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HEMATINICS (Revision)

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Dr. Soban sadiq * Oral Therapy: Ferrous Sulphate Ferrous Fumarate Ferrous Gluconate Parenteral Therapy: Iron Dextran Iron-sucrose complex Iron sodium gluconate ... – PowerPoint PPT presentation

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Title: HEMATINICS (Revision)


1
HEMATINICS(Revision)
  • Dr. Soban sadiq

2
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3
TREATMENT
  • Oral Therapy
  • Ferrous Sulphate
  • Ferrous Fumarate
  • Ferrous Gluconate
  • Parenteral Therapy
  • Iron Dextran
  • Iron-sucrose complex
  • Iron sodium gluconate complex

4
Clinical uses
  • Iron deficiency anemia in
  • Infants
  • Pregnant and lactating women
  • Children during rapid growth periods

5
ADVERSE EFFECTS ORAL IRON
  • Common adverse effects
  • Nausea
  • Epigastric discomfort
  • Abdominal cramps
  • Constipation/diarrhea
  • These effects are usually dose-related and can
    often be
  • overcome by lowering the daily dose of iron or by
    taking the
  • tablets immediately after or with meals
  • Patients taking oral iron develop black stools
    this has no
  • clinical significance in itself but may obscure
    the diagnosis of
  • continued gastrointestinal blood loss

6
PARENTERAL IRON THERAPY
  • Parenteral therapy should be reserved for
    patients who
  • are unable to tolerate or absorb oral iron and
    for
  • patients with extensive chronic blood loss .
  • Postgastrectomy conditions
  • Small bowel resection
  • Inflammatory bowel disease(proximal small bowel)
  • Malabsorption syndromes

7
VITAMIN B12....
  • Essential in two reactions
  • Conversion of methylmalonyl-coenzyme A to
    Succinyl-CoA
  • Conversion of Homocysteine to Methionine
  • The second reaction is linked to folic acid
  • metabolism and synthesis of deoxythymidylate
  • (dTMP)
  • dTMP is a precursor for DNA synthesis

8
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10
VITAMIN B12.....
  • In Vitamin B12 deficiency, folate accumulates
  • as N-Methyltetrahydrofolate
  • The supply of tetrahydrofolate is depleted
  • This slows production of RBCs
  • Folic acid replacement can correct B12
  • deficiency anemia, but not the neurological
  • manifestation of B12 deficiency.

11
VITAMIN b12...
  • Absorption
  • Vitamin B12 binds to Intrinsic factor (secreted
    by
  • gastric parietal cells)
  • It prevents digestion of B12
  • In bound state ,it binds to receptors on brush
  • border of mucosa
  • These receptors are located in ileum
  • Bound intrinsic factor and B12 are absorbed with
  • pinocytosis

12
VITAMIN B12....
  • DISTRIBUTION
  • Vitamin B12 is distributed to various cells
  • bound to a plasma glycoprotein,Transcobalamin II
  • STORAGE
  • Excess vitamin B12 (upto 300-500 microgram) is
  • stored in liver

13
VITAMIN B12
  • ELIMINATION
  • Trace amounts of vitamin B12 are normally lost
  • in urine and stool.
  • Significant amount of vitamin B12 are excreted
  • in urine (when large amounts are given
  • parenterally)

14
FOLIC ACID.....
  • ABOSRPTION
  • Form
  • Dietary folates in polyglutamate forms first
    undergo hydrolysis by conjugase (present in brush
    border of intestinal mucosa) and form
    monoglutamate
  • Site
  • Proximal jejunum
  • Only modest amounts of folic acid are stored in
  • body,therefore a decrease in diet will lead to
  • anemia in few months

15
Folic acid
  • Distribution
  • Widely distributed through out the body via
  • blood stream
  • Storage
  • Normally, 5-20 mg is stored in liver and other
  • tissues
  • Elimination
  • Excreted in urine and stool, and also destroyed
  • by catabolism

16
CLINICAL USES OF VIT B12 AND FOLIC ACID
  • These are used in anemia (megaloblastic)
  • Pernicious anemia ( Vitamin B12, basically IF)
  • Prophylaxis for neural tube defects (folic acid
  • before conception)
  • Neuropathy (Vitamin B12)
  • Cancer chemotherapy
  • Certain drug therapies lead to deficiency of
    folic
  • acid so replacement is required

17
VITAMIN B12 PREPARATIONS
  • Tablet and syrup forms
  • Cyanocobalamin, Hydroxycobalamin
  • Parenteral
  • I/M, I/V.
  • Use
  • To corrects major depletion of B12 quickly
  • If patient is unable to take orally
  • Required in patients with pernicious anemia(IF
    deficiency)
  • Parenteral therapy can lead to pain at injection
    site

18
VITAMin B12 and folic acid
  • Both are very well tolerated
  • There are no remarkable adverse effects of
  • therapy

19
  • The side effect which primarily limits
    acceptability of oral iron therapy is
  • Black stools
  • Epigastric pain and bowel upset
  • Staining of teeth
  • Metallic taste

20
  • Choose the correct statement about iron therapy
  • Iron is given in megaloblastic anemia
  • Iron must be given orally except in pernicious
    anemia
  • Prophylactic iron therapy must be given during
    pregnancy
  • Infants on breast feeding do not require
    medicinal iron

21
  • A 23 year old pregnant woman is referred by her
    obstetrician for evaluation of anemia.If this
    woman has macrocytic anemia,an increased serum
    concentration of vitamin B12,the most likely
    cause of her anemia is deficiency of ,
  • Cobalamin
  • Erythropoietin
  • Folic acid
  • Intrinsic factor
  • Iron

22
  • If the patient had folic acid deficiency,her
    infant would have a higher than normal risk of
  • Cardiac abnormality
  • Kidney damage
  • Limb deformity
  • Neural tube defect

23
  • A pregnant patient is found to have microcytic
    anemia.Optimal treatment of microcytic anemia is
  • A high fibre diet
  • Erythropoietin injections
  • Ferrous sulphate tablet
  • Folic acid supplements
  • Hydroxocobalamin injections

24
  • The iron stored in intestinal mucosal cells is
    complexed to
  • Intrinsic factor
  • Transcobalamin II
  • Transferrin
  • Ferritin

25
  • An important biochemical consequence of vitamin
    B12 deficiency is accumulation of
  • Dihydrofolate
  • dTMP
  • Folic acid
  • Tetrahydrofolate
  • Methyltetrahydrofolate

26
  • Mr. Abid, 25 years of age was suffering from
    chronic lethargy and weakness On examination he
    was very pale and he had signs of neuropathy as
    well. His Laboratory tests showed megaloblastic
    type of anemia. His physician performed
    Schillings test, which was positive. Choice of
    management would be
  •  
  • Cyanocobalamin orally
  • Folic acid orally
  • Vitamin B12, I/V
  • Folic acidVitamin B12 orally
  • Intrinsic factor orally
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