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1. Hematinics.pptx
- 1. Yenepoya Pharmacy College& Research Centre Yenepoya (Deemed to be University), Deralakatte, Mangaluru Haematinics By Tahreen Taj Asst. Professor YPCRC
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- 3. Hematinics These are substancesrequired in the for formation of blood, and are used treatment of anaemias Iron Vitamin B12 Foli c acid
- 4. Anemia Anaemia is acondition of RBC/Hb deficiency and occurs when there is an imbalance between production and destruction of RBC
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- 6. Causes of Anemia Bloodloss (acute orchronic) Impaired red cell formation dueto: Deficiency of essential factors, i.e. iron, vit- B12, FA. Bone marrow depression (hypoplastic anaemia), erythropoietin deficiency. Increased destruction of RBCs(haemolytic anaemia)
- 7. IRON Essential body component Normalrange of Iron in adults is 2.5 – 5 g It is present in following forms in the body • 66 % Hemoglobin • 25 % Ferritin and Hemosiderin • 3 % Myoglobin • 6% • Cytochromes, catalases,xanthine oxidases etc… Parenchymal Iron
- 8. Hemoglobin = Heme+ Globin
- 9. Dietary sources Rich: Liver,egg yolk, oyster, dry beans, dry fruits, wheat germ, yeast. Medium: Meat, chicken, fish, spinach, banana, apple Poor: Milk products, rootvegetables
- 10. Pharmacokinetics of Iron Ironabsorption Factorsaffecting ionabsorption Mucosalblock Transport, utilization, storage andexcretion
- 11. Essentials of medicalpharmacology by K.D.Tripati, JAYPEE 2008
- 12. Iron absorption Elsevier, kumaret al: Robins basic pathology
- 13. Factors affecting Ironabsorption Acid Reducing substances Meat Factors Facilitating Factors Impending Tea, coffee, antacids Phosphates Phytates Tetracyclins Presence of food
- 14. Transport & Utilization Fe2+ transported to blood is oxidized toFe3+ It complexes with Transferrin (Tf) inplasma Fe-Tf-Fe complex enters RBC through transferrin receptors (TfR) by endocytosis Iron dissociates at acidic pH and will be utilized to form Hb.
- 15. Storage Stored in REcells of liver, spleen, bone marrow, hepatocytes and myocytes by iron status in Apoferritin synthesis is regulated the body Fe Less- less Af, more Tf Fe More – More Af Excretion 0.5 – 1 mg per day Highly conserved Excreted by shedding of mucosal cells, bile, desquamatted skin, urine and sweat Menstruation
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- 17. Iron oral formulations Preferredroute Ferrous salts preferred- cheap, high iron content, better absorption Preparations 1. Ferrous sulfate(20-32 %): cheapest. It often leaves a metallic taste in mouth- 200mg tab 2. Ferrous gluconate (12% iron): 300 mg tab 3. Ferrous fumarate (33% iron): is less water soluble than ferrous sulfate and tasteless; 200 mg tab 4. Colloidal ferric hydroxide; 50 mg/ml drops
- 18. Indications of OralIron therapy Prophylactic use: Pregnancy from 4th month to lactation Menstruation Infancy andchildhood Prematurebabies Professional blooddonors
- 19. Therapeutic use Iron deficiencyanemia (due to menorrhagia, peptic ulcer, piles, hookworm infection) Mal-absorption syndrome Anemia of pregnancy Severe pernecious anemia Adverse effects pain, vomiting, Epigastric nausea, heart pain Bloating, staining of teeth, metallic taste is more than Constipation common diarrhoea
- 20. Acute Iron Poisoning •It occurs mostly in infants and children • 10-20mg tablets or equivalent of the liquid preparation (> 60 mg/kg iron) may cause serious toxicity • It is very rare in adults. • Manifestations - vomiting, abdominal pain, diarrhoea, dehydration, acidosis, convulsions.
- 21. Treatment for AcuteIron Poisoning • It should be prompt. • To prevent further absorption of iron from gut a) Induce vomiting or perform gastric lavage with sodium bicarbonate. b) Give egg yolk and milk orally: to complex iron. Activated charcoal does not adsorb iron. • To bind and remove iron already absorbed Desferrioxamine, Alternatively DTPA or calcium edetate • Supportive measures: • Fluid and electrolyte balance should be maintained Respiration and BP may need support. • Diazepam i.v. should be cautiously used to control convulsions, if they occur.
- 23. Maturation factors Vitamin –B12 Folic acid
- 25. Vitamin-B12 (COBALAMIN) • Complexcobalt containing compounds • Synthesized from microorganisms • Dietary sources- liver, kidney, seafish, egg yolk, meat • Vegetables and fruits lack cobalamin • Daily requirement: 1-2ug, pregnancy and lactation-3-5 • ug/day
- 26. Metabolic functions ofVit-B12 Conversion of homocystein to methionine Propionic acid metabolism (Succinic acid producion) Fattyacid synthesis (phospholipids and myelin) in neural tissue Required for cell growth and multiplication Folate metabolism
- 27. Pharmacokinetics Absorption: Present infood conjugate and will be released during cooking and forms complex with intrinsic factor and will absorbed into the intestine actively Transportation: Transcobalamin II Storage: liver Degradation: not degraded in the body. Excreted through bile
- 28. Vit – B12 Deficiency Megaloblasticanemia Gastric mucosal damage Degeneration of spinal cord Peripheral neuritis Poor memory, mood changes Preparations Cyanocobalamine injection Hydroxocobalamin injection Methylcobalamin tablets
- 29. Uses Vit B12 deficiency Prophylacticallyin diabetes and alcoholics Neuropathies, psychiatric disorders Tobacco amblyopia Adverse effects Safe Allergicreactions due to contaminants
- 30. Folic acid Contain 2-8molecules of glutamicacid Humans obtained do not synthesize FA but from green leafy vegeables, milk, meat and egg Synthesized by gutflora
- 31. Metabolic functions ofFA FA DHFA THFA Conversion of homocystein tomethionine Conversion of serine toglycine Purinesynthesis Synthesis ofthymidylate Histidinemetabolism
- 32. Pharmacokinetics of FA Route:oral, parenteral Absorption: from proximaljejunum Excretion: urine andstool
- 33. Uses Megaloblastic anemia Pregnant women Prematureinfants Hemolytic anemia Liver disease Renal dialysis Methotrexate toxicity Megaloblastic anemia Neural tubedefect Allergicreactions due to contaminants Deficiency of FA
- 34. It regulates redblood cell proliferation and differentiation in bone marrow