Hematinics

Hematinics

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  Hematinics Dr. Binu Babu Ph.D,M.Sc. (N), MBA Mrs. Jincy Ealias M.Sc. (N)
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  Hematinics • Hematinics arethe 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
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  Iron
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  Iron • Iron isessential 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.
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  Pharmacokinetics • The averageIndian 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.
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  • Iron istransported 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.
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  Factors influence iron absorption Increaseabsorption • Ascorbic acid • Amino acids • Meat • Increased gastric acidity Decrease absorption • Antacids • Phosphates • Phytates • Tetracyclines • Presence of food in the stomach
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  IRON PREPARATIONS Iron isavailable 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
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  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
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  Adverse Effects ofOral Iron • Epigastric pain • Nausea • Vomiting • Gastritis • Metallic taste • Constipation (due to astringent effect) or diarrhea (irritant effect) • Liquid preparations cause staining of teeth.
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  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
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  Preparations • Iron dextran •Given IV/IM • Iron-sorbitol-citric acid complex • Given only IM • Ferrous sucrose • Given only IM • Ferric carboxymaltose
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  Administration • Given deepIM 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.
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  Adverse effects ofparenteral 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)
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  Iron poisoning • Commonin 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
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  Treatment • Treatment shouldbe 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.
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  Vitamin B12
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  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
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  Pharmacokinetics • Vitamin B12is 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.
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  Preparations • Cyanocobalamin • 100μg/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
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  Administration • Vitamin B12replacement therapy is given by intramuscular injection. • Hydroxocobalamin is preferred, given as an initial loading dose followed by three monthly maintenance treatment for life.
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  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
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  Folic Acid
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  Folic Acid • Essentialfor 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
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  Pharmacokinetics • Absorption takesplace in the jejunum and is transported in the blood by active and passive transport, and is stored in the liver.
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  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.
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  Haematopoietic growth factors
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  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
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  Erythropoietin • Stimulates RBCproduction. 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.
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  Preparations • Epoetin • Giventhrice 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
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  Myeloid growth factors Myeloidgrowth factors include • Granulocyte - macrophage colony stimulating factor (GM-CSF) • Granulocyte colony stimulating factor (G-CSF) • Monocyte colony stimulating factor (M-CSF)
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  Mechanism of action Myeloidgrowth 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
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  Uses • Bone marrowtransplantation • Following cancer chemo-therapy • Aplastic anemia • Congenital neutropenia • Myelodysplasia • AIDS patients with neutropenia
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  Megakaryocyte Growth Factors 1.Thrombopoietin • Increases the production of platelets. Uses • Thrombocytopenia following cancer chemotherapy. • Drug-induced thrombocytopenia • Bone marrow transplantation
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  2. Interleukin-II • Enhancesmegakaryocyte 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
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  Nursing implications • Assessfor 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.
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  • Nurse shouldeducate 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.