This document discusses hematinics, which are compounds required for blood formation and treatment of anemia. The major hematinics discussed are iron, vitamin B12, and folic acid. Details provided include daily requirements, dietary sources, pharmacokinetics, preparations, administration, uses and nursing implications of these hematinics. Hematopoietic growth factors that regulate red blood cell production such as erythropoietin and myeloid growth factors are also summarized.

1. Hematinics
Dr. Binu Babu
Ph.D, M.Sc. (N), MBA
Mrs. Jincy Ealias
M.Sc. (N)

2. Hematinics
• Hematinics are the compounds or nutrients
required in the formation of blood (hematopoiesis)
and are used for the treatment of anemia.
• Major Hematinics are;
• Iron
• Vitamin B12
• Folic acid

3. Iron

4. Iron
• Iron is essential for the production of hemoglobin.
Daily Requirement of Iron
• Adult male 0.5-1 mg
• Adult female 1-2 mg
• Pregnancy and lactation 3-5 mg
Dietary sources of iron
• Fish, chicken, spinach, liver, egg yolk, meat,
dry fruits, wheat, jaggery, apple, banana.

5. Pharmacokinetics
• The average Indian diet provides about 10-20 mg
of iron.
• Only 10% of dietary iron is absorbed.
• Inorganic ferrous iron (from non vegetarian
sources) is better absorbed than ferric iron (from
vegetarian sources).
• Maximum absorption taken place in the
duodenum and upper jejunum.

6. • Iron is transported with the help of a glycoprotein
transferrin and stored as ferritin and hemosiderin,
in the liver, spleen and bone marrow.
• Excretion: Daily 0.5-1 mg of iron is excreted. In
females, iron is also lost in menstruation.

7. Factors influence iron
absorption
Increase absorption
• Ascorbic acid
• Amino acids
• Meat
• Increased gastric
acidity
Decrease absorption
• Antacids
• Phosphates
• Phytates
• Tetracyclines
• Presence of food in
the stomach

8. IRON PREPARATIONS
Iron is available both in oral and parenteral forms.
Indications
• For treatment
• Iron deficiency
anemia
• Pregnancy
• Blood loss
• Poor iron absorption
from gut
• For prophylaxis
• Iron deficiency anemia
• Pregnancy
• Lactation
• Chronic illness

9. Oral Iron Preparations
• Used for long term therapy.
1. Ferrous sulphate-200 mg tab
• Most economical form of iron.
• Available commercially and in government supplies.
2. Ferrous fumarate-200 mg tab
3. Ferrous gluconate-300 mg tab
4. Ferrous succinate-100 mg
5. Iron calcium complex-5% iron
6. Ferric ammonium citrate-45 mg

10. Adverse Effects of Oral Iron
• Epigastric pain
• Nausea
• Vomiting
• Gastritis
• Metallic taste
• Constipation (due to astringent effect) or diarrhea
(irritant effect)
• Liquid preparations cause staining of teeth.

11. Parenteral iron preparations
Indications
• When oral iron is not tolerated
• Failure of absorption-as in malabsorption, chronic
bowel disease
• Noncompliance to oral iron
• Severe deficiency with bleeding.
• Post gastrectomy patients

12. Preparations
• Iron dextran
• Given IV/IM
• Iron-sorbitol-citric acid complex
• Given only IM
• Ferrous sucrose
• Given only IM
• Ferric carboxymaltose

13. Administration
• Given deep IM in the gluteal region using 'Z
technique to avoid staining of the skin.
• Intravenous iron is given slowly over 5-10 minutes
or as infusion (diluted in 500 ml of NS or glucose
and infused over 6-8 hrs) after a test dose.
• Oral iron should be stopped 24 hours before
starting parenteral iron therapy and not restarted
until five days after the last injection.

14. Adverse effects of parenteral preparation
Local:
• Pain at the site of
injection
• Pigmentation of
the skin
• Abscess at the
site of injection
Systemic:
• Fever
• Headache
• Nausea, vomiting
• Joints pain
• Enlargement of lymph node
• Palpitation
• Difficulty in breathing
• Anaphylaxis (rarely)

15. Iron poisoning
• Common in infants and children
• Due to accidental ingestion of about 10 iron tablets, can be
lethal.
Manifestations
• Vomiting
• Abdominal pain
• Hematemesis,
• Bloody diarrhea
• Shock
• Drowsiness
• Cyanosis
• Acidosis,
• Dehydration
• Cardiovascular collapse
• Coma

16. Treatment
• Treatment should be initiated immediately as
death may occur in 6-12 hours.
• Gastric lavage with sodium bicarbonate solution
• Desferrioxamine is the antidote. It is instilled
into the stomach after lavage, to prevent iron
absorption; also injected IV/IM.
• Correction of acidosis and shock.

17. Vitamin B12

18. Vitamin B12
• Cyanocobalamin
• Essential for DNA synthesis and RBC maturation.
Dietary sources
• Liver, fish, egg yolk, meat, cheese and pulses
Daily requirement
• Adults 1-3 μg
• Pregnancy and lactation 3-5 μg

19. Pharmacokinetics
• Vitamin B12 is absorbed with the help of
intrinsic factor, a protein secreted by the
stomach.
• It is carried in the plasma by B12-binding
proteins called transcobalamin and is stored
in the liver.

20. Preparations
• Cyanocobalamin
• 100 μg/ml injection may be given IM or deep
SC
• Hypersensitivity reactions can occur
• Hydroxocobalamin
• 100, 500, 1000 μg/ml injection
• Has long lasting effect but can result in the
formation of antibodies.
• Multivitamin preparations – oral form

21. Administration
• Vitamin B12 replacement therapy is given by
intramuscular injection.
• Hydroxocobalamin is preferred, given as an
initial loading dose followed by three monthly
maintenance treatment for life.

22. Uses
Prophylaxis and treatment
• Megaloblastic anemia
• Pernicious anemia
• Needs life long treatment with vitamin B12
• Prophylactic dose of vitamin B12 is 3-10 mcg
daily.
• Intestinal malabsorption
• B12 neuropathies like subacute combined
degeneration respond to vitamin B12

23. Folic Acid

24. Folic Acid
• Essential for DNA synthesis and RBC maturation.
Dietary source:
• Egg, Green vegetables, liver, yeast, milk
Daily requirement
• Adults 50-100 μg
• Pregnancy and lactation 200-400 μg

25. Pharmacokinetics
• Absorption takes place in the jejunum and is
transported in the blood by active and passive
transport, and is stored in the liver.

26. Uses
• Megaloblastic anemia
• Folic acid 2-5 mg/day is given orally along with
vitamin B12.
• Malabsorption syndrome
• Folic acid is given IM.
• Prophylactically in pregnancy, lactation,
infancy
• 500 mg daily orally.

27. Haematopoietic
growth factors

28. Hematopoietic growth factors
• Hematopoietic growth factors are hormones that
regulate erythropoiesis.
• Hemotapoietic Growth Factors Include:
• Erythropoietin
• Myeloid growth factors
• GM-CSF
• G-CSF
• M-CSF
• Megakaryocyte growth factors
• Thrombopoietin
• Interleukin-II

29. Erythropoietin
• Stimulates RBC production.
Uses
• Treatment of anemia in chronic renal failure,
bone marrow disorders, malignancies, chronic
inflammation & anemia associated with AIDS.
Mechanism of action
• Erythropoietin binds to erythropoietin
receptors on red cell progenitors and
stimulates RBC production.

30. Preparations
• Epoetin
• Given thrice weekly in a dose of 25-100 units/kg by
IV/SC route.
• Darbepoetin
• Given once weekly or once every 2-4 wks.
• Given in a dose of 0.45 mcg/kg by IV/SC route once
weekly.
Adverse effects
• Hypertension
• Allergic reaction
• Thrombosis

31. Myeloid growth factors
Myeloid growth factors include
• Granulocyte - macrophage colony stimulating
factor (GM-CSF)
• Granulocyte colony stimulating factor (G-CSF)
• Monocyte colony stimulating factor (M-CSF)

32. Mechanism of action
Myeloid growth factors bind to specific receptors
on the myeloid progenitor cells
Stimulates proliferation and differentiation of
neutrophils and monocytes
Adverse effects
• Bone pain
• Fever
• Arthralgia
• Myalgia
• Dyspnea

33. Uses
• Bone marrow transplantation
• Following cancer chemo-therapy
• Aplastic anemia
• Congenital neutropenia
• Myelodysplasia
• AIDS patients with neutropenia

34. Megakaryocyte Growth Factors
1. Thrombopoietin
• Increases the production of platelets.
Uses
• Thrombocytopenia following cancer chemotherapy.
• Drug-induced thrombocytopenia
• Bone marrow transplantation

35. 2. Interleukin-II
• Enhances megakaryocyte maturation.
• Given daily via subcutaneous injection until the
platelet count >10000/μl.
Side effects
• Fluid retention and associated cardiac symptoms
• Injection site reactions
• Paraesthesias
• Blurred vision
Uses
• Thrombocytopenia

36. Nursing implications
• Assess for contraindications or cautions and
any known allergies to the drug to be
administered to avoid hypersensitivity
reactions.
• Ensure that iron deficiency anemia is
confirmed before administering drugs to
ensure proper use of the drug.
• Administer the oral form of iron with meals
that do not include eggs, milk, coffee, and
tea to prevent Gl irritation.

37. • Nurse should educate the patient, to take iron
with citrus juices to enhance its absorption.
• Patient should be educated regarding good
dietary habits and importance of taking balanced
diet.
• Take measures to alleviate constipation.
• IV infusion of iron should be given slowly to
prevent hypersensitivity.
• Monitor for adverse effects.