Hematopoietic Vitamins, Erythropoietic Vitamins, Vitamin B12, Folic acid, Blood, Anemia, Vitamins, Hemopoietic Vitamins

1. HEMOPOIETIC VITAMINS
(GMERS Medical College,Himmatnagar)

2. SOME BASIC TERMS:
Hemopoiesis : Production of blood cells which occurs in bone
marrow .
Hematinics: RBC formation requires amino acids, iron, copper,
folic acid, vitamin B12, Vitamin B6, PLP & Pantothenic acid;All
these are used as hematinics in clinical practice.
Hemopoietic Vitamins: The vitamins required for blood cells
production, i.e. hemopoiesis , are called HEMOPOIETIC
VITAMINS.

3. How Vitamins help in Hemopoiesis?
• All hemopoietic vitamins work on same basic
principles:
1) Help in Heme synthesis
2) Help in DNA synthesis
• If there is any type of defect in one or both
processes, ANEMIA will be manifested.

4. VITAMIN B12
DNA SYNTHESIS
MATURATION OF
ERYTHROCYTES
VITAMIN B12
HEME SYNTHESIS
(along with folic acid)
HEMOGLOBIN
ERYTHROPOIESIS

5. VITAMIN B12 & FOLATE IN
DNA SYNTHESIS

6. Vitamin B12 in Heme Synthesis
• Vitamin B12, in the form of
5-deoxyadenosylcobalamin, acts
as coenzyme for enzyme
Methylmalonyl CoA mutase for
the conversion of Methylmalonyl
CoA to Succinyl CoA.
Porphyrins

7. FOLATE IN HEME SYNTHESIS

8. Another pathway:
Porphyrins
Serine Hydroxymethyl
Transferase
(PLP)

9. VITAMIN B12 DEFICIENCY
PERNICIOUS ANEMIA
(ADDISONIAN ANEMIA):
It is a type of Vitamin B12 Deficiency resulting
from impaired uptake due to lack of intrinsic
factor(IF), secreted from parietal cells of stomach.
• Vitamin B12 deficiency is most commonly seen in
malabsorption
MAJOR CAUSES:
1.AUTO-IMMUNE DESTRUCTION OF PARIETAL
CELLS:
 Parietal cells are responsible for synthesis of
intrinsic factor . Lack of IF prevents Vitamin
B12 absorption.
 Patients who have/had gastrectomy become
IF deficient and therefore Vitamin B12
deficient.
2.GENETIC DEFECT( CONGENITAL PERNICIOUS
ANEMIA) Very rare

10. MANIFESTATIONS: Neuropsychiatric problems,
Vomitting, heart burn, abdominal bloating and gas,
diarrhoea, loss of appetite & weight loss
ASSESSMENT:
Anti-IF antibodies in serum
Schilling Test: Vitamin B12 Deficiency test
TREATMENT: Intramuscular shots of Vitamin B12

11. MEGALOBLASTIC ANEMIA:
• Occurs due to the inhibition of DNA Synthesis during RBC
Production.
• The Cell Cycle cannot progress from G2 phase to Mitotic Phase
• As a result, MEGALOBLASTS & IMMATURE RBCs are formed
• These RBCs have fragile membrane and get broken down more
rapidy leadiing to short life span of RBCs.
MEGALOBLASTS IN PS
ASSESMENT OF VITAMIN B12 :
1)Methylmalonic aciduria
2)Serum B12 : quantitated by
radioimmunoassay or by ELISA
3)Peripheral smear : Bone marrow
morphology shows megaloblastic
anemia
4)Homocystinuria

12. FOLATE DEFICIENCY
MACROCYTIC ANEMIA:
• During RBC generation, DNA synthesis is delayed, but protein synthesis is
continued & hence, Hb accumulates in RBC precursors.
• The asynchrony or dissociation between the maturity of nucleus & cytoplasm is
manifested as IMMATURE NUCLEUS & MATURE EOSINOPHILIC CYTOPLASM
in BONE MARROW.
• RETICULOCYTOSIS is seen
• HEMOLYSIS occur due to rapid destruction of RBCs in spleen leading to their
short lifespan .
RBCs & WBCs
are
approximately
same sized
ASSESSMENT OF FOLATE DEFICIENCY:
1)FIGLU TEST
2)Serum Folate level: Normal folic acid level
in serum is about 20ng/mL. Measured by
radioimmunoassay
3) Peripheral picture: Macrocytic,
Hypochromic
4) Homocysteinuria

13. VITAMIN B6
(PLP)

14. VITAMIN B6 DEFICIENCY
Causes:
1) Pyridoxine inhibiting drug ( e.g. isoniazid)
2) Undernutrition and Malabsorption
3) Alcoholism
Manifestations:
1. Sideroblastic anemia
2. Neurological manifestations
3. Seborrheic Dermatitis
4. Hypochromic microcytic anemia

15. ASSESSMENT OF VIT. B6 DEFICIENCY
1)Plasma PLP: Less than 10nmol/L
2)Xanthurenic aciduria
3)Homocysteinuria
SIDEROBLASTIC ANEMIA
Treatment: Supplements of Vitamin B6

16. VITAMIN C
FOLIC ACID 7,8-DHFA 5,6,7,8-THFA
NADPH + H+ NADPH + H+NADP+
NADP+
FOLATE
REDUCTASE
FOLATE
REDUCTASE
VITAMIN C

17. •In food, iron is present mainly in two forms:
1)HEME IRON(in meat):
Directly absorbed with help of heme
transporter protein.
2)NON-HEME IRON(Inorganic Iron):
Inorganic iron is absorbed in Fe+2 form.
•Vitamin C, by acting as a reducing agent, reduces Fe+3 to Fe+2.
VITAMIN C IN IRON ABSORPTION

18. VITAMIN C DEFICIENCY
• IRON DEFICIENCY ANEMIA:
Causes:
1)Loss of Blood by Hemorrhage
2)Decreased uptake of iron
Clinical Features:
1)KOILONYCHIA: Nail becomes dry, soft and spoon shaped
2)ATROPHIC GLOSSITIS: Tongue becomes red in colour
3)ANGULAR STOMATITIS
4)PLUMMER-WILSON SYNDROME: Esophagus may develop
their membranous webs at the post cricoid area leading to
dysphagia
5)APATHY

19. Laboratory Diagnostics:
1)PS: Normoblastic, Hypochromic, Microcytic Anemia,
Anisopoikilocytosis
2)MCV,MCH,MCHC are decreased
3)Serum iron decrease - 50mg% (Normal :60-160mg%)
4)Serum ferritin is very low indicating poor tissue iron store
5)Erythroid hyperplasia
Treatment:
1)Oral administration of Ferrous ion
2)Supplements of Vitamin C: An intake of 25-50 mg Vit.C
enhance iron absorption.

20. PANTOTHENIC ACID
SH CH2-CH2-NH CO-CH2-CH2-NH CO-CHOH-C(CH3)2-CH2 O-P-O-P-O-Ribose-Adenine
Beta-
mercaptoethanolamine
Beta-alanine Pantothenate ADP
PANTOTHENIC ACID
COENZYME A
SUCCINYL CO A
HEME SYNTHESIS
4’Phosphopantotheine
STRUCTURE OF CO-ENZYME A

21. SOURCES OF HEMOPOIETIC VITAMINS
HEMOPOIETIC VITAMINS SOURCES
VITAMIN B12 Liver, eggs, fish, cheese, milk and dairy products
FOLIC ACID Green leafy vegetables, yeast, cereals, pulses
VITAMIN B6 Yeast, Wheat, cereals, legumes, milk, egg, fish
VITAMIN C Amla(Indian gooseberry), guava, lemon, etc.
VITAMIN B5 Intestinal flora, yeast, liver eggs

22. THANK YOU!