blood

1. Drugs affecting bloodDrugs affecting blood
and blood formationand blood formation

2. IronIron
Mucosal block theoryMucosal block theory
Fe reaching the mucosal cells—Fe reaching the mucosal cells—
transported into plasma/oxidised to ferrictransported into plasma/oxidised to ferric
form and complexed with apoferritin toform and complexed with apoferritin to
form ferritinform ferritin
Ferrtin is stored in mucosal cellsFerrtin is stored in mucosal cells
Shed after its life span ofShed after its life span of 2-4 days2-4 days

3. Oral formulations of FeOral formulations of Fe
FerrFerrousous salts are usedsalts are used
CheapCheap
High Fe contentHigh Fe content
Better absorbedBetter absorbed
Adr- gastric irritation and constipationAdr- gastric irritation and constipation

4. Oral formulationsOral formulations
Ferrous sulphate---20% FeFerrous sulphate---20% Fe
Ferrous gluconate---12%Ferrous gluconate---12%
Ferrous fumarate---33%Ferrous fumarate---33%
Colloidal ferric hydroxide---50%Colloidal ferric hydroxide---50%

5. Adr of oral FeAdr of oral Fe
Epigastric painEpigastric pain
Heart burnHeart burn
NauseaNausea
VomitingVomiting
Staining of teethStaining of teeth
Metallic tasteMetallic taste
BlotingBloting
ColicColic
Constipation/diarrhoeaConstipation/diarrhoea

6. p.e. Fe formulationsp.e. Fe formulations
Fe –dextran-colloidal solutionFe –dextran-colloidal solution
containing 50mg elemental Fe/mLcontaining 50mg elemental Fe/mL
Iron-sorbitol-citric acidIron-sorbitol-citric acid complex-50mg fecomplex-50mg fe
/ml/ml

7. Fe requirementFe requirement
4.4*body wt (kg) * Hb deficit4.4*body wt (kg) * Hb deficit
(g/dl)(g/dl)

8. Acute Fe poisoningAcute Fe poisoning
Mostly in infants and childrenMostly in infants and children
10-20 Fe tab10-20 Fe tab
>60mg/Kg B.Wt>60mg/Kg B.Wt

9. Clinical featuresClinical features
VomitingVomiting
Abdominal painAbdominal pain
HaemetemesisHaemetemesis
DiarrhoeaDiarrhoea
LethargyLethargy
CyanosisCyanosis
DehydrationDehydration
AcidosisAcidosis
ConvulsionsConvulsions
ShockShock
Collapse and deathCollapse and death

10. Pathological lesion isPathological lesion is
1.1. HaemorrhageHaemorrhage
2.2. Inflammation in the gutInflammation in the gut
3.3. Hepatic necrosisHepatic necrosis
4.4. Brain damageBrain damage

11. treatmenttreatment
1.1. To prevent further absorption of feTo prevent further absorption of fe
2.2. To bind and remove fe already absorbedTo bind and remove fe already absorbed
3.3. Supportive measuresSupportive measures

12. To prevent frthr absTo prevent frthr abs
1.1. Induce vomitingInduce vomiting
2.2. Perform gastric lavage with sodiumPerform gastric lavage with sodium
bicarbonatebicarbonate
3.3. Give egg-yolk and milk orallyGive egg-yolk and milk orally —to—to
complex fe . Activated charcoal does notcomplex fe . Activated charcoal does not
adsorb feadsorb fe

13. To bind and remove Fe alreadyTo bind and remove Fe already
absorbedabsorbed
DesferrioxamineDesferrioxamine
Fe chelating agentFe chelating agent
Injected i.m.Injected i.m.
50mg/Kg repeated 4-12 hourly50mg/Kg repeated 4-12 hourly
Till serum fe falls below 300micro gram/dlTill serum fe falls below 300micro gram/dl
Alternative-DTPA,calcium edetateAlternative-DTPA,calcium edetate

14. SupportiveSupportive
Diazepam i.v.---if convulsionsDiazepam i.v.---if convulsions

15. FOLINIC ACID/leucovorinFOLINIC ACID/leucovorin
Methotrexate therapyMethotrexate therapy
Does not need to be reduced by DHFRDoes not need to be reduced by DHFR
Methotrexate inhibits DHFRMethotrexate inhibits DHFR
Toxicity of methotrexate is notToxicity of methotrexate is not
counteracted by folic acid….but by foliniccounteracted by folic acid….but by folinic
acidacid

16. ErythropoetinErythropoetin
Produced by peritubular cells of kidneyProduced by peritubular cells of kidney
Anaemia---rapid secretion of EPO---Anaemia---rapid secretion of EPO---
Bone marrowBone marrow
1.1. Stimulates colony forming cells ofStimulates colony forming cells of
erythroid serieserythroid series
2.2. Induces haemoglobin formation andInduces haemoglobin formation and
erythoblast maturationerythoblast maturation
3.3. Release of reticulocytes in circulationRelease of reticulocytes in circulation

17. Indication of Epoetin alpha,betaIndication of Epoetin alpha,beta
Anaemia of chronic renal failureAnaemia of chronic renal failure