DRUGS USED TO TREAT DRUGS USED TO TREAT ANEMIAS:HEMATINICSANEMIAS:HEMATINICS

Dr.SYED SHEHNAZ ILYAS,M.D.

BLOOD COMPONENTSBLOOD COMPONENTSPLASMALiquid part of bloodContains proteins essential for

immune response &blood clottingFORMED ELEMENTS OF THE BLOOD LEUKOCYTES (WBCS): Part of the

immune systemERYTHROCYTES (RBCS): Carry oxygen

to the tissues and remove carbon dioxide

FACTORS ESSENTIAL FOR FACTORS ESSENTIAL FOR ERYTHROPOESISERYTHROPOESIS

ADEQUATE AMOUNTS OF IRONForm hemoglobin –for oxygen

MINUTE AMOUNTS OF VIT.B12 & FOLIC ACID

ESSENTIAL AMINO ACID & CARBOHYDRATE

To complete the hemoglobin rings, cell membrane, and basic structure

ANEMIAANEMIA

↓ Concentration Of haemoglobin in blood

Symptoms of fatigue, pallor, dizziness, exertional dyspnea (∵of tissue hypoxia)

Cardiovascular adaptations to chronic anemia—tachycardia, increased cardiac output, vasodilation

TYPES OF ANEMIATYPES OF ANEMIAIRON DEFICIENCY ANEMIA Deficiency of iron Hypochromic, microcytic anaemia (small red

cells with low Hb)MEGALOBLASTIC ANEMIA Deficiency of folic acid /vitamin B12 Macrocytic anaemia (large R.B.C,↓Number)PERNICIOUS ANEMIA

No intrinsic factor :vitamin b12 not absorbed

IRON DEFICENCY IRON DEFICENCY ANEMIAANEMIA

Deficient synthesis of Hb Due to lack of iron

HYPOCHROMIC MICROCYTIC ANEMIA In adults most common cause : blood

loss(menses,labour)

IRON ABSORPTIONIRON ABSORPTION Animal foods iron is better absrbed Iron is absorbed from brush border of upper part

of small IntestineFACTORS AFFECTING IRON ABSORPTION Only ferrous form absorbed (ferric converted to

ferrous form by acids) ↑ ABSORBTION: Acids, reducing agents (vit.C,

succinate), meat, Fe Deficiency ↓ABSORBTION :Alkalies, antacids, phosphorus,

phytates, tetracyclines surgeries (partial gastrectomy, infectious

diseases, malabsorption syndrome

IRON DISTRIBUTIONIRON DISTRIBUTION

TRANSPORTBound to transferrin: -

globulin STORAGE Complexed with

apoferritin (AF) and stored as ferritin in R.E.Cells, bone Marrow Hepatocytes

As heme-in Hb of RBC, myglobin & cytoch. Oxidase enzymes

 

IRON ELIMINATIONIRON ELIMINATION

Exfoliation of intestinal mucosal cells

Trace amounts are excreted in bile, urine, and sweat.

Total loss of iron is 1 mg/day

IRON PREPARATIONSIRON PREPARATIONSORAL PREPARATIONS Ferrous fumarate (elemental Fe 66 mg Ferrous gluconate (elemntl Fe 36mg) Ferrous sulfate (elemental Fe 65 mg)    ADVERSE EFFECTS Nausea, vomiting, staining teeth, Metallic taste, heart burn, Constipation (astringent effect) Diarrhea (irritant effect)

IRON PREPARATIONSIRON PREPARATIONS

PARENTERAL PREPARATIONS 20 – 40 mL Iron dextran deep I.M/I.V. Iron sorbitol citric acid complexADVERSE EFFECTS Pain, pigmentation skin, sterile abcess Fever, headache, Palpitation, chest

pain, Anaphyloid reaction, Metallic taste 

MEGALOBLASTIC MEGALOBLASTIC ANEMIAANEMIA

Deficient synthesis of Hb Due to • Lack of Vit B12 • Folic acid • Both

Macrocytic anemia+ leukopenia or thrombocytopenia or both

Hypercellular bone Marrow With ↑ megaloblastic erythroid & other precursor cells.

Available as cyanocobalamin hydroxycobalamin.

Source: microbial synthesis Not synthesized By plants or

animals Chief dietary source is

microbially derived Vitamin B12 in meat (liver), eggs, dairy products and legumes.

VITAMIN B12VITAMIN B12

VIT.B12:PHARMACOKINETIVIT.B12:PHARMACOKINETICSCSVit B12+intrinsic

Factor (Stomach parietal cell R. On distal ileum Active absorption Transport in blood: transcobalamin II Stored in liver Trace amount lost in urine & stool.

R:GASTRIC BINDING PROTEIN,

Cbl: COBALOMIN, IF;INTRINSIC FACTOR,TCII:TRANSCOBALOMIN II

VITAMIN B12 VITAMIN B12 DEFICIENCYDEFICIENCY

SYMPTOMS OF DEFICIENCY Megaloblastic anemia Neurologic syndrome :paresthesias

spasticity, ataxia,neuritisTREATMENT Vitamin B12:I.M Injection given life

longADVERSE EFFECTS: Hypokalemia and hypersensitivity

FOLIC ACID FOLIC ACID (PTEROYLGLUTAMIC (PTEROYLGLUTAMIC

ACID)ACID) Richest source is yeast, liver kidney

and green vegetables. Involved in DNA synthesisSYMPTOMS OF DEFICIENCY Megaloblastic anemia Glossitis, diarrhea, weight Loss,

debilityTREATMENT:Folic acid 1 mG/DayOTHER USES: Prevention of fetal neural

tube defects

APLASTIC &HEMOLYTIC APLASTIC &HEMOLYTIC ANEMIAANEMIA

APASTIC ANEMIA • Due to drugs: total lack of all hemopoetic

cells• Stop the drug involved in aplastic anemia

HEMOLYTIC ANEMIA• Due to genetic problems

Rx FOR BOTH ANEMIAS• Blood transfusion• Corticosteroids• May use iron, Vitamin B12 & folic acid