HEMATINICS

TREATMENT
Oral Therapy:
Ferrous Sulphate
Ferrous Fumarate
Ferrous Gluconate
Parenteral Therapy:
Iron Dextran
Iron-sucrose complex
Iron sodium gluconate complex

Clinical uses

Iron deficiency anemia in

Infants
Pregnant and lactating women
Children during rapid growth periods

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

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

VITAMIN B12....
Essential in two reactions:
1.Conversion of methylmalonyl-coenzyme A to
Succinyl-CoA
2.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

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.

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

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

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)

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

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

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

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

VITAMin B12 and folic acid

Both are very well tolerated
There are no remarkable adverse
effects of
therapy

 The side effect which primarily limits

acceptability of oral iron therapy is

Black stools
Epigastric pain and bowel upset
Staining of teeth
Metallic taste

 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

 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

 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

 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

 The iron stored in intestinal mucosal

cells is complexed to

Intrinsic factor
Transcobalamin II
Transferrin
Ferritin

 An important biochemical consequence

of vitamin B12 deficiency is
accumulation of

Dihydrofolate
dTMP
Folic acid
Tetrahydrofolate
Methyltetrahydrofolate

 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 acid+Vitamin B12 orally
Intrinsic factor orally