Treatment of Megaloblastic.pptxTreatment of Megaloblastic.pptx

Treatment of Megaloblastic.pptx

1. TREATMENT OF ANEMIA

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14. Types of Dietary Iron Heme iron → Found in non-vegetarian food (meat, fish, poultry) Easily absorbed. Non-heme iron → Found in vegetarian sources (green leafy vegetables, jaggery, pulses) Less easily absorbed. Chemical Forms of Iron Ferric iron (Fe³⁺) → Form in food Ferrous iron (Fe²⁺) → Form that can be absorbed by the intestine

15. Absorption Process Step 1: Conversion in stomach HCl (gastric acid) converts ferric (Fe³⁺) → ferrous (Fe²⁺) Step 2: Entry into intestinal cell DMT-1 (Divalent Metal Transporter-1) on the luminal side of intestinal cell absorbs only ferrous iron into the cell. Step 3: Exit into blood Ferroportin on the basolateral side transports iron from intestinal cell into the blood. While exiting, iron is converted back: ferrous (Fe²⁺) → ferric (Fe³⁺) .

16. Transport in Blood Transferrin → Protein that carries iron in the blood (2 iron atoms per molecule) Delivers iron to bone marrow for hemoglobin synthesis. Storage Extra iron is stored in liver as ferritin (storage protein). Regulation by Hepcidin Hepcidin → Hormone made by the liver. Function: Blocks ferroportin (destroys it) → stops iron from leaving intestinal cells → decreases absorption.

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45. Hematopoietic Growth Factors – Are they synthetic? Naturally: Your body makes growth factors (like erythropoietin, G-CSF, GM-CSF, thrombopoietin, IL-11) → these are proteins that tell bone marrow to make blood cells. Clinically (drugs): Scientists use recombinant DNA technology to produce synthetic (lab-made) versions of these natural proteins. That’s why we call them recombinant growth factors . They are synthetic copies of natural hormones.

46. Erythropoiesis-Stimulating Agents (ESAs) Normal erythropoietin (EPO) made by kidney → stimulates bone marrow to make RBCs. In renal failure → less EPO → anemia. Drugs: Epoetin alfa (recombinant EPO). Darbepoetin alfa (longer acting, glycosylated). Methoxy PEG-epoetin beta (very long-acting, 1–2/month). Uses: Anemia of renal failure, chemo/HIV, bone marrow disorders. Adverse effects: Hypertension, thrombosis. ❗Do not let Hb > 12 g/dL → risk of mortality, CV events.

47. Myeloid Growth Factors Filgrastim (G-CSF): stimulates neutrophils . Sargramostim (GM-CSF): stimulates neutrophils + macrophages + megakaryocytes . Uses: Speed up neutrophil recovery after chemo. Treat congenital or acquired neutropenia. Mobilize stem cells before transplantation (often with plerixafor). Adverse effects: G-CSF → mild bone pain. GM-CSF → more severe: fever, joint pain, capillary leakage, edema. Pegfilgrastim : Long-acting form of G-CSF.

48. Megakaryocyte Growth Factors IL-11 ( Oprelvekin ): ↑ platelet production. Use: Prevent thrombocytopenia after chemo. Side effects: Fatigue, headache, dizziness, fluid retention. Romiplostim: SC injection, thrombopoietin receptor agonist. Use: Chronic idiopathic thrombocytopenia (ITP). Eltrombopag : Oral thrombopoietin receptor agonist. Use: Chronic ITP not responding to other treatment. Risk: Hepatotoxicity + bleeding , restricted use.