Haematinics
Haematinics
Haematinics
HAEMATINICS
Haematinics are the agents required in the formation of blood
and used for the treatment of anaemia.
• Essential Haematinics: Iron, Vitamin B12, Folic acid
Oral Preparations
•Ferrous sulphate 200mg- 3-4 tablets/day
•Ferrous succinate
•Iron choline citrate
•Ferric ammonium citrate
•Ferric gluconate
Parenteral iron
Given parenterally as deep IM injection or intravenously, only in following
indications: Parentral Preparations
•Oral iron is not tolerated: bowel upset • Iron- dextran
•Failure to absorb oral iron: malabsorption. • Iron-sorbitol-citric acid
•Non-compliance to oral iron. • Iron sucrose and sodium ferric
gluconate
•In severe deficiency with chronic bleeding.
•Along with erythropoietin
Adverse effects :
pain at the site of injection
pigmentation of skin
Headache, joint pain, palpitation,
urticaria, nausea, rarely anaphylaxis
Acute Iron Poisoning
• More common in infants and children Uses of Iron:
• 1-2g can be lethal Iron deficiency anaemia: prophylaxis
Symptoms: and treatment
Vomiting, abdominal pain, haematemesis, Increased Iron requirement:
Bloody diarrhoea, shock, drowsiness, pregnancy, infancy, professional
acidosis, dehydration, cardiovascular blood donors.
collapse
• Immediate treatment is important
Treatment
Gastric lavage with sodium bicarbonate
Give egg yolk and milk orally: to complex
iron. Activated charcoal does not adsorb iron.
Antidote : Desferrioxamine IV/IM :
prevents Iron absorption.
Correction of acidosis and shock
Maturation Factors: Vitamin B12 & Folic Acid
Water soluble, B-complex Group Vitamins. Daily requirement of Vitamin B12 &
folic acid
Essential for Normal DNA synthesis
Adults Pregnancy
Deficiency: Megaloblastic anaemia Vit B12 1-3µg 3-5µg
•Impaired DNA synthesis Folic acid 50-100µg 200-400µg
•Abnormal maturation of RBCs
•Other manifestations: Glossitis, stomatitis
•Neurological manifestations-
subacute degeneration of spinal cord
peripheral neuritis
VITAMIN-B12 (Cyanocobalamin)
• Complex cobalt containing compounds Cyanocobalamin and hydroxocobalamin
• synthesized by microorganisms; plants and animals acquire it from them.
Dietary sources : Liver, kidney, sea fish, egg yolk, meat, cheese.
• Two active coenzyme forms of B12 are deoxyadenosyl-cobalamin (DAB12) and
methyl-cobalamin (methyl B12).
Functions:
folate
DHFRa se
FA reductase DHFA THFA
THFA- essential for the biosynthesis of purines.
Deficiency & manifestation: Therapeutic use:
• Megaloblastic anaemia. • Megaloblastic anaemia
• Folic acid deficiency
• Dietary deficiency.
• Protect epithelial cell
• Malabsorption. • Growth in infants
• Epithelial damage. • in pregnancy
• Weight loss Preparations and dose:
• • Folic acid: -liquid oral, Injectable
Few drugs e.g. phenytoin,
• Folinic acid:-CALCIUM LEUCOVORIN 3
phenobarbitone, methotrexate,
mg/ml inj.
oral- contraceptives can induce
folate deficiency.
Erythropoietin (EPO)
• Hormone secreted by peritubular cells of kidney, essential for normal
erythropoiesis.
• Kidney cells release EPO in response to anaemia and hypoxia
• Binds to EPO receptors on red cell progenitors and stimulates red cell production:
Induces haemoglobin formation and erythroblast maturation.
Releases reticulocytes in the circulation.
Recombinant human erythropoietin
1. Epoetin α: given thrice weekly
2. Epoetin ß: once in 2-4 weeks
3. Darbopoetin α: longer half-life
given once a week
• administered by i.v. or s.c.
Erythropoietin (EPO)
Therapeutic Uses:
In treatment of anaemia due to:
• Chronic renal failure if Hb < 8 mg/dl
• Zidovudine therapy in AIDS patients
• Cancer chemotherapy
• Multiple myeloma and cancer of bone marrow
Adverse Effects: with sudden rise in hematocrit.
Hb level should not exceed 12g/dl.
• Increased clot formation in the A-V shunts
• Hypertensive episodes
• Serious thromboembolic events
• Flu like symptoms
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