Haematinics.pptx by Rajan kumar singh sanskar college of pharmacy and research

Haematinics

1. Haematinics Presented By Siddhi Gaur Assistant Professor

2. Haematinics These are substances required in the formation of blood, and are used for the treatment in anemias. Anaemia 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)

3. Iron Iron is important for the synthesis of haemoglobin, myoglobin, cytochromes and other enzymes. Iron has for long been considered important for the body. Lauha bhasma (calcined iron) has been used as an ancient medicine. Distribution of iron in body: It is distributed into : Haemoglobin (Hb): 66% Iron stores as ferritin and haemosiderin: 25% Myoglobin (in muscles): 3% Paenchymal iron (in enzymes etc.): 6 % Daily requirements: To make good average daily loss iron, requiement are: Adult male: 0.5-1 mg Adult female: 1-2 mg (menstruating) Infant: 60 µg/kg Children: 25 µg/kg Pregnancy: 3-5 µg/kg Dietary sources of iron: Rich: Liver, egg yolk, oyster, dry beans, dry fruit, yeast Medium: Meat , chicken, fish, spinach, banana, apple Poor: Milk and its product, root vegetables

4. Storage of iron: Iron is stored in ferric form by combination with large protein apoferritin. Appoferritin + Fe3 gives ferritin and ferritin aggregate to give haemosiderin Iron absorption: Its absorption occurs all over the intestine but majorly at the upper part. Dietary iron is present as a haeme or inorganic iron. Absorption of haeme iron is better (upto 35% compared to inorganic iron with averages 5%).

5. Transport, Utilization, Storage and Excretion Transport: Iron is transported inside erythropoietic and other cells through attachment of transferrin to specific membrane bound transferrin receptors (TfRs). Utilization : Iron dissociates from the complex at the acidic pH of the intracellular vesicles; the released iron is utilized for haemoglobin and other purposes. Storage : Iron is stored in RE cells (in liver, spleen, bone marrow) as well as hepatocytes and myocytes as ferritin and haemosiderin. Excretion : Iron is tenaciously conserved by the body; daily excretion in adult male is 0.5-1 mg, mainly as exfoliated g.i. mucosal cell, some RBCs and in bile (all lost in feaces), other routes are desquamated skin, very little in urine and sweat.

6. Preparation of dose Oral iron : The preferred route for iron administration is oral route Some oral preparations are: Ferrous sulfate : Cheapest, often leaves a metallic taste in mouth, FERSOLATE 200mg tablet. Ferrous gluconate : 12% iron, FERRONICUM 300 mg tablet, 400mg/ 15ml elixir. Ferrous fumarate : 33% iron, is less soluble in water than ferrous sulfate and tasteless, NORI-A 200MG tablet. Adverse effect : Epigatric pain, heartburn, nausea, vomiting, bloating, metallic taste, etc . Parenteral iron : Iron-dextran- high molecular weight, colloidal solution containing 50 mg elemental iron/ ml, can be injected by i.m. as well as i.v. route Adverse effect : Local pain at site of i.m. injection, pigmentation of skin. Systemic pain- Fever, headache, joint pain, flushing, palpitation, chest pain, lymph node enlargement.

7. Vitamin B12 Vitamin B12: Cyanocobalamin and hydroxycobalamin are complex combalt containing compound present in the diet and referred as vit B12. Water soluble , Thermostable red crystal, synthesised in nature only by microorganisms. Dietary source: Liver, kidney, egg yolk, sea fish, meat, cheese are the main vitamin B12 containing sources, the only vegetable source is legumes (Pulses) which get it from microorganism harboured in their in root nodules. Daily requirements: 1-3 µg, Pregnancy and lactation 3-5 µg Metabolic function : Vit B12 convert homocysteine to methionine Convert malonic acid to succinic acid through DAB12 Vit B12 is necessary for cell growth and multiplication

8. Utilization: Vit B12 is present in food as protein conjugates and is released by cooking or proteolysis in stomach facilitated gastric acid. Vit B12 is transported in blood in combination with specific β globulin transcobalamine II (TCII). Vit B12 is not degraded in the body. It is excreted mainly in bile (3-7 µg/day) Deficiency of vit B12 occurs due to: Addisonian pernicious anaemia (autoimmune disorder which results in destruction of gastric parietal cells- absence in intrinsic factor in gastric juice- inability to absorb vit B12. Malabsorption (damage intestinal mucosa), inflammatory bowel disease. Nutritional deficiency. Increased demand (Pregnancy and lactation ). Preparation, Dose, administration Cyanocobalamin: 35 µg/5 ml liquid Hydroxycobalamin: 500 µg, 1000 µg injection Uses : Treatment of vit B12 deficiency Prophylaxis Tobacco amblyopia

9. Folic acid (Vit B9) Also called Pteroyl glutamic acid (PGA) Yellow colour crystals, insoluble in water but its sodium salt is freely soluble in water Dietary source: liver, green leafy vegetables, egg, yeast, meat, milk Daily requirement: 0.2 mg/day During pregnancy and lactation 0.8 mg/kg Metabolic function: Folic acid Dehydrofolic acid (DHFA) Tetrahydrofolate reductase (THFA) Essential for DNA synthesis and RBC formation Folate reductase Dehydrofolate reductase

10. Deficiency of vit B9 occurs due to: Inadequate diet Malabsorption Biliary fistula Increased demand (Pregnancy and lactation ) Chronic alcoholism Preparation, Dose, administration Folic acid: FOLVITE, FOLITAB 5mg tablet liquid oral, injectable are present Folinic acid: Calcium leucovorin 3mg/ml, Recovorin 15mg Uses : Megaloblastic anaemia Prophylaxis Methotrexate toxicity