The document discusses haematinics, which are substances that stimulate red blood cell production or increase haemoglobin levels. It describes various types of anaemia, haematinics like iron, vitamin B12, and folic acid, and their roles, administration, and side effects in treatment of anaemia. It also discusses plasma expanders which are intravenous fluids used to increase blood volume. Various plasma expanders are detailed, including crystalloids like saline and ringers solution, and colloids like albumin, dextran, gelatin, hydroxyethyl starch, and polyvinylpyrrolidone. Their mechanisms, uses, properties and potential adverse effects are outlined.

1. Dr. ABHIPSA PATRA
Dept of Pharmacology
VIMSAR BURLA

2. Haematinics
These are substances required in the
formation of blood & are used for
treatment of anaemias.
 agents that
- stimulate the production of red
blood cells or
- increase the amount of
haemoglobin in the blood.

3.  Anaemia is usually defined as adecrease
in amount of red blood cells or
hemoglobin in theblood.
 There are different classifications of
anaemia based on morphology & patho
physiology.
Anaemia

4. On the basis of morphology
.
Anemia
1.Normocytic
normochromic
2.Microcytic
hypochromic
3.Macrocytic

5. On the basis of Patho-physiology
Anemia
1.Blood loss 2.Impaired RBC
production
3.Haemolytic

6. Causesof Anemia
1.Blood loss
2. Inherited condition
3. Impaired RBCproduction
4. Kidney disease

7. 1.Easyfatigue & energyloss
2.Dizziness
3.Pale skin
4.Headache
5.Usually rapid heartbeat
Symptoms of anemia

8. Treatment of Anaemia:-
Haematinics
The important haematinics are– 1.Iron
2.Vitamin-B12
3.FolicAcid
Haematinics are the agents that
stimulates the production of red blood
cells or increase the amount of
haemoglobin inblood.
The important haematinics are-
1. Iron
2. Vit B12
3. Folic Acid

9. Iron is an essential mineral that is required
for human life.Much of the iron in the body
is found in red blood cells.
Distribution of iron in body:
Haemoglobin – 66%
Iron stores as ferritin & haemosiderin – 25%
Myoglobin – 3%
Parenchymal iron – 6%

10. Adult male : 0.5-1 mg .
Adult female : 1-2 mg.
Infants : 60microgm /kg.
Children : 25microgm /kg.
Pregnancy (last 2 trimesters) : 3-5 mg.
Dietary sourses:
Rich: Liver, egg yolk,oyster, dry beans, dry fruits,
wheat germ, yeast
Medium: Meat, chicken, fish, spinach, banana, apple
Poor: Milk & its products, root vegetables

11. The major part of dietary iron is
inorganic & in the ferric form. It
needs to be reduced to the ferrous
form before absorption.
Its absorption occurs all over in the
intestine.

12. Iron is transported into erythropoietic & other
cells .
Iron dissociated from the complex at the acidic
pH of the intracellular vesicles, the released iron
is utilized for haemoglobin synthesis .
Stored in RE cells in liver, spleen bone
marrow, also in hepatocytes & myocytes as
ferritin .
Excreted through sweat ,very little in
urine, desquamated skin, in some RBCs and in
bile(all lost in faeces).

13. Factors affecting Iron Absorption
Facilitating
absorption
 1. Acid
 2. Reducing
subtances
- ascorbic acid
3. Meat
Impending
absorption
 1. Alkalies ( antacids)
 2. phosphates
 3. phytates
 4. Tetracyclines
 5. presence of other
food in stomach

14. Oral Iron Preparation:
1. Ferrous Sulfate- Fersolate200mg tab.
2. Ferrous gluconate- Ferronicum 300mg
tab,400mg/15ml.
3. Ferrous fumarate- NORI-A 200mg tab.
4. Colloidal ferric hydroxide-Neoferum 200mg
tab, 400mg/5ml liquid, 100mg/ml drops.

15. Parenteral Iron Preparation
1. Iron dextran: - 2ml ampule,
dose: - 1.5mg/5ml/day
2. Iron sorbitol citric acid
complex- 1.5ml ampoule.

16. Therapeutic use ofIron preparation
1.Treatment ofiron deficiency
anemia
2. Pregnancy lactation
3.Infants growing
phase
4.Professional blood
donors

17. Adverse effects-
Epigastric pain
Heartburn
Nausea ,vomiting
Metallic taste
Constipation
Staining of teeth
On parenteral route: Pain at inj site,
headache, fever, palpitation, dyspnoea,
chest pain
On IV administration: anaphylactic shock

18. ACUTE IRON POISONING
 occurs mostly in infants and children
 10–20 iron tablets or equivalent of the liquid
preparation (> 60 mg/kg iron) may cause serious
toxicity in them. very rare in adults.
 Manifestations are vomiting, abdominal pain,
haematemesis, diarrhoea, lethargy, cyanosis,
dehydration, acidosis, convulsions; finally shock,
cardiovascular collapse and death.
 In few cases death occurs early (within 6 hours), but
is typically delayed to 12–36 hours, with apparent
improvement in the intervening period.

19. TREATMENT
 Should be prompt to prevent further absorption of iron from gut
 (a) Induce vomiting or perform gastric lavage with sodium
bicarbonate solution—to render iron insoluble.
 (b) Give egg yolk and milk orally: to complex iron.
 To bind and remove iron already absorbed Desferrioxamine (an
iron chelating agent) is the drug of choice. It should be injected
i.m. 0.5–1 g (50 mg/kg in children) repeated 4–12 hourly as
required, or i.v. (if shock is present) 10–15 mg/kg/hour; max 75
mg/kg in a day till serum iron falls below 300 µg/dl.
 Alternatively, DTPA or calcium edetate may be used.

20. Supportive measures
 Fluid and electrolyte balance should be
maintained and acidosis corrected by appropriate
i.v. infusion.
 Respiration and BP may need support.
 Diazepam i.v. may be cautiously used to control
convulsions, if they occur.

21. Deficiency of vit B12 & folic acid, result in
megaloblastic anaemia characterized by the
presence of large red cell precursors in bone
marrow & their large & shortlived progeny
in peripheral blood.
- vit B12 & folic acid are therefor called
maturation factors.

22. Cyanocobalamin & hydroxocobalaminare
complex cobalt containing compounds
present in the diet & referred to as vit
B12.
Daily requirement:
1-3 mg,pregnancy & lactation 3-5mg.

23. It occurs as yellow crystals which are
insoluble in water, but its sodium salt is
freely water soluble.
Daily requirement:
In adult is <0.1mg but dietary allowance
of 0.2mg/day is recommended.
During pregnancy , lactation 0.8mg/day is
considered appropriate.

24. B12-Cyanocobalamin:
Patients with gastric,ileal resections, small
bowel disease or malabsorption require
parental use.
Iron :
Best to give on empty stomach but can be given
with food to decrease gastric upset.
Assess haemoglobin levels & bowel
movement as constipation is common.
Folic acid:
Contraindicated in uncorrected pernicious
anemia.

25. ERYTHROPOIETIN
 Erythropoietin (EPO) is a hormone produced by peritubular cells of
the kidney, essential for normal erythropoiesis.
 Anaemia and hypoxia are sensed by kidney cells and induce rapid
secretion of EPO
 (a) Stimulates proliferation of colony forming cells of the
erythroid series
 (b) Induces haemoglobin formation and erythroblast maturation.
 (c) Releases reticulocytes in the circulation
 Epoetin α, β :-
 It is recombinant human erythropoietin,
 administered by i.v. or s.c. injection

26. USE & ADVERSE EFFECTS
 The primary indication is anaemia of chronic renal failure which is
due to low levels of EPO. Only for symptomatic patients with Hb ≤ 8
g/dl s
 Other uses are:
 1. Anaemia in AIDS patients treated with zidovudine.
 2. Cancer chemotherapy induced anaemia.
 3. Preoperative increased blood production for autologous
transfusion during surgery.
 Adverse effects:
 increased clot formation in the A-V shunts (most patients are on
dialysis), hypertensive episodes or persistently raised BP, serious
thromboembolic events, occasionally seizures. Flu-like symptoms
lasting 2–4 hr occur in some patients.
 Darbepoetin α :
- a hyperglycosylated modified preparation of EPO

27. Dr. ABHIPSA PATRA
Dept of Pharmacology
VIMSAR BURLA
PLASMA EXPANDERS

28. Blood:
Blood is a fluid connective tissue that circulate
continuously around the body, allowing constant
communication between tissues distant from each
other.
Plasma:
A clear, straw coloured, watery fluid in which several
different types of blood cells are suspended.

29. Blood and plasma volume expanders
Plasma expanders are agents that have relatively high
molecular weight and boost the plasma volume by
increasing the osmotic pressure.
They are used to treat patients who have suffered
hemorrhage or shock.

30. Volume Expanders contd..
Volume expanders are the intravenous fluid solutions
that are used to increase or retain the volume of fluid
in the circulating blood.
These are used to correct hypovolemia due to
loss of plasma or blood.

31. Types of volume expanders
There are two main types of volume expanders:
1.Crystalloids: crystalloids are aqueous solutions
of mineral salts or other water-soluble
molecules. E.g. normal saline, dextrose,
Ringer’s solution etc.
2.Colloids: Colloids are larger insoluble molecules,
such as dextran, human albumin, gelatin, blood.
Blood itself is a colloid.

32. Colloids are better than Crystalloids
because:
The larger molecules of colloids are retained more
easily in the intravascular space & increase osmotic
pressure.
So, more effective resuscitation of plasma volume
occurs by colloids than produced by that of
crystalloids.
Duration of action is relatively longer than
crystalloids.

34. Ideal properties of PVEs.
Iso-oncotic with plasma
Distributed to intravascular compartment only
Pharmacodynamically inert
Non-pyrogenic, non-allergenic & non-antigenic
No interference with blood grouping or cross-
matching
Stable, easily sterilizable and cheap.

35. Generally used Plasma expanders
Human albumin
Dextran
Degraded gelatin polymer (Polygeline)
Hydroxyethyl starch (Hetastarch/HES)
Polyvinyl pyrrolidone (PVP)

36. Mechanism of action:
 Generally works on the principle of osmosis.
 Increases Plasma osmotic pressure, drawing
water into plasma from interstitial fluid.

37. Uses Of Plasma Expanders
Used in conditions where blood or plasma has been
lost or has moved to extravascular compartments
e.g., in burns, hypovolaemic shock, endotoxin
shock, severe trauma and extensive tissue
damage.
Can also be used as a temporary measure in
cases of whole blood loss till the same can be
arranged.
Note: They do not have oxygen carrying capacity.

38. Some Volume Expanders
1.Human Albumin
It is obtained from pooled human plasma.
It can be used without regard to patient’s blood
group and doesn’t interfere with coagulation.
It is free of risk of transmission of hepatitis because
the preparation is heat treated.
St. ofAlbumin

39. Contd…
Crystalloid solution must be infused concurrently
for optimum benefit.
It has been used in acute hypoproteinaemia, acute
liver failure and dialysis.
It is comparatively expensive.
Available products:
 Albudac, Albupan 50, 100 ml inj.,
 Albumed 5%, 20% infusion (100 ml)

40. 2.Dextran
It is highly branched polysaccharide molecule
obtained from sugar beat .
It is produced by using the bacterial enzyme
dextran sucrase from the bacterium Leuconostoc
mesenteroides which grows in a sucrose medium.
Most commonly used plasma expanders and is
available in two forms.
1.Dextran 70
2.Dextran 40

41. a) Dextran 70
1.It is most commonly used preparation.
2.It expands plasma volume for nearly 24 hrs.
3.Excreted slowly by glomerular filtration as well as
oxidized in body over weeks .
4.and some amount is deposited in retuculo-
endothelial cells.

42. Dextran 70 has nearly all the
properties of an ideal plasma
except:
 It may interfere with blood grouping and cross
matching.
 It can interfere with coagulation and
platelet function and thus prolong bleeding time .
 Some polysaccharide reacting antibodies, if present,
may cross react with dextran and trigger anaphylactic
reaction like Urticaria, itching, bronchospasm, fall in
BP
.

43. b) Dextran 40
It is 10% solution in Dextrose or Saline.
It acts more rapidly than dextrose-70.
It reduces blood viscosity .
It is excreted through renal tubules and occasionally may
produce acute renal failure.
The total dose should not exceed 20 ml/kg in 24 hr.
Dextrans can be stored for 10 years and are cheap so are
the most commonly used plasma expanders.
Caution: Dextran doesn’t provide necessary electrolytes and
can cause hyponatremia or other electrolyte disturbances.

44. 3. Degraded gelatin polymer (polygeline)
It is synthetic polymer (polypeptide) of MW-30,000.
It doesn’t interfere with blood grouping and
cross matching and is non-antigenic.
Expands plasma volume for 12 hrs.
It is more expensive than dextran and can also be used
for priming of heart-lung and dialysis machines.
Brands:
Haemaccel; Seraccel 500 ml vaccine.

45. 4. Hydroxyethyl starch(Hetastarch)
It is a complex mixture of ethoxylated
amylopectin of various molecular sizes;
average MW 4.5 lacs.
It maintains blood volume longer.
It doesn’t cause acute renal failure or
coagulation disturbances.
It improves hemodynamic status for 24 hrs.

46. Hetastarch contd..
Adverse effects:
Vomiting, mild fever, itching, chills, flu like symptoms, swelling
of salivary glands, Urticaria, bronchospasm etc.
Brand:
Expan 6% inj (100 , 500 ml)
It has also been used to improve harvesting of granulocytes because
it accelerates erythrocyte sedimentation.
Adverse effects: Anaphylactic reactions, mild fever, chilling,
periorbital edema, Urticaria, itching .

47. 5. Polyvinylpyrrolidine(PVP)
It is a synthetic polymer of average MW 40,000
used as a 3.5% solution.
PVP was used as blood plasma expander
for trauma victims after the 1950s.
It interferes with blood grouping and cross
matching and is histmine releaser.
It binds to penicillin and Insulin.

48. Contd….
It is excreted by kidney and small amounts by liver
into
bile.
A fraction is stored in RE cells for prolonged
periods.
It is less commonly used plasma expander.
Sample of PVP

49. Some Crystalloids:
1. Normal Saline (Isotonic):
It is the crystalloid fluid containing 0.9% NaCl.
NS is frequently used in patients who cannot take fluids orally
and have developed dehydration or hypovolemia.
2. Lactated Ringer’s solution
It was introduced in 1880 by Sydney ringer, a British physician.
The solution was designed to promote the contraction of frog
hearts and was contained with calcium and potassium in a NaCl
diluents .
It is contraindicated as diluents for blood transfusions.

50. 3.Dextrose solutions:
Generally 5% dextrose solutions are used which
provides 170 kcal/lit.
It is IV sugar solution which provides some energy to
the body parts.
Osmolarity is lower than serum.
Useful when Kidney function is Impaired.

51. Contraindications to plasma
expanders
Allergy
Heart failure
Severe anaemia
Thrombocytopenia
Pulmonary edema
Renal insufficiency.

52. Some commercially used
Plasma volume expanders.

53. Thankyou