Comprehensive Overview of Haematinics and Anaemia Management

Comprehensive Overview of Haematinics and Anaemia Management

• 2.
  HAEMATINICS Haematinics or haematinicagents are those substances which are required for the formation of blood. They are essential for the treatment of anaemia. Essential Haematinics Iron Vitamin B₁₂ Folic Acid ANAEMIA Anaemia is a condition in which there is a low blood level, mainly due to a decrease in blood or a deficiency of factors required for normal red blood cell formation.
• 3.
  Reasons Behind Anaemia 1.Blood Loss Blood loss may be: Acute & Chronic Examples: Trauma Haemorrhage 2. Defects in RBC Formation Anaemia may occur due to a defect in the formation of red blood cells. 3. Deficiency of Essential Factors Deficiency of essential factors such as: Iron Vitamin B₁₂ Folic acid  may result in anaemia.
• 4.
  IRON Iron is animportant essential body constituent. Total Body Iron The total body iron is approximately 4–5 g. Iron is essential for haemoglobin production. Haemoglobin Haemoglobin is an iron-containing protein. It contains four haem groups, which carry oxygen and transport it throughout the body. DISTRIBUTION OF IRON IN THE BODY The distribution of iron in the body is approximately: Haemoglobin (Hb) – 62% Iron stores as ferritin and haemosiderin – about 27% Myoglobin in muscles – 4% Enzymes, e.g., cytochromes – 6%
• 5.
  Individual Daily Requirement Adultmale 0.5–1 mg Adult female 1–2 mg Children About 0.5 mg Pregnancy 3–5 mg STORAGE OF IRON Iron is stored in the body mainly in the ferric form in combination with a large protein called apoferritin. Storage Reaction Apoferritin + Iron ↓ Ferritin Iron may also be stored as: Haemosiderin Haemoglobin and Iron Requirement Approximately 100 mL of blood contains about 15 g of haemoglobin. A considerable amount of elemental iron is required for the formation of haemoglobin. DAILY IRON REQUIREMENT
• 6.
  DIETARY SOURCES OFIRON Rich Sources Liver Egg yolk Dry fruits Moderate Sources Meat Chicken Fish Banana, etc. Poor Sources Milk and milk products Root vegetables IRON ABSORPTION Iron absorption occurs throughout the intestine, but the maximum absorption occurs in the upper part of the intestine, particularly the duodenum. The average daily diet contains approximately 10–20 mg of iron.
• 7.
  ABSORPTION, TRANSPORT, UTILIZATIONAND STORAGE OF IRON Normally, iron is introduced into the body through dietary sources. Dietary iron is present in two forms: Heme iron & Non-heme or inorganic iron A. Heme Iron Heme iron is directly absorbed into mucosal cells of the intestine through HCP1 (Heme Carrier Protein 1). Heme Iron ↓ HCP1 ↓ Mucosal Cell ↓ Absorption B. Inorganic Iron Inorganic iron is first dissociated and converted into the ferrous form (Fe² ) ⁺ . This ferrous iron is absorbed through: DMT1 – Divalent Metal Transporter 1 Inorganic Iron ↓ Conversion to Ferrous Form (Fe² ) ⁺ ↓ DMT1 ↓ Mucosal Cell
• 8.
  Storage in MucosalCells Some absorbed iron is converted into the ferric form (Fe³ ) ⁺ and stored as ferritin in the mucosal cells. Iron is also stored mainly in the: Liver, Spleen & Bone marrow In the form of: Ferritin & Haemosiderin Entry of Iron into Blood Iron enters the blood plasma through: Ferroportin Iron in Mucosal Cell ↓ Ferroportin ↓ Blood / Plasma
• 9.
  In plasma, ironis converted into the ferric form (Fe³ ) ⁺ and forms a complex with the glycoprotein: Transferrin Transferrin is the iron transport protein and binds ferric iron. Transport to Tissues Iron-transferrin binds to specific: TfRs – Transferrin Receptors The complex is engulfed by endocytosis, and iron is released inside the cell. The released iron is further used for: Synthesis of Haemoglobin The transferrin receptor then returns to its original position.
• 10.
  PREPARATIONS OF IRON Ironpreparations are classified into: A. Oral Iron Oral iron is the preferred route. Examples: Ferrous sulphate Ferrous gluconate Ferrous fumarate Ferrous succinate B. Parenteral Iron Parenteral iron preparations include: Iron dextran Ferrous sucrose Ferric carboxymaltose Iron isomaltoside, etc.
• 11.
  USES OF IRON Ironis used in: 1. Treatment of Iron Deficiency Anaemia 2. Increased Iron Requirement During Pregnancy 3. Professional Blood Donors 4. Prophylaxis of Anaemia ADVERSE EFFECTS OF ORAL IRON Nausea Vomiting Metallic taste Constipation PARENTERAL IRON Parenteral iron is administered by: Deep intramuscular injection Intravenous injection
• 12.
  Indications Parenteral iron maybe given when: The patient is unable to absorb oral iron There is severe iron deficiency There is chronic bleeding Oral iron is not tolerated Adverse Effects Headache Joint pain Palpitations Nausea Pain at the injection site Pigmentation or skin discoloration
• 13.
  IRON POISONING Iron poisoningmay occur due to an overdose of iron. It is most commonly seen in: Infants & Young children Symptoms Vomiting Abdominal pain Diarrhoea Drowsiness, etc. Treatment 1. Gastric Lavage Gastric lavage may be performed with sodium bicarbonate 2. Antidote Desferrioxamine acts by binding iron and reducing its toxic effects.
• 14.
  VITAMIN B₁₂ Important formsor preparations include: Cyanocobalamin Hydroxocobalamin Methylcobalamin Daily Requirement The daily requirement is approximately: 1–3 µg  DIETARY SOURCES OF VITAMIN B₁₂ Liver Kidney Shellfish Milk Egg yolk Meat Curd
• 15.
  ABSORPTION OF VITAMINB₁₂ Vitamin B is absorbed in the intestine with the help of: ₁₂ Intrinsic Factor Intrinsic factor is produced by the parietal cells of the stomach. After absorption, vitamin B is transported into the blood by: ₁₂ Transcobalamin It is then transported to: Liver Erythropoietic tissues FUNCTIONS OF VITAMIN B₁₂ Vitamin B is essential for: ₁₂ Normal DNA synthesis Normal maturation and production of red blood cells Vitamin B is involved in the conversion of methyl-tetrahydrofolic acid into ₁₂ tetrahydrofolic acid, which subsequently participates in DNA synthesis.
• 16.
  CAUSES OF VITAMINB DEFICIENCY ₁₂ Vitamin B deficiency may occur due to: ₁₂ Chronic gastritis Gastric mucosal damage Nutritional deficiency Increased demand during pregnancy  PREPARATIONS OF VITAMIN B₁₂ Vitamin B may be administered through: ₁₂ Intramuscular injection Subcutaneous injection Preparations include: Cyanocobalamin Hydroxocobalamin
• 17.
  FOLIC ACID Folic acidis also known chemically as: Pteroyl Glutamic Acid (PGA) It consists of: Pteridine Para-aminobenzoic acid (PABA) Glutamic acid  SOURCES OF FOLIC ACID Liver Green vegetables DAILY REQUIREMENT OF FOLIC ACID The daily requirement is approximately: 0.2 mg/day  ABSORPTION OF FOLIC ACID Folic acid is absorbed mainly through: Duodenum & Jejunum
• 18.
  FUNCTION OF FOLICACID Folic acid is essential for: DNA Synthesis Folic Acid ↓ Dihydrofolic Acid ↓ Tetrahydrofolic Acid ↓ DNA Synthesis CAUSES OF FOLIC ACID DEFICIENCY Folic acid deficiency may occur due to: Inadequate dietary intake Malabsorption Increased requirements Drug-induced deficiency Examples of drugs causing deficiency: Phenytoin & Phenobarbitone.
• 19.
  PREPARATIONS OF FOLICACID Folic acid Folinic acid  USES OF FOLIC ACID Treatment of megaloblastic anaemia Folic acid deficiency During pregnancy During lactation During growth in infants  ERYTHROPOIETIN (EPO) Erythropoietin is a hormone secreted by the peritubular cells of the kidney. It stimulates the bone marrow and increases the production of: Red Blood Cells (RBCs) It also helps in the survival and protection of RBCs.
• 20.
  Erythropoietin Secretion Anaemia /Hypoxia ↓ Kidney ↓ Release of EPO ↓ Stimulation of Bone Marrow ↓ Increased RBC Production USES OF ERYTHROPOIETIN Chronic renal failure Acute renal conditions, as mentioned in the notes Zidovudine-induced anaemia in AIDS patients  ADVERSE EFFECTS OF ERYTHROPOIETIN Sudden increase in haematocrit Increased blood viscosity Hypertensive episodes