HAEMATINICS

Hematinics are compounds required in the

formation of blood.

 Iron

 Vitamin B12

 Folic acid
 IRON :

 Essential component for normal

erythropoiesis – Hemoglobin
production.

 Total body iron – 2.5 – 5 grams.

 2/3rd present in hemoglobin.

 Each molecule of hemoglobin has

four iron containing residues.

 Other – Myoglobin, cytochromes and

enzymes.
 DAILY REQUIREMENT :

Adult male : 0.5 to 1mg

Adult female : 1- 2mg

Pregnancy and lactation :3-5mg

Dietary sources :
Liver, egg yolk, meat, fish, chicken, spinach, dry fruits,
wheat and apple.
Absoprtion :
 10% of iron is
absorbed.

 Heme or non
heme iron.

 Absorbed from
the duodenum in
the ferrous (Fe2+)
form.

 Heme iron better

absorbed than
the inorganic iron
Factors affecting iron absorption :
 Ascorbic acid, amino acids , meat , gastric acidity –
increase absorption.

 Antacids, phosphates, phytates, tetracyclines, presence

of food in the stomach decrease absorption.
Transported – Glycoprotein – Transferrin
Stored as Ferritin and Haemosiderin in liver, spleen and bone
marrow.

Excretion :
 Daily 0.5-1mg of iron is lost – Shedding of intestinal
mucosal cells and small amounts on the bile,
desquamated skin and urine.
 Females - Menstruation
 IRON
• Oral Iron preparations
– Ferrous sulphate
– Ferrous fumarate
– Ferrous gluconate
– Ferrous succinate
– Iron calcium complex
– Ferric ammonium citrate
 Ferrous salts are better absorbed than ferric salts and
are cheaper.

 Dose : Ferrous sulfate 200mg 3-4 tablets daily.

 ADVERSE EFFECTS :
• Epigastric pain
• Nausea Vomiting
• Metallic taste
• Constipation
• Diarrhea
• Staining of teeth – liquid preparations.
• Parenteral iron preparations
– Iron dextran : can be given by IM or IV route
– Iron sucrose I.V. use only
– Iron sorbitol citric acid complex
• Can be given by IM route only
 IRON
• Indications for oral iron therapy
– Iron deficiency anaemia
• During pregnancy
• Due to blood loss
• Due to nutritional iron deficiency
• Indications for parenteral iron therapy
– Intolerance to oral iron
– Severe malabsorption
– Poor compliance to oral iron
– Severe anaemia
– Severe bleeding due to trauma/accident
 Technique of giving parenteral iron
• Given by deep IM into gluteal region using “Z”
track technique to prevent staining of skin.
 IRON
Adverse effects of parenteral iron :
• Injection is painful
• Abscess or discolouration of skin at the site of
injection
• Nausea, vomiting, headache, lymphadenopathy,
anaphylactic reaction
 IRON POISONING
• Manifestations:
– Nausea, vomiting, abdominal pain, haematemesis,
bloody diarrhoea, drowsiness, dehydration, convulsions,
coma & death
• Treatment:
– Maintain airway, breathing, circulation
– Correct dehydration & electrolyte imbalance
– Gastric lavage with sodium bicarbonate
 IRON POISONING
– Antidote is Desferrioxime
• Given by IM or IV route
• It binds with iron & prevents its further
absorption and also facilitates iron excretion
 FOLIC ACID
• Causes of folate deficiency
– Dietary deficiency
– Decreased absorption - due to malabsorption
– Hepatic disease & Vitamin C deficiency
– Pregnancy & lactation – Increased demand
• Manifestations: Megaloblastic anaemia, glossitis,
diarrhoea, weight loss
• FUNCTIONS OF FOLIC ACID :
Converted to dihydrofolic acid then to
tetrahydrofolic acid which serves as co enzyme
for many reactions involved in DNA synthesis.
• DIETARY SOURCE :
Green vegetables, liver, yeast, egg, milk and some
fruits.
Absorption takes place in duodenum and jejunum.

Transported in the blood, widely distributed in the body

and is stored in the liver.

• DAILY REQUIREMENT :
Adults : 50 – 100 micrograms
Pregnancy and lactation : 200 - 400 micrograms
• USES:
– Megaloblastic anaemia
– Prophylaxis in pregnancy & lactation to prevent neural
tube defects
– To antagonise methotrexate toxicity ( Folinic acid ).
 FOLINIC ACID :
• Citrovorum factor, Leucovorin.

• N- Formyl tetrahydrofolic acid.

• Active co-enzyme form.

• Used in Methotrexate toxicity.

VITAMIN B12 (CYANOCOBALMIN):
• Water soluble vitamin B complex.
• Essential for normal DNA synthesis and
maturation of RBCs.
• Deficiency results in Megaloblastic anemia.

Characterized by :
Glossitis, stomatitis, malabsorption and
neurological manifestations.
Dietary source :
Liver , fish, egg yolk, meat, cheese and pulses.

Vit B12(extrinsic factor) is absorbed with the

help of intrinsic factor, a protein secreted by
stomach.
It is carried in the plasma as transcobalamin and
is stored in the liver.
Daily dietary requirements :
Adults : 1-3micrograms.
Pregnancy and lactation : 3-5micrograms.
 Causes of deficiency :
Gastrectomy, Chronic gastritis, malabsorption and
fish tapeworm infestation (it uses Vitamin B12).
Addisonian pernicious anemia :
Deficiency of intrinsic factor due to destruction of
parietal cells resulting in failure of Vitamin B12
absorption.
 Preparations :
 Cyanocobalamin – 100 micrograms / ml injection
may be given IM or deep SC .

 Hydroxycyanocobalmin – 100, 500, 1000

micrograms / ml injection has longer lasting
effect but hydroxocobalamin administration can
result in formation of antibodies.

 Multivitamin preparations contain variable

amounts of vitamin B12 with or without intrinsic
factor for oral use.
 Uses :
• Vitamin B12 deficiency – Prophylaxis and
treatment of megaloblastic anemia due to
vitamin B12 deficiency of any cause.

If Vitamin B12 deficiency is due to lack of intrinsic

factor, it is given IM or SC.
Oral folic should be added along with Vitamin B12
in order to meet the increased demand of folic
acid.
Prophylactic dose of vitamin B12 is 3-10microgram
daily.
• Vitamin B12 neuropathies.
 HEMATOPOIETIC GROWTH FACTORS :

Erythropoietin

Myeloid growth factors:

 GM – CSF
 G – CSF
 M – CSF

Megakaryocyte growth factors :

 Thrombopoietin
 Interleukin - II
• Erythropoietin :
Produced by the kidney in response to hypoxia
and anemia.
Binds to erythropoietin receptors on red blood cell
progenitors.
Stimulates red cell production.

Cause hypertension, thrombosis and allergic

reactions.
Uses :
 Anemia due to chronic renal failure.
 Bone marrow disorders.
 Malignancies
 Chronic inflammation and anemia associated
with AIDS.
 Myeloid growth factors :
GM – CSF (Granulocyte macrophage colony
stimulating factors) :
SARGRAMOSTIM

G – CSF ( Granulocyte colony stimulating

factors):
FILGRASTIM
Uses :
Bone marrow transplantation.
Following cancer chemotherapy.
Aplastic anemia
Congenital neutropenia
Myelodysplasia
Neutropenia in AIDS
• Megakaryocyte growth factors :
Thrombopoietin :
Increases production of platelets.
Used post cancer chemotherapy.
 Thank you !!
Have a nice day :)