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Low RBC or Hgb count.

Causes of anemia

Maturation defects or increased destruction of RBCs


Normal formation & development of all blood cells in bone marrow.


Formation of erythrocytes (RBCs)

Maturation defects causes

Cytoplasmic or nuclear

Megaloblastic anemia

Type of macrocytic anemia that results from inhibition of DNA synthesis during red blood cell production, maturation defect of RBCs. Include B12 & Folic Acid deficiencies.

Pernicious anemia

A type of megaloblastic anemia resulting in the loss of gastric parietal calls required for secreting intrinsic factor needed in B12 abosrption. Deficiency in vitamin B12; required in RBC formation (maturation defects).

Increased destruction of RBC cause

Intrinsic RBC abnormalities (sickle cell anemia, heredity) and extrinsic mechanisms (trauma, blood loss)

Treatment of anemia

Must determine type of anemia before treatment in order to effectively treat.


essential mineral in body, O2 carrier in hemoglobin, stored in liver, spleen, and bone marrow. Requires ascorbic acid for absorption. Eggs, corn, beans & cereals (foods that contain phytates) may prevent absorption.

Iron supplements

Ferrous salts, multivitamin, iron dextran (thick black fluid, given IM, must Z-track or IV). Given to prevent & treat iron deficiency.

Ferrous salts

Ferrous fumurate (33%), ferrous sulphate (20%), ferrous gluconate (12%).

iron supplement contraindications

allergy, hemolytic anemia, hemochromatosis (iron overload) and any other anemia not associated with iron deficiecy.

Iron supp adverse effects

Nausea, vomiting, diarrhea, constipation, stomach cramps, pain with injection, discolouration of eyes & enamel (give straw for oral preparations), black/tarry stool.

Oral Iron supp interactions

Take between meals for max absorption or with meals to avoid GI distress; must stay upright for 15-30 min post admin due to risk of regurgitation. Inc effect with ascorbic acid. Dec effect with antacids. Dec fx of thyroid & tetracycline meds.

Iron supp contraindications

Ferrous slats: po route contra in ppl with ulcerative colitis, peptic ulcer disease/ liver disease/GI disorders. Iron dextran contra for all anemias excpet for iron-deficiency anemia.

Folic acid

Folate. Water soluble B-complex vitamin; acquired through dietary intake. Dried beans, peas, oranges & green veg all good sources. Required during pregnancy for fetal erythropoiesis. Absorption occurs in upper duodenum (therefore malabsorption syndromes generally cause folate deficiencies).

Folic acid indications

Folic acid deficiency anemia, prophylaxis of neural tube deformities (ie. during pregnancy), tropical sprue, megaloblastic or macrocytic anemia. Oral given with food. IV solution added to total paraenteral nutrition solutions.

Folc acid contraindications

Undetermined anemias or any non-folic acid related anemias (ie. pernicious anemia) - may mask symptoms of pernicious anemia (which requires dif treatment, untreated can lead to neuro damage).


Vitamin B12. Required for bone/blood formation. Water soluble vitamin. Found in liver, kidney fish, shellfish, meat, dairy foods.

B12 deficiencies

Lead to neurological damage, GI lesions, megaloblastic anemia. Caused by malabsorption, poor dietary intake, oral absorption requires intrinsic factor (glycoprotein from parietal cells in gastric lining).

B12 indications

B12 deficiencies, pernicious anemia (lack of intrinsic factor), megaloblastic anemia.

routes for B12

Preferred route is IM (red, thick liquid; IV can do but v thick), PO route requires intrinsic factor.

B12 adverse effects

Nontoxic, can be ingested in large doses. Adverse effects include itching, diarrhea, fever, optic nerve atrophy, hypokalemia.

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