)
 Polyglutamine-FA in food is hydrolyzed to
monoglutamine-FA  absorbed
 Minimal requirement is ~ 50 μg/day
Folic Acid deficiency
 Symptoms of deficiency : megaloblastic anemia
and mucosal damage.
 Causes of deficiency include : insufficient intake,
malabsorption (Antiepileptic drugs, oral
contraceptives decrease FA absorption), and
increased requirements during pregnancy
 Methotrexate inhibite dihydro-FA reductase 
depresses the formation of the active species,
tetrahydro-FA.
 Therapy : oral administration of FA.
Dose of FA
 Adult males : 400 micrograms; females : 400-600
micrograms
 Pregnancy : 400-600 micrograms
 Breastfeeding : 500 micrograms.
 The maximum daily intake : 1,000 micrograms.
 For anemia caused by folate deficiency, 1-5
milligrams has been taken by mouth daily until
recovery
 For folate deficiency, 250-1,000 micrograms has
been taken by mouth daily
Iron
• Ferro better absorbed than ferri.
• Within the mucosal cells of the gut, iron is
oxidized and either deposited as ferritin or
passed on to the transport protein, transferrin.
• The transferrin–iron complex undergoes
endocytotic uptake into erythrocyte precursors
to be utilized for hemoglobin synthesis.
 Iron deficiency
 A frequent cause : chronic blood loss ex. due to
gastric/intestinal ulcers or tumors. Low intake of iron
 Diagnosis :
o Hemoglobin level under normal according age
o Mean corpusculum haemoglobin concentration
(MCHC) <31% (normal:32%-35%)
o Fe serum level <50 µg/dL (normal:80-180µg/dL)
o Transferin saturation <15% (normal:20%-25% )
o Ferritin serum level < 10 ng/mL (normal : 20-200
ng/mL)
 Therapy
 Elimination cause of bleeding
 Dose: 3-6 mg elemental iron/kgBB/day in 2-3 doses
(Oral administration of Fero compounds)
 The recommended dose of elemental iron for adults
with iron deficiency : 150 to 200 mg/day. Example,
one 325 mg iron sulfate tablet taken three times per
day supplies 195 mg of elemental iron per day
 Parenteral : only when adequate oral replacement is
not possible
 Reach normal Hb value and restore deposit.
 Maurer : 2-3 month after reach normal hb value
Posologi Preparation of Iron
Adverse effects & Interactions
 Adverse effects : gastrointestinal complaints
(epigastric pain, diarrhea, constipation) 
intake with or after meals, although absorption
is higher from the empty stomach.
 Risk of overdosage: hemosiderosis
 Interactions : Antacids inhibit iron
absorption.Combination with ascorbic acid
(vitamin C) protect Fe2+ from oxidation to
Fe3+
Erythropoietin
 Nephrogenic anemia
 Parenteral administration of recombinant
erythropoietin (epoetin alfa) or
hyperglycosylated erythropoietin (darbepoetin;
longer half-life than epoetin).
 Erythropoietin biological half-life of ~ 5 hours
after intravenous injection and a t½ 20 hours
after subcutaneous injection.
Tulis Resep
1. Ny. W sedang hamil 6 bulan mengeluh
lemah dan lesu. Konjungtiva anemis.
Kadar Hb : 10 gr%. Apusan darah
menunjukkan mikrositik hipokromik.
Berikan resep untuk ny. W!
2. Ny. R, 45 tahun menderita anemia
megaloblastik berikan terapi untuk Ny. R!