This document discusses hematinic drugs used to treat anemia. It describes three main categories of hematinics: iron supplements, which come in various oral and injectable forms; vitamin B12 and folic acid, which are important for red blood cell maturation; and erythropoietin, a hormone produced in the kidney that is essential for red blood cell production. Side effects of oral iron supplements include gastrointestinal issues. Parenteral iron is recommended when oral iron is not absorbed or tolerated. Vitamin B12 and folic acid deficiencies can cause megaloblastic anemia.

1. Pharmacology
By-
Dr. Mrunal R. Akre

2. Haemopoetic

3. Haemopoetic,
 Haematinics
◦ These are substances required in the
formation of blood, and are used for
treatment of anaemias.
◦ Anaemia occurs when the balance between
production and destruction of RBCs is
disturbed by:
 (a) Blood loss (acute or chronic)
 (b) Impaired red cell formation due to:
 • Deficiency of essential factors, i.e. iron, vitamin B12, folic
acid.
 • Bone marrow depression (hypoplastic anaemia),
erythropoietin deficiency.
 (c) Increased destruction of RBCs (haemolytic
Anaemia)

4.  IRON
◦ Oral iron
 1. Ferrous sulfate: (hydrated salt 20% iron, dried salt 32% iron) is the cheapest; may be preferred on
this account. It often leaves a metallic taste in mouth; FERSOLATE 200 mg tab.
 2. Ferrous gluconate (12% iron): FERRONICUM 300 mg tab, 400 mg/15 ml elixer.
 3. Ferrous fumarate (33% iron): is less water soluble than ferrous sulfate and tasteless; NORI-A 200 mg
tab.
 4. Colloidal ferric hydroxide (50% iron): FERRI DROPS 50 mg/ml drops.
 5. Carbonyl iron: It is high purity metallic iron in very fine powder form (particle size < 5 μM), prepared
by decomposition of iron pentacarbonyl, a highly toxic compound
 Other forms of iron present in oral formulations are:
 Ferrous succinate (35% iron)
 Iron choline citrate
 Iron calcium complex (5% iron)
 Ferric ammonium citrate (20% iron)
 Ferrous aminoate (10% iron)
 Ferric glycerophosphate
 Ferric hydroxy polymaltose
 Side effects are: Epigastric pain, heartburn, nausea, vomiting, bloating, staining of teeth, metallic taste,
colic, etc.
◦ Parenteral iron
 Iron therapy by injection is indicated only when:
 1. Oral iron is not tolerated: bowel upset is too much.
 2. Failure to absorb oral iron: malabsorption; inflammatory bowel disease. Chronic inflammation (rheumatoid arthritis)
decreases iron absorption, as well as the rate at which iron can be utilized.
 3. Non-compliance to oral iron.
 4. In presence of severe deficiency with chronic bleeding.
 5. Along with erythropoietin: oral ion may not be absorbed at sufficient rate to meet the demands of induced rapid
erythropoiesis.
 Parenteral iron therapy needs calculation of the total iron requirement of the patient for which several
formulae have been devised.
 A simple one is:
 Iron requirement (mg) = 4.4 × body weight (kg) × Hb deficit (g/dl)

5.  MATURATION FACTORS
◦ Deficiency of vit B12 and folic acid, which are B group vitamins,
results in megaloblastic anaemia characterized by the
presence of large red cell precursors in bone marrow and their
large and shortlived progeny in peripheral blood
◦ VITAMIN-B12
 Cyanocobalamin and hydroxocobalamin are complex cobalt containing
compounds present in the diet and referred to as vit B12.
 Daily requirement 1–3 μg, pregnancy and lactation 3–5 μg.
 Preparations, dose, administration
 Cyanocobalamin: 35 μg/5 ml liq.
 Hydroxocobalamin: 500 μg, 1000 μg inj.
 In India both oral and injectable vit B12 is available mostly as combination
preparation along with other vitamins, with or without iron.
◦ FOLIC ACID
 It occurs as yellow crystals which are insoluble in water, but its sodium
salt is freely water soluble. Chemically it is Pteroyl glutamic acid (PGA)
consisting of pteridine + paraaminobenzoic acid (PABA) + glutamic
acid.
 Daily requirement of an adult is < 0.1 mg but dietary allowance of 0.2
mg/day is recommended.
 During pregnancy, lactation or any condition of high metabolic activity,
0.8 mg/day is considered appropriate.
◦ ERYTHROPOIETIN
 Erythropoietin (EPO) is a sialoglycoprotein hormone (MW 34000)
produced by peritubular cells of the kidney that is essential for normal
erythropoiesis