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Haematinics
Iron Deficiency Anaemia (IDA) (=Sideropenic anaemia)
Sources
Low
Medium
High
Fruits
Red meats
Organ tissues
Vegetables
Chicken
Fish
Fats
Eggs
Green
Whole wheat
vegetables
flour
Tomatoes
Iron Metabolism
Absorption in Duodenum & Jejunum (proximal)
Absorption when

Iron stores

Iron requirements
Absorbed better in Ferrous (Fe2+) via active transport
Stored in

Ferritin (mucosa)

Transferrin (plasma)
Haemosiderin (alternative storage) = Ferritin + extra
Iron
Iron loss 1mg/ day

Urine

Faeces

Shed cells

Menstruation 20mg/ month

RBCs are destroyed by RES (reticuloendothelial system)
after 120 days iron returned to Transferrin & Ferittin
Hypochromic
Microcytic

Folic Acid
Functions
Production of RBCs in bone marrow
Neural tube formation
Sources
Leafy green vegetables
Fish, Meat, Poultry
Whole grains
Pharmacokinetics
Absorbed in small intestine (primarily Proximal)
Appears in plasma approx. 15-30 mins
Metabolised in liver
(7,8-dihydroFolic acid then to 5,6,7,8-tetrahydroFolic acid)
TetrahydroFolic acid derivates distributed to all body
tissues (primarily stored in Liver)
Excreted in urine (small amounts in feces )
Excreted in milk of lactating mothers

Children
Nutrition diet

Clinical
Tissue hypoxaemia easy fatiguability
Cardiopulmonary compe nsation palpitation,
dyspnoea
Metaboolic consequences O2 dissociation curve
change
Glossitis, Angular stomatitis, Brittle nails, Dysphagia
Pica (crave to eat non-food)

Erythropoietin
Function (hormone )
Controls RBC production

Absorption & Distribution

Intrinsic Factor (IF) produced by cell in stomach
IF + B12
Form IF-B12 comple x, absorbed in intestines

Production

Deficiency of IF
Cause abnormal formation of erythrocytes
(failure of B12 absorption)

Endogenous erythropoietin produced by kidney

(response to anaemia, hypoxia)
Signal BM to produce more RBC
Megaloblastic
anaemia
Large,
abnormal,
immature
erythrocytes

Causes
Excessive blood loss
Inadequate intake of iron
Women
Men
Menstruation
Blood loss
Pregnancy
Gastric ulcer
Neoplasm

Vitamin B12 (Cobalamin)

Functions
Normal functioning of Brain & Nervous system
Formation of blood

Deficiency Causes

Folate need (pregnancy, lactation)

Intake (poor diet, alcoholics)

Malabsorption syndromes

Treatment with drugs DHF (dihydrofolate)

reductase inhibitors (eg. Trimethoprim)

Renal dialysis (Folate removed during dialysis)

Liver disease (diminished hepatic storage Folate)

Cancer, Leukaemia, Myeloproliferative disorders

Clinical
Mild jaundice
Glossitis
Angular stomatitis

Pernicious Anaemia
(lack of gastric IF)
(autoimmune disease )
Abnormally large RBC
(macrocytes)
Abnormal WBC
(abnormal nuclei)
Deficiency Causes
Failure of IF secretion
Absense of IF intestinal receptors
Gastrectomy (achlorhydria, lack of IF)
Malabsorption syndrome
Lack of B12 binding protein in plasma
(transcobalaimin II, , globulin)
stomach acidity (inability to remove B12 from meat)
Liver disorders (interfere with storage of B12)

Failure to respond to erythropoietin

Concurrent iron deficiency (corrected with oral iron)

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Iron Deficiency Anaemia (IDA) (=Sideropenic anaemia)

Iron Preparation
Oral
Parenteral (IV, IM)
Corrects IDA as rapidly
Given only when oral
as parenteral
therapy failed
Should not be used

Cannot take oral drugs

(affe ct absorption)

Experience GIT
SR (sustained release)
intolerance to oral
EC (enteric-coated)
Types
Types
Ferrous sulfate
Iron Dextran (IM, IV)
Ferrous gluconate
Dextriferron (IV)
Ferrous fumarate
Saccharated iron oxide (IV)
Side Effects
Side Effects
Black stools
Local pain, tissue staining
Nausea
Headache
Epigastric pain
Diarrhea, Nausea, Vomiting
Constipation
Bronchos pasm
Diarrhoea
Anaphylaxis (*test dose)
Death
Side effects are dose
Z track injection
dependent.
Avoid local tissue staining
Overcome by
(brown discoloration)
Prevent escape of solution

Daily dose
from mus cle tissue

Taking after/ with

meals
Contraindications
Hypersensitivity to drug
Hemochromatosis/ Hemolytic anaemia
Anaphylatic-type reaction (parenteral)
Interactions
(form insol uble complex, absorption)
Tetracycline (antibiotic)
Methyldopa
Levodopa
Bisphosphonates
Quinolones
Calcium (food)
Absorption (Better at pH) Decreased when taking
Antacids, Phosphates, Tannins (from tea)
Toxicity
Acute (children common)
Chronic
Necrotising gastroenteritis = Haemosiderosis
Nausea, Vomiting,
= Haemochromatosis
Diarrhoea
Acidosis, Cyanosis,
Excess deposits in Heart,
Circulatory collapse
Liver, Pancreas
(organ failure)
Gastric scarring
Pyloric stenosis
Treatment
Treatment
Induce vomiting, lavage
Intermittent phelebotomy
(phosphate, carbonates)
Desferrioxamine
Hasten evacuation
(if involve iron overload
(catharsis/ purging)
ocular haemosiderosis,
Sodium bicarbonate
haemochromatosis)
Desferrioxamine/
deferoxamine

Folic Acid
Oral supplements
Megaloblastic anaemia
Folic acid deficiency
1mg dose sufficient to
Remove megaloblastic anaemia
Restore normal serum folate levels
Replenish body stores of folate
Side Effects
Allergic hypersensitivity (parenteral)

Vitamin B12
Cyanocobalamin (synthetic form of B12 )
Oral
Pernicious anaemia can be
treated entirely
(1000 ug/ day)

Parenteral
Cyanocobalamin

Hydroxocobalamin
( protein-bound)
(remain longer in blood)
Side Effects
Itching, Rash
Mild diarrhoea
Peripheral vascular thrombosis, RBC production

Contraindications
Pernicious anaemia
Aneamis which B12 is deficient

Side Effects
Rapid Haematocrit & Hb
Hypertension, Thrombotic compli cations
Influenza-like symptoms
(can be reduced if IV injection given over 5 mins)
Allergic reaction (infrequent, mild)

Darbepoetin alfa
(long acting, synthetic form of erythropoietin)
Treatment of
Chronic renal failure (IV, subcutaneous injection)
Anaemia in cancer patients undergoing chemotherapy

Interactions
Phenytoin (antagonize anticonvulsant action)
Epilepsy patient require dose of Phenytoin if Folic Acid
given

Folinic Acid (Not the same as Folic Acid)

(= leucovorin)(Calcium folinate/ Leucovorin calcium)

Treat folate deficiency megaloblastic anaemia

Adjuvant cancer chemotherapy (involve

Methotrexate) (rescue/ reverse toxic effects of
methotrexate)

Used synergistically with 5-fluorouracil

(chemotherapy agent)

Erythropoietin
Therapeutic uses (Treating anaemia)
Chronic Kidney Disease & Myelodysplasia
Cancer patients receiving chemotherapy & radiation
Critical illness (heart failure)
AIDS patient receiving zidovudine (AZT)
1 Bone Marrow

Supplements
Supplement in processed foods
Vitamin pill form (multi-vitamins)
Mode
Liquid
Transdermal patch
Nasal spray
Injection

Risks of use
Cardiovascular problems
Cardiac arrest
Arrhythmia
Hypertension
Hypertensive encephalopathy
Congestive heart failure
Vascular thrombosis/ ischemia
Myocardial infarction
Edema