DRUGS USED TO TREAT ANEMIAS:HEMATINICS

Dr.SYED SHEHNAZ ILYAS,M.D.

BLOOD COMPONENTS
PLASMA Liquid part of blood Contains proteins essential for immune response &blood clotting FORMED ELEMENTS OF THE BLOOD LEUKOCYTES (WBCS): Part of the immune system ERYTHROCYTES (RBCS): Carry oxygen to the tissues and remove carbon dioxide

FACTORS ESSENTIAL FOR ERYTHROPOESIS
ADEQUATE AMOUNTS OF IRON Form hemoglobin –for oxygen MINUTE AMOUNTS OF VIT.B12 & FOLIC ACID ESSENTIAL AMINO ACID & CARBOHYDRATE To complete the hemoglobin rings, cell membrane, and basic structure

ANEMIA
↓ Concentration Of haemoglobin in blood Symptoms of fatigue, pallor, dizziness, exertional dyspnea (∵of tissue hypoxia) Cardiovascular adaptations to chronic anemia—tachycardia, increased cardiac output, vasodilation

TYPES OF ANEMIA
IRON DEFICIENCY ANEMIA Deficiency of iron Hypochromic, microcytic anaemia (small red cells with low Hb) MEGALOBLASTIC ANEMIA Deficiency of folic acid /vitamin B12 Macrocytic anaemia (large R.B.C,↓Number) PERNICIOUS ANEMIA No intrinsic factor :vitamin b12 not

IRON DEFICENCY ANEMIA
Deficient synthesis of Hb Due to lack of iron HYPOCHROMIC MICROCYTIC ANEMIA In adults most common cause : blood loss(menses,labour)

Animal foods iron is better absrbed Iron is absorbed from brush border of upper part of small Intestine FACTORS AFFECTING IRON ABSORPTION Only ferrous form absorbed (ferric converted to ferrous form by acids) ↑ ABSORBTION: Acids, reducing agents (vit.C, succinate), meat, Fe Deficiency ↓ABSORBTION :Alkalies, antacids, phosphorus, phytates, tetracyclines surgeries (partial gastrectomy, infectious diseases, malabsorption syndrome

IRON ABSORPTION

IRON DISTRIBUTION
TRANSPORT Bound to transferrin: βglobulin STORAGE Complexed with apoferritin (AF) and stored as ferritin in R.E.Cells, bone Marrow Hepatocytes As heme-in Hb of RBC, myglobin & cytoch. Oxidase enzymes

IRON ELIMINATION
Exfoliation of intestinal mucosal cells Trace amounts are excreted in bile, urine, and sweat. Total loss of iron is 1 mg/day

IRON PREPARATIONS
ORAL PREPARATIONS Ferrous fumarate (elemental Fe 66 mg Ferrous gluconate (elemntl Fe 36mg) Ferrous sulfate (elemental Fe 65 mg)     ADVERSE EFFECTS Nausea, vomiting, staining teeth, Metallic taste, heart burn, Constipation (astringent effect) Diarrhea (irritant effect)

IRON PREPARATIONS
PARENTERAL PREPARATIONS 20 – 40 mL Iron dextran deep I.M/I.V. Iron sorbitol citric acid complex ADVERSE EFFECTS Pain, pigmentation skin, sterile abcess Fever, headache, Palpitation, chest

MEGALOBLASTIC ANEMIA
Deficient synthesis of Hb Due to
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Lack of Vit B12 Folic acid Both

Macrocytic anemia+ leukopenia or thrombocytopenia or both Hypercellular bone Marrow With ↑ megaloblastic erythroid & other precursor cells.

VITAMIN B12
Available as cyanocobalamin hydroxycobalamin. Source: microbial synthesis Not synthesized By plants or animals Chief dietary source is microbially derived Vitamin B12 in meat (liver), eggs, dairy products and legumes.

VIT.B12:PHARMACOKINETI Vit B12+intrinsic CS
Factor (Stomach parietal cell R. On distal ileum Active absorption  Transport in blood: transcobalamin II Stored in liver TraceBINDING PROTEIN, R:GASTRIC amount lost
Cbl: COBALOMIN, IF;INTRINSIC FACTOR,TCII:TRANSCOBALOMIN II

VITAMIN B12 DEFICIENCY
SYMPTOMS OF DEFICIENCY Megaloblastic anemia Neurologic syndrome :paresthesias spasticity, ataxia,neuritis TREATMENT Vitamin B12:I.M Injection given life long ADVERSE EFFECTS: Hypokalemia and hypersensitivity

Richest source is yeast, liver kidney and green vegetables. Involved in DNA synthesis SYMPTOMS OF DEFICIENCY Megaloblastic anemia Glossitis, diarrhea, weight Loss, debility TREATMENT:Folic acid 1 mG/Day OTHER USES: Prevention of fetal

FOLIC ACID (PTEROYLGLUTAMIC ACID)

APLASTIC &HEMOLYTIC ANEMIA
APASTIC ANEMIA

Due to drugs: total lack of all hemopoetic cells Stop the drug involved in aplastic anemia Due to genetic problems Blood transfusion Corticosteroids May use iron, Vitamin B12 & folic acid

HEMOLYTIC ANEMIA

Rx FOR BOTH ANEMIAS
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