Hematinic study

1. Yenepoya Pharmacy College & Research Centre
Yenepoya (Deemed to be University), Deralakatte, Mangaluru
Haematinics
By
Tahreen Taj
Asst. Professor YPCRC

2. Objectives
Hematinics-Iron
VitaminB12
Folicacid

3. Hematinics
These are substances required in the
for
formation of blood, and are used
treatment of anaemias
Iron
Vitamin
B12
Foli
c
acid

4. Anemia
Anaemia is a condition of RBC/Hb
deficiency and occurs when there is an
imbalance between production and
destruction of RBC

5. Imbalance
RBC
production
RBC
destruction

6. Causes of Anemia
Blood loss (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
Normal range 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
Factors affecting ionabsorption
Mucosalblock
Transport, utilization, storage andexcretion

11. Essentials of medical pharmacology by K.D.Tripati,
JAYPEE 2008

12. Iron absorption
Elsevier, kumar et al: Robins basic pathology

13. Factors affecting Iron absorption
Acid
Reducing substances
Meat
Factors Facilitating Factors Impending
Tea, coffee, antacids
Phosphates
Phytates
Tetracyclins
Presence of food

14. Transport & Utilization
Fe 2+ 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 RE cells 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

16. Iron formulations
Oral
Parenteral

17. Iron oral formulations
Preferred route
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 Oral Iron therapy
Prophylactic use:
Pregnancy from 4th month to lactation
Menstruation
Infancy andchildhood
Prematurebabies
Professional blooddonors

19. Therapeutic use
Iron deficiency anemia (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 Acute Iron 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)
• Complex cobalt 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 of Vit-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 in food 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
Megaloblastic anemia
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
Prophylactically in
diabetes and
alcoholics
Neuropathies,
psychiatric disorders
Tobacco amblyopia
Adverse effects
Safe
Allergicreactions
due to
contaminants

30. Folic acid
Contain 2-8 molecules of glutamicacid
Humans
obtained
do not synthesize FA but
from green leafy vegeables,
milk, meat and egg
Synthesized by gutflora

31. Metabolic functions of FA
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
Premature infants
Hemolytic anemia
Liver disease
Renal dialysis
Methotrexate toxicity
Megaloblastic anemia
Neural tubedefect
Allergicreactions due to
contaminants
Deficiency of FA

34. It regulates red blood cell proliferation
and differentiation in bone marrow