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8/9/2019 Kuliah 3 Pharmacologycal Aspect in Anemia - Copy
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PharmacologycalPharmacologycalAspects in AnaemiaAspects in Anaemia
Eti Nurwening SholikhahDepartment of Pharmacology and Therapy
Faculty of MedicineUniversitas ad!ah Mada
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What are vitamins?What are vitamins?
"omple# su$stances that regulate"omple# su$stances that regulate
$ody processes$ody processes
"oen%ymes &partners' with"oen%ymes &partners' with
en%ymes in reactionsen%ymes in reactions
No calories( thus no energyNo calories( thus no energy
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CategoriesCategoriesFat-solubleFat-soluble
Dissolve in fatDissolve in fat
"an $e stored"an $e stored
Water-solubleWater-soluble
Dissolve in waterDissolve in water
"arried in"arried in
$loodstream( not$loodstream( notstoredstored
)( D( E( * )( D( E( * " and +,comple#" and +,comple#
vitaminsvitamins
) and D e#cess can) and D e#cess can
$e harmful$e harmful
E and * usually notE and * usually not
E#cess amountsE#cess amounts
may cause e#tramay cause e#trawork on kidneyswork on kidneys
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Vitamin A (and carotenoids)Vitamin A (and carotenoids)
Functions-Functions-
. Normal visionNormal vision
. Protects fromProtects frominfectionsinfections
. /egulates/egulates
immune systemimmune system
. )ntio#idant)ntio#idant&carotenoids'&carotenoids'
Food sources-Food sources-
. 0iver0iver
. Fish oilFish oil
. EggsEggs
. Forti1ed milk orForti1ed milk or
other foodsother foods
. /ed( yellow(/ed( yellow(orange( and darkorange( and dark
green veggiesgreen veggies
&carotenoids'&carotenoids'
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Vitamin D (theVitamin D (the
sunshine vitamin)sunshine vitamin) Functions-Functions-
. PromotesPromotes
a$sorption ofa$sorption of
calcium andcalcium and
phosphorusphosphorus
. 2elps deposit those2elps deposit those
in $ones3teethin $ones3teeth
. /egulates cell/egulates cellgrowthgrowth
. Plays role inPlays role in
immunityimmunity
Sources-Sources-
. Sunlight &45 . 46Sunlight &45 . 46
mins 7# a week'mins 7# a week'. Salmon withSalmon with
$ones$ones
. MilkMilk
. 8range !uice8range !uice&forti1ed'&forti1ed'
. Forti1ed cerealsForti1ed cereals
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Vitamin Vitamin
Functions-Functions-
. )ntio#idant( may)ntio#idant( may
lower risk forlower risk forheart disease andheart disease and
stroke( somestroke( some
types of cancerstypes of cancers
.Protects fattyProtects fatty
acids and vitaminacids and vitamin
))
Sources-Sources-
. 9egeta$le oils9egeta$le oils
. Foods made fromFoods made fromoil &salad dressing(oil &salad dressing(
margarine'margarine'
. NutsNuts
.SeedsSeeds
. :heat germ:heat germ
. reen( leafyreen( leafy
veggiesveggies
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Vitamin ! Vitamin !
Functions-Functions-
. 2elps $lood clot2elps $lood clot
. 2elps $ody make2elps $ody makesome othersome other
proteinsproteins
Sources-Sources-
. +ody can produce+ody can produce
on its own &fromon its own &from$acteria in$acteria in
intestines'intestines'
. reen( leafyreen( leafy
veggiesveggies
. Some fruits( otherSome fruits( other
veggies( and nutsveggies( and nuts
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"hiamin (#$)"hiamin (#$)
Functions-Functions-
. 2elps produce2elps produce
energy fromenergy fromcar$scar$s
Sources-Sources-
. :hole,grain and:hole,grain and
enriched grainenriched grainproductsproducts
. PorkPork
. 0iver0iver
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%ibo&avin (#')%ibo&avin (#')
Functions-Functions-
. Produce energyProduce energy
. "hanges"hangestryptophantryptophan
&amino acid' into&amino acid' into
niacinniacin
Sources-Sources-
. 0iver0iver
. ;ogurt and milk ;ogurt and milk
. Enriched grainsEnriched grains
. EggsEggs
. reen( leafyreen( leafy
veggiesveggies
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iaciniacin
Functions-Functions-
. 2elps $ody use2elps $ody use
sugars3fatty acidssugars3fatty acids. 2elps en%ymes2elps en%ymes
function normallyfunction normally
. Produces energyProduces energy
Sources-Sources-
. Foods high inFoods high in
protein typicallyprotein typically&poultry( 1sh(&poultry( 1sh(
$eef( peanut$eef( peanut
$utter( legumes'$utter( legumes'
. Enriched andEnriched and
forti1ed grainsforti1ed grains
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Pyridoine (#*)Pyridoine (#*)
Functions-Functions-
. 2elps $ody make2elps $ody make
non,essentialnon,essential
amino acidsamino acids
. 2elps turn2elps turn
tryptophan intotryptophan into
niacin andniacin and
serotoninserotonin. 2elp produce $ody2elp produce $ody
chemicals &insulin(chemicals &insulin(
hemoglo$in( etc'hemoglo$in( etc'
Sources-Sources-
. "hicken"hicken
. FishFish
. PorkPork
. 0iver0iver
. :hole grains:hole grains
. NutsNuts
. 0egumes0egumes
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Folate (+olic acid)Folate (+olic acid)
Functions-Functions-
. Produces DN) andProduces DN) and
/N)( making new/N)( making new
$ody cells$ody cells. :orks with vitamin:orks with vitamin
+47 to form+47 to form
hemoglo$inhemoglo$in
. May protect againstMay protect against
heart diseaseheart disease
. 0owers risk of neural0owers risk of neural
tu$e defects in $a$iestu$e defects in $a$ies
. "ontrols plasma"ontrols plasmahomocystine levelshomocystine levels&related to heart&related to heartdisease'disease'
Sources-Sources-. Forti1ed andForti1ed and
enriched grains andenriched grains and$reakfast cereals$reakfast cereals
. 8range !uice8range !uice
. 0egumes0egumes
. reen( leafy veggiesreen( leafy veggies
. PeanutsPeanuts
. )vocados)vocados
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Vitamin #$'Vitamin #$'
(cobalamin)(cobalamin) Functions-Functions-
. :orks with folate:orks with folate
to make /+"<sto make /+"<s. =n many $ody=n many $ody
chemicals andchemicals and
cellscells
. 2elps $ody use2elps $ody usefatty acids3aminofatty acids3amino
acidsacids
Sources-Sources-
. )nimal products)nimal products
. MeatMeat
. FishFish
. PoultryPoultry
. EggsEggs
. Milk( other dairyMilk( other dairy
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#iotin#iotin
Functions-Functions-
. Produces energyProduces energy
. 2elps $ody use2elps $ody useproteins( car$s(proteins( car$s(
and fats fromand fats from
foodsfoods
Sources-Sources-
. :ide variety of:ide variety of
foodsfoods
. EggsEggs
. 0iver0iver
. :heat germ:heat germ
. PeanutsPeanuts
. "ottage cheese"ottage cheese
. :hole grain $read:hole grain $read
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Pantothenic AcidPantothenic Acid
2elps produce2elps produce
energyenergy
2elps the $ody2elps the $odyuse proteins( fat(use proteins( fat(
and car$s fromand car$s from
foodfood
Sources-Sources-
. Found in almostFound in almost
all foodsall foods
. Meat( poultry( 1shMeat( poultry( 1sh
. :hole grain:hole grain
cerealscereals
. 0egumes0egumes
. MilkMilk
. Fruits( veggiesFruits( veggies
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Vitamin CVitamin C
Functions-Functions-
. 2elps produce2elps produce
collagen &connectivecollagen &connective
tissue in $ones(tissue in $ones(muscles( etc'muscles( etc'
. *eeps capillary*eeps capillary
walls( $lood vesselswalls( $lood vessels
1rm1rm
. 2elps $ody a$sor$2elps $ody a$sor$
iron and folateiron and folate
. 2ealthy gums2ealthy gums
. 2eals cuts and2eals cuts and
woundswounds
. Protects fromProtects from
infection( $oostsinfection( $oosts
immunityimmunity
. )ntio#idant)ntio#idant
SourcesSources
. "itrus fruits"itrus fruits
. 8ther fruits(8ther fruits(
veggiesveggies
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De,cienciesDe,ciencies
/ickets &children and vitamin D'/ickets &children and vitamin D'
8steoporosis3osteomalacia8steoporosis3osteomalacia
&vitamin D'&vitamin D' Scurvy &vitamin "'Scurvy &vitamin "'
Night $lindness &vitamin )'Night $lindness &vitamin )'
+eri$eri &thiamin'+eri$eri &thiamin'
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What are minerals?What are minerals?
/egulate $ody processes/egulate $ody processes
ive structure to things in theive structure to things in the
$ody$ody No calories &energy'No calories &energy'
"annot $e destroyed $y heat"annot $e destroyed $y heat
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Categories o+ mineralsCategories o+ minerals
Ma!or mineralsMa!or minerals
. "alcium"alcium
. PhosphorusPhosphorus
. MagnesiumMagnesium
. ElectrolytesElectrolytes
&sodium( chloride(&sodium( chloride(
potassium'potassium'
Trace minerals Trace minerals
. "hromium"hromium
. "opper"opper
. FlourideFlouride
. =odine=odine
. =ron=ron
. ManganeseManganese
. SeleniumSelenium
. >inc>inc
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CalciumCalcium
+one $uilding+one $uilding
Muscle contractionMuscle contraction
2eart rate2eart rate
Nerve functionNerve function
2elps $lood clot2elps $lood clot
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PhosphorusPhosphorus
enerates energyenerates energy
/egulate energy meta$olism/egulate energy meta$olism
"omponent of $ones( teeth"omponent of $ones( teeth
Part of DN)( /N) &cell growth(Part of DN)( /N) &cell growth(
repair'repair'
)lmost all foods( especially protein,)lmost all foods( especially protein,
rich foods( contain phosphorusrich foods( contain phosphorus
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agnesiumagnesium
Part of ?55 en%ymes ®ulatesPart of ?55 en%ymes ®ulates
$ody functions'$ody functions'
Maintains cells in nerves( musclesMaintains cells in nerves( muscles "omponent of $ones"omponent of $ones
+est sources are legumes( nuts(+est sources are legumes( nuts(
and whole grainsand whole grains
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lectrolyteslectrolytes
"hloride-"hloride-
. Fluid $alanceFluid $alance
. Digestion of food( transmits nerve impulsesDigestion of food( transmits nerve impulses
PotassiumPotassium
. Maintains $lood pressureMaintains $lood pressure
. Nerve impulses and muscle contractionNerve impulses and muscle contraction
SodiumSodium. Fluid $alanceFluid $alance
. Muscles rela#( transmit nerve impulsesMuscles rela#( transmit nerve impulses
. /egulates $lood pressure/egulates $lood pressure
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Sources-Sources-
. Salt &sodium chloride'Salt &sodium chloride'
. Fruits( veggies( milk( $eans( 1sh(Fruits( veggies( milk( $eans( 1sh(chicken( nuts &potassium'chicken( nuts &potassium'
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.ron.ron
Part of hemoglo$in( carries o#ygenPart of hemoglo$in( carries o#ygen
+rain development+rain development
2ealthy immune system2ealthy immune system Sources-Sources-
. )nimals &heme' vs@ plants &non,heme')nimals &heme' vs@ plants &non,heme'
. +etter a$sor$ed from heme+etter a$sor$ed from heme
. "onsume vitamin " with non,heme"onsume vitamin " with non,heme
. Forti1ed cereals( $eans( eggs( etc@Forti1ed cereals( $eans( eggs( etc@
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AntioidantsAntioidants
Slow or prevent damage to $ody cellsSlow or prevent damage to $ody cells
May improve immune function and lowerMay improve immune function and lower
risk for infection and cancerrisk for infection and cancer "arotenoids . $eta carotene &familiar'"arotenoids . $eta carotene &familiar'
9itamin "9itamin "
9itamin E9itamin E
Found in colorful fruits3veggies and grainsFound in colorful fruits3veggies and grains
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PhytonutrientsPhytonutrients
Phyto . plantPhyto . plant AASparkB $ody processes that may 1ght( orSparkB $ody processes that may 1ght( or
reduce risk for some diseasesreduce risk for some diseases Fruits3veggiesFruits3veggies E#amples-E#amples-
. "arotenoids"arotenoids
. 0utein0utein
. 0ycopene0ycopene
. FlavanolsFlavanols
. Pre$iotics3pro$ioticsPre$iotics3pro$iotics
. Soy$eansSoy$eans
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Functional FoodsFunctional Foods
Foods that provide $ene1ts $eyondFoods that provide $ene1ts $eyond
$asic nutrition$asic nutrition
PhytonutrientsPhytonutrients Pre$iotics3pro$ioticsPre$iotics3pro$iotics
Fatty 1sh3omega ?<sFatty 1sh3omega ?<s
Soy proteinSoy protein 8ats &heart,healthy'8ats &heart,healthy'
Fla#seedFla#seed
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:ater:ater
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WaterWater =nvolved in every process of the $ody=nvolved in every process of the $ody /epresents large portion of $ody<s mass/epresents large portion of $ody<s mass
. Men- 6C,6Men- 6C,6
. :omen- ,6?:omen- ,6?
. Due to diGerences in +ody "omposition@Due to diGerences in +ody "omposition@Muscle has higher hydration level than fatMuscle has higher hydration level than fattissue@tissue@
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WaterWater
Two main A:ater Two main A:ater"ompartmentsB"ompartmentsB
. =ntracellular Huid &="F'=ntracellular Huid &="F'
. E#tracellular Huid &E"F'E#tracellular Huid &E"F'Plasma 3 interstitial HuidPlasma 3 interstitial Huid
0ymph 3 "SF 3 Urine 3 etc0ymph 3 "SF 3 Urine 3 etc
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Functions o+ #ody WaterFunctions o+ #ody Water
Serves as +ody<s transport mediumServes as +ody<s transport medium. as diGusion 3 nutrient transport 3as diGusion 3 nutrient transport 3
waste disposalwaste disposal
. 2eat dissipation2eat dissipation
. Ioint lu$rication Ioint lu$rication
. Provides AturgorB for cell structureProvides AturgorB for cell structure
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Water #alanceWater #alance
Normally a$out 7@6 0 of HuidNormally a$out 7@6 0 of Huid
intake reJuiredintake reJuired
:ater o$tained from three:ater o$tained from threesources- 0iJuid( food( Ksources- 0iJuid( food( K
metabolism.metabolism.
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Water .nta/eWater .nta/e
ormal 0 $'11 ml2dayormal 0 $'11 ml2day. ((
*3 42 eercise)*3 42 eercise)
Food 0 $111 ml 2dayFood 0 $111 ml 2day
etabolism 0 561 ml 2 dayetabolism 0 561 ml 2 day
. Up to 76 of water reJuirementUp to 76 of water reJuirement
. "om$ination of 2"om$ination of 2,, and 8and 87L7L as end resultas end result
of meta$olism@of meta$olism@
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Water 7utputWater 7utput
8rine9 (8rine9 (:6; <:6; <''7)7) $611 ml2day$611 ml2day 42 high protein diets42 high protein diets
=/in9 vaporative cooling> 11 ml 2=/in9 vaporative cooling> 11 ml 2
day (day (
drastically 42 e@)drastically 42 e@) Water Vapor9 haled air> 561 ml2dayWater Vapor9 haled air> 561 ml2day
(Varies 42 climate e@)(Varies 42 climate e@) Feces9 '11 ml2day (mayFeces9 '11 ml2day (may signi,cantlysigni,cantly
42 illness)42 illness)
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Water and erciseWater and ercise
2umidity greatly2umidity greatly ↑↑ 22778 loss8 loss
=ngest 55 ml $efore e#ercise=ngest 55 ml $efore e#ercise
Drink 8FTEN during e#erciseDrink 8FTEN during e#ercise
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Bastric mptyingBastric mptying
Temperature- "old Huids empty Temperature- "old Huids emptyfasterfaster
9olume-9olume- ↑↑ volume fastervolume faster 8smolarity- Emptying is slowed8smolarity- Emptying is slowed
when liJuid is concentrated withwhen liJuid is concentrated with
simple sugars@simple sugars@
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nergynergy
%euirement9%euirement9. Bro4th and maintenance o+ bodyBro4th and maintenance o+ body
tissuetissue
. aintenance o+ body temp@aintenance o+ body temp@
. involuntary muscle movementinvoluntary muscle movement
. Voluntary muscle movementVoluntary muscle movement
=ources9 +rom oidation $gm=ources9 +rom oidation $gm
. CA< $*/E (/cal)CA< $*/E (/cal)
. Fat 5/E (:/cal)Fat 5/E (:/cal)
. Protein $/E (/cal)Protein $/E (/cal)
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nergynergy
@' E 0 $cal@' E 0 $cal easurementseasurements
. Direct calorimetryDirect calorimetry
. .ndirect calorimetry.ndirect calorimetry #asal#asal metabolismmetabolism
. Amount o+ energy reuired toAmount o+ energy reuired to
carry out the basic processescarry out the basic processessuch as cellular activity heartsuch as cellular activity heart
beat respirationbeat respiration
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#%#%99. an *6/g $@$/ cal2minan *6/g $@$/ cal2min
. 4oman 66/g 1@:$/ cal2min4oman 66/g 1@:$/ cal2min "otal"otal energyenergy reuirementreuirement99
time 3 number o+ unit 2mintime 3 number o+ unit 2min
FactorsFactors aGectingaGecting energyenergy reuirementreuirement . AgeAge
. nvironmental temp@nvironmental temp@
. DiseaseDisease
. PregnancyPregnancy
. nergy inta/energy inta/e
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=peci,c dynamic=peci,c dynamic
action o+ +oodaction o+ +ood
"he increased o+ energy"he increased o+ energy
ependiture due to +ood metabolismependiture due to +ood metabolism
euals $1; o+ ependitureeuals $1; o+ ependiture cess energy inta/e is stored ascess energy inta/e is stored as
+at in the body+at in the body
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FiberFiber
De,nitionDe,nition9 plant material that9 plant material that
canHt be digested by enIymescanHt be digested by enIymes
o+ B."o+ B." Found in the cell 4all andFound in the cell 4all and
4ithin cell o+ seed roots4ithin cell o+ seed roots
leaves +ruitsleaves +ruits
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Composition9Composition9. Cellulose9 glucose polysaccharideCellulose9 glucose polysaccharide
tough ,brous strand lea+y veg@tough ,brous strand lea+y veg@. Pectin plant gum mucilages9 nonPectin plant gum mucilages9 non
cellulose polysaccharidecellulose polysaccharidePectin combine 4ith 4ater to +ormPectin combine 4ith 4ater to +orm
gelgelPlant gum to cover site o+ inJuryPlant gum to cover site o+ inJury
ucilages hold 4ater in seed toucilages hold 4ater in seed to
prevent dryingprevent drying
. Kignin9 gives the 4ood itsKignin9 gives the 4ood its
strength and shapestrength and shape
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Analysis o+ ,ber9Analysis o+ ,ber9
. Crude ,ber contentCrude ,ber content
. %oughage%oughage
Gects o+ dietary ,bers9Gects o+ dietary ,bers9
. outhouth9/eeps teeth gum healthy9/eeps teeth gum healthy
. =tomach=tomach9 slo4 emptying o+ stomach 9 slo4 emptying o+ stomach
digestiondigestion
. =mall=mall bo4elbo4el9 viscosity transit time9 viscosity transit time
complete absorptioncomplete absorption. KargeKarge bo4elbo4el9 bacteria in stool <'7 stool9 bacteria in stool <'7 stool
bul/ de+ecation intracolonic pressurebul/ de+ecation intracolonic pressure
colonic transit timecolonic transit time
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FiberFiber inin dietdiet9 depends on type o+9 depends on type o+
dietdiet FiberFiber hypothesishypothesis9 $:19 $:1
( degenerative disorder in 8!)( degenerative disorder in 8!)
Ko4 inta/e o+ ,ber related to theKo4 inta/e o+ ,ber related to the+ollo4ing disease9+ollo4ing disease9
Colonic disorder (con@ d@dc@capp)Colonic disorder (con@ d@dc@capp)
Disorder 4hich are 'dry to colonicDisorder 4hich are 'dry to colonicdisorder (h@h dvt pe)disorder (h@h dvt pe)
etabolic disorder (ob dm ac gs)etabolic disorder (ob dm ac gs)
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AntioidantsAntioidants
Slow or prevent damage to $ody cellsSlow or prevent damage to $ody cells
May improve immune function and lowerMay improve immune function and lower
risk for infection and cancerrisk for infection and cancer "arotenoids . $eta carotene &familiar'"arotenoids . $eta carotene &familiar'
9itamin "9itamin "
9itamin E9itamin E
Found in colorful fruits3veggies and grainsFound in colorful fruits3veggies and grains
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PhytonutrientsPhytonutrients
Phyto . plantPhyto . plant AASparkB $ody processes that may 1ght( orSparkB $ody processes that may 1ght( or
reduce risk for some diseasesreduce risk for some diseases
Fruits3veggiesFruits3veggies E#amples-E#amples-
. "arotenoids"arotenoids
. 0utein0utein
. 0ycopene0ycopene
. FlavanolsFlavanols
. Pre$iotics3pro$ioticsPre$iotics3pro$iotics
. Soy$eansSoy$eans
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Functional FoodsFunctional Foods
Foods that provide $ene1ts $eyondFoods that provide $ene1ts $eyond
$asic nutrition$asic nutrition
PhytonutrientsPhytonutrients Pre$iotics3pro$ioticsPre$iotics3pro$iotics
Fatty 1sh3omega ?<sFatty 1sh3omega ?<s
Soy proteinSoy protein 8ats &heart,healthy'8ats &heart,healthy'
Fla#seedFla#seed
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icronutrienticronutrient
supplementation insupplementation in
pregnancypregnancy
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Micronutrient needs inMicronutrient needs in
pregnancypregnancy
. =ron=ron
. FolateFolate
. 9it )9it )
. >inc>inc
. 8therO8therO
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=nfection=nfection
. Malaria =ntestinal helminthsMalaria =ntestinal helminths
other common infectionsother common infections
. Decreased nutrient intakeDecreased nutrient intake
. =ncreased nutrient use=ncreased nutrient use
. =nfection,speci1c insult=nfection,speci1c insult
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OBAT-OBAT HEMATINIKOBAT-OBAT HEMATINIK
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Eritropoesis normalEritropoesis normal
memerlukan:memerlukan: Zat besi (Fe)Zat besi (Fe)
Vitamin BVitamin B1212
Asam folat Asam folat
Defisiensi anemiaDefisiensi anemia
diatur oleh: eritopoetindiatur oleh: eritopoetin
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Defisiensi besiDefisiensi besi anemiaanemia
mikrositik hipokromikmikrositik hipokromik Sebab:Sebab:
– perdarahanperdarahan
– kehamilankehamilan – arious abnormalities of the !utarious abnormalities of the !ut
– ba"i prematur (den!an status besi rendah)ba"i prematur (den!an status besi rendah)
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B#S$B#S$
AbsorbsiAbsorbsi::
– di duodenum dan %e%unum proksimaldi duodenum dan %e%unum proksimal
– &'1 dari "an! dikonsumsi (&'1 dari "an! dikonsumsi (** +&'1 m!,hr)++&'1 m!,hr)+
bertambah bila persediaan kuran!bertambah bila persediaan kuran!
– diabsorbsi dalam bentuk ferro+ den!an transportdiabsorbsi dalam bentuk ferro+ den!an transport
aktif aktif
– ditin!katkan oleh: kobal+ inosin+ etionin+ itamin -+ditin!katkan oleh: kobal+ inosin+ etionin+ itamin -+
.-l+ suksinat+ sen"a/a asam lain.-l+ suksinat+ sen"a/a asam lain – menurun bila terdapat fosfat atau antasidamenurun bila terdapat fosfat atau antasida
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TransportTransport
' setelah diabsorbsi+ diikat oleh transferin' setelah diabsorbsi+ diikat oleh transferin
' kalau tidak untuk eritropoesis+ disimpan' kalau tidak untuk eritropoesis+ disimpan
seba!ai feritinseba!ai feritin
EkskresiEkskresi
-- +& ' 1 m!,hari+& ' 1 m!,hari
' melalui sel epitel kulit 0 saluran erna "an!' melalui sel epitel kulit 0 saluran erna "an!
terkelupas+ kerin!at+ urin+ feses+ kuku+terkelupas+ kerin!at+ urin+ feses+ kuku+
rambutrambut
K b t hK b t h
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KebutuhanKebutuhan
laki'laki de/asalaki'laki de/asa : 1 m!,hari: 1 m!,hari
/anita de/asa/anita de/asa : 12 m!,hari: 12 m!,hari/anita hamil 0 men"usui/anita hamil 0 men"usui : * & m!,hari: * & m!,hari
SediaanSediaan – !aram ferro!aram ferro absorbsin"a palin! efisien:absorbsin"a palin! efisien:
2&2&
– defisiensi+ perlu &'1m!,hr (intake 2'defisiensi+ perlu &'1m!,hr (intake 2'
m!)m!)
– 3reparat parenteral diberikan han"a bila tidak3reparat parenteral diberikan han"a bila tidak
bisa diberikan per'oralbisa diberikan per'oral
#f k i#f k t i
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#fek nonterapi:#fek nonterapi:
Iritasi saluran cerna:Iritasi saluran cerna:
– nauseanausea ' diare' diare – n"eri epi!astrikn"eri epi!astrik ' konstipasi' konstipasi
ToksisitasToksisitas
' terutama pada anak'anak' terutama pada anak'anak' neroti4in! !astroenteritis : n"eri perut+ muntah+' neroti4in! !astroenteritis : n"eri perut+ muntah+
diare berampur darah+ s"ok5diare berampur darah+ s"ok5
' Asidosis+ koma+ menin!!al' Asidosis+ koma+ menin!!al
' setelah konsumsi 1 !' setelah konsumsi 1 !
' antidotum: deferoksamin' antidotum: deferoksamin
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ibo!la"in #Bibo!la"in #B$$%%
6oen4im dalam metabolisme flao'6oen4im dalam metabolisme flao'
protein dalam respirasi selprotein dalam respirasi sel
dapat men!atasi anemia normositik'dapat men!atasi anemia normositik'normokromiknormokromik
anemia ter%adi pada malnutrisi protein'anemia ter%adi pada malnutrisi protein'
kalorikalori 1 m!,hari peroral atau im1 m!,hari peroral atau im
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&iridoksin #B&iridoksin #B''%%
6oen4im "an! meran!san! pertumbuhan heme6oen4im "an! meran!san! pertumbuhan heme
(e!isiensi(e!isiensi an5 mikrositik hipokromik+an5 mikrositik hipokromik+
an5 me!aloblastikan5 me!aloblastik
absorbsi Fe menin!katabsorbsi Fe menin!kat
Fe'bindin! protein %enuh+ hiperferemiaFe'bindin! protein %enuh+ hiperferemia
re!enerasi darah menurunre!enerasi darah menurun
hemosiderosishemosiderosis
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KobalKobal
Biasan"a terdapat seba!ai ampuran dalamBiasan"a terdapat seba!ai ampuran dalamsediaan Fesediaan Fe
7enin!katkan absorbsi Fe melalui usus7enin!katkan absorbsi Fe melalui usus
#fek toksik: erupsi kulit+ struma+ an!ina+#fek toksik: erupsi kulit+ struma+ an!ina+
tinnitus+ tuli+ pa"ah %antun!+ sianosis+ komatinnitus+ tuli+ pa"ah %antun!+ sianosis+ koma
malaise+ anoreksia+ mual+ muntahmalaise+ anoreksia+ mual+ muntah
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Vitamin B12 0 Asam folatVitamin B12 0 Asam folat
3entin! pada beberapa reaksi untuk sintesis3entin! pada beberapa reaksi untuk sintesis
D8AD8A
defisiensidefisiensi anemia me!aloblastikanemia me!aloblastik
S #Si k b l i # it i
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Sianokobalamin #"itaminSianokobalamin #"itamin
B)$%B)$%sianokobalaminsianokobalamin
hidroksokobalaminhidroksokobalamin
kobalaminkobalamin
deoksiadenasil kobalamin 0deoksiadenasil kobalamin 0
metil kobalaminmetil kobalamin
(aktif dalam tubuh)(aktif dalam tubuh)
(e!isiensi *itamin B)$(e!isiensi *itamin B)$ de!enerasi SS3de!enerasi SS3
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(e!isiensi *itamin B)$(e!isiensi *itamin B)$
de!enerasi SS3 de!enerasi SS3
9anda'tanda:9anda'tanda:
' !an!!uan hematopoesis' !an!!uan hematopoesis' !an!!uan neurolo!i' !an!!uan neurolo!i
' kerusakan sel epitel' kerusakan sel epitel
biasan"a karena malabsorbsibiasan"a karena malabsorbsi
– karena kekuran!an faktor intrinsik (anemiakarena kekuran!an faktor intrinsik (anemia
pernisiosa)pernisiosa)
– post !astretomipost !astretomi
– beberapa !an!!uan "an! men!akibatkanbeberapa !an!!uan "an! men!akibatkan
!an!!uan absorbsi!an!!uan absorbsi
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KebutuhanKebutuhan
' 1' 1 µµ!,hari!,hari
' pada defisiensi tanpa komplikasi+ 1' pada defisiensi tanpa komplikasi+ 1 µµ!,hari!,hari
sudah menukupisudah menukupi
' bila faktor intrinsik berkuran!+ kebutuhan' bila faktor intrinsik berkuran!+ kebutuhan
menin!katmenin!katSumber alamiSumber alami::
makanan he/ani (hati+ !in%al+ %antun!)+ keran!makanan he/ani (hati+ !in%al+ %antun!)+ keran!
kunin! telur+ makanan lautkunin! telur+ makanan lautE!ek sampin+E!ek sampin+::
transient hipokalemia pada terapi defisiensi berattransient hipokalemia pada terapi defisiensi berat
Ab b iAbsorbsi
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Absorbsi Absorbsi
'' diabsorbsi baik dan epat pada pemberiandiabsorbsi baik dan epat pada pemberian
seara im 0 skseara im 0 sk'' absorbsi pada pemberian peroral lambat diabsorbsi pada pemberian peroral lambat di
ileumileum
'' faktor intrinsik ekso!en han"a ber!una bilafaktor intrinsik ekso!en han"a ber!una biladefisiensi faktor intrinsikdefisiensi faktor intrinsik
'' setelah diabsorbsi+ hampir semua Vitsetelah diabsorbsi+ hampir semua Vit
B12 dalam darah terikat den!an proteinB12 dalam darah terikat den!an proteinplasmaplasma
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(e!isiensi asam !olat(e!isiensi asam !olat pada kehamilanpada kehamilan
s"ndroma malabsorbsis"ndroma malabsorbsi alkoholismealkoholisme
anemia hemolitikanemia hemolitik
pen!!unaan obat'obat "n! men!hambat en4impen!!unaan obat'obat "n! men!hambat en4imdihidrofolat reduktase (trimetoprim+ metotreksat)dihidrofolat reduktase (trimetoprim+ metotreksat)
obat "an! berinteraksi pada absorbsi 0obat "an! berinteraksi pada absorbsi 0
pen"impananpen"impanan
anemia me!aloblastikanemia me!aloblastik
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AbsorbsiAbsorbsi baik pada pemberian peroralbaik pada pemberian peroral
EkskresiEkskresi melalui !in%almelalui !in%alSediaan:Sediaan:
tablettablet
in%eksiin%eksi dalam multiitamindalam multiitamin
dalam tablet antianemia laindalam tablet antianemia lain
E!ek sampin+E!ek sampin+: san!at %aran!: san!at %aran!
dosis tin!!i: berinteraksi den!an antikonulsandosis tin!!i: berinteraksi den!an antikonulsan
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HidroksiureaHidroksiurea
untuk terapi sikle ell anemiauntuk terapi sikle ell anemia efek sampin!:efek sampin!:
– depresi sistem hemopoetikdepresi sistem hemopoetik
– netropenianetropenia
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ImunosuppressantsImunosuppressants SiklosporinSiklosporin
antithymocyte globulinantithymocyte globulin
terapi anemia aplastikterapi anemia aplastik
prednisonprednison
untuk anemia hemolitik: mensupresi antibodi $!untuk anemia hemolitik: mensupresi antibodi $!
"an! melapisi eritrosit pada anemia hemolitik"an! melapisi eritrosit pada anemia hemolitik
autoimunautoimun siklofosfamid dosis tin!!i dan radiasisiklofosfamid dosis tin!!i dan radiasi
untuk anemia aplastik berat "an! !a!al den!anuntuk anemia aplastik berat "an! !a!al den!an
terapi lainterapi lain
E it tiE it ti
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EritropoetinEritropoetin ;ntuk terapi:;ntuk terapi:
anemia pada penderita infeksi .$Vanemia pada penderita infeksi .$V
anemia "an! berhubun!an den!an multipleanemia "an! berhubun!an den!an multiple
m"elomam"eloma
transplantasi sumsum tulan!transplantasi sumsum tulan!
monitor hematokrit semin!!u sekali sampaimonitor hematokrit semin!!u sekali sampai
terapai hematokrit normalterapai hematokrit normal
dapat men"ebabkan hipertensidapat men"ebabkan hipertensi