Pharmacotherapy

in
Haematology System

dr. R. Setiadji, M.Sc

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The related drugs

• Iron
• Folate
• B12 Vitamin
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Memilih obat P
Tetapkan diagnosis

Tetapkan tujuan pengobatan

Susun daftar obat manjur
Pilih obat manjur berdasar tujuan

WHO:Guide to good prescribing.

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Choose efective drug based on

Indication
Side effect
Availability/Posology
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Anaemia approach
Normal Reticulocyt In Adequate Reticulocyt Yes Clinical
Normal MCV

No Clinical Yes Clinical

Normal MCV Abnormal MCV

MCV > 100 80<MCV <100 MCV < 80

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KLASIFIKASI
• Makrositer
• Normositer
• Mikrositer
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Treatment
• Drug
• Blood Transfusion
• Heperbaric oxygen
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List of Anemia Drugs

• Ferrous fumarate
• Ferrous sulfat
• Ferrous gluconat
• Ferrous bisglycinate
• Na ferredetate
• Vitamin B12
• Folate
• Erythropoietin
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Anemia
• Erythrocyte
• Hb
• Oxygen
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Symptom
• Bisa asimptomatis
• Non spesifik:
– Lemah
– letih
– Konsentrasi
– Debar2
– Angina
– Gagal jantung
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Sign
• Hipertensi
• Pucat
• Koilonychia
• Jaundice
• Bone deformitas
• Leg ulcer
• Tachycardia
• murmur
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DIFERENTIAL DIAGNOSIS HYPOCHROMIC MICROCYTIC

ANEMIA

• Thalassemia
• Chronic inflamatory disease with inadequate iron
supply
• Myelodysplastic syndrome
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DIAGNOSIS
• AE
• Hb
• Ukuran eritrosit
• HMT
• Reticulocyt
• Bone marrow
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Mikrositik Anemia
• Heme
• Globin
• Sideroblastik
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Iron deficiency
• Diet
• Chronic Bleeding
– Mens
– Penyakit
 GI bleeding
 Clorectal Ca
 polyp
 Parasit cacing tambang, schistosomiasis,
ameba
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Treatment
• Severity
• Cause
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severity
• Old cardiovascular instability; severe iron
deficiency
• Young
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Causa
• Pregnancy
• Growing
• Infrequent bleeding
• Diet inadequate
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Causa
• Blood lost
• Malabsorption
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Treatment
• Transfusion
• Oral Fe
• Parenteral Fe
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transfusion
• Cardiovascular instability
• Continued blood loss
• Immediate intervention
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Oral Iron Therapy

• Repair anaemia and storage
• Empty stomach
• < 300mg/day
• Citric acid?
• Gastric/ post surgery doage naik
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Side effect
• GIT disturbance
• Non compliance
• Delayed release
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Kriteria sukses
• Reticulocyt naik dalam 4-7 hari
• Puncak 10 hari
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Kegagalan Oral terapi

• Absorpsi
• Compliance
• Confounding diagnosis

• Solusi?
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Parenteral Iron
• Utk intolerance oral
• Need relatively acute
• Need iron on ongoing basis (Persistent
gastrointestinal bleeding)
• Kebutuhan meningkat karena banyak pemakaian
erythropoeitin
• Iron dextran alergy:
– Chest pain ,wheezing, decrease BP