2. General term for those nutrients, including iron, folic
acid, and vitamin B12, required for the formation and
development of blood cells in bone marrow (the process of
haematopoiesis), deficiency of which may result in
anaemia.
Treatment of anemia
Increase the number of RBC or hemoglobin content of
RBC or both when there is deficiency
4. Aneamia
Not a single disease
Results from a number of different pathologies
Defined as a reduction from the normal quantity of Hb in
blood
WHO defines anemia as Hb levels less than 13 g/dl for
males and less than 12 g/dl for females
Low Hb levels results in decreased oxygen carrying
capacity of blood
Causes:
Blood loss
Impaired RBC functions due to deficiency
5. Iron As Haematinic Agent
Hematopoiesis
The production of circulating erythrocytes, leukocytes and
platelets from undifferentiated stem cells, is called
hematopoiesis.
It requires:
Iron –for Hb formation
6. Iron storage
Iron is the integral component of haemoglobin In our
body:
66-67% of iron is present in hemoglobin.
3% occurs in myoglobin
1% in enzymes -cytochrome, catalase, peroxidase
25% is stored in form of ferritin and hemosiderin
7. Pharmacokinetics :
Absorption:
absorbs 5–10% of iron ingested or about 0.5–1 mg daily.
normally absorbed in the duodenum and proximal
jejunum.
absorption increases in response to low iron stores or
increased iron requirements.
STORAGE
primarily as ferritin, in macrophages in the liver, spleen,
and bone, and in parenchymal liver cells. Apoferritin
synthesis is regulated by the levels of free iron.
Ferritin is detectable in serum. Since the ferritin present in
serum is in equilibrium with storage ferritin in
reticuloendothelial tissues, the serum ferritin level can be
used to estimate total body iron stores.
8. Transport:
transported in the plasma bound to transferrin, a -globulin
that specifically binds two molecules of ferrous iron The
transferrin-iron complex enters maturing erythroid cells by a
specific receptor mechanism. Transferrin receptors
internalize the transferrin-iron complex through the process
of receptor-mediated endocytosis.
Increased erythropoiesis is associated with an increase in the
number of transferrin receptors on developing erythroid
cells. Iron store depletion and iron deficiency anemia are
associated with an increased concentration of serum
transferrin.
9. ELIMINATION
Small amounts are lost in the feces by exfoliation of
intestinal mucosal cells, and trace amounts are excreted in
bile, urine, and sweat.
10. Indications of oral iron therapy
Prophylactic use :
1) pregnancy- from 4th month to lactation.
2) Menstruation
3) Infancy and childhood
4) Premature babies and babies weaned late
5) Professional blood donors
11. Therapeutic use :
1) Iron deficiency anemia
2) Iron deficiency anemia due to:
- menorrhagia
- peptic ulcer
- piles
- hook worm infestation
3) Malabsorption syndrome
4) Anemia of pregnancy
5) Treatment of severe pernicious anemia
12. Parenteral iron preparations:
Iron dextran is a stable complex of ferric hydroxide and
low-molecular-weight dextran containing 50 mg of
elemental iron per milliliter of solution. It can be given by
deep intramuscular injection or by intravenous infusion,
although the intravenous route is used most commonly
Headache, light-headedness, fever, arthralgias, nausea
and vomiting, back pain, flushing, urticaria,
bronchospasm, and rarely, anaphylaxis and death.
Hypersensitivity reaction to the dextran component.
Hypersensitivity reactions may be delayed for 48–72
hours after administration.
Anaphylactic reactions
Iron-sucrose complex and iron sodium gluconate
complex only by the intravenous route.
13. Sources :
Yeast, liver, green vegetables, Fruits, nuts and cereals
Daily requirements :
Adult: 50 mcg / day
Pregnant women : 100-200 mcg / day
Lactating women : 100-200 mcg / day
FOLIC ACID:
14. Pharmacokinetics :
Route : oral , parenteral
Absorption: from proximal jejunum
Excretion: Folates are excreted in the urine and stool
and are also destroyed by catabolism
folic acid deficiency and megaloblastic anemia can
develop within 1–6 months after the intake of folic acid
stops.
15. Pharmacodynamics:
Functions :
Tetrahydrofolate cofactors participate in one-carbon
transfer reactions
1) DNA synthesis : cofactors for the synthesis of
purines and pyrimidines
2) Synthesis of thymidylic acid :
Enzyme thymidylate synthase catalyzes the transfer
of the one-carbon unit.
16. Causes of folic acid deficiency:
A) Nutritional ( major
causes)
1) poor intake due to
old age
Starvation
Anorexia
2) gastrointestinal disease
Partial gastrectomy
Coeliac disease
Crohn’s disease
B) Poor Utilisation:
1) Physiological
pregnancy
starvation
prematurity
2) Pathological
hemolytic disease with
excess RBC formation
malignant disease with
increased cell turnover
inflammatory disease
18. Effects of folic acid deficiency
Megaloblastic anemia
Neural tube defect ( spina bifida ) in the foetus
High-risk patients:
pregnant women
patients with alcohol dependence,
hemolytic anemia
liver disease
certain skin diseases
patients on renal dialysis
19. Indications of folic acid:
1) Treat magaloblastic anemia due to folate deficiency
2) Pregnant women
3) Premature infants
4) Patients with hemolytic anemia
5) Liver disease
6) Chronic skin disease
7) Renal dialysis
8) With anti convulsant drugs
20. Folic acid in large amounts may counteract the
antiepileptic effect of phenobarbital, phenytoin, and
primidone, and increase the frequency of seizures in
susceptible children
21. Liquid oral preparations and injectables in combination form
Given im
Dose
Therapeutic : 2-5 mg / day
Prophylactic : 0.5 mg / day
Preparations and doses of folic acid :
22. Vit B12
consists of a porphyrin-like ring with a central cobalt atom
attached to a nucleotide.
Deoxyadenosylcobalamin and methylcobalamin are the active
forms
The chief dietary source of vitamin B12 is microbially derived
vitamin B12 in meat (especially liver), eggs, and dairy
products
extrinsic factor
23. Pharmacokinetics
stored, primarily in the liver, with an average adult having a
total vitamin B12 storage pool of 3000–5000 mcg
normal daily requirements of vitamin B12 are only about 2 mcg
is absorbed only after it complexes with intrinsic factor, a
glycoprotein secreted by the parietal cells of the gastric mucosa
the intrinsic factor-vitamin B12 complex is subsequently
absorbed in the distal ileum by a highly specific receptor-
mediated transport system.
Nutritional deficiency is rare but may be seen in strict
vegetarians after many years without meat, eggs, or dairy
products.
vitamin B12 is transported to the various cells of the body
bound to a plasma glycoprotein, transcobalamin II
Stored in liver
Excreted through urine
24. Indications of Vit B12
a) Megaloblastic anemia
b) Neurologic syndrome associated with cobalamin
deficiency
c) Pernicious anemia
25. Vitamin B12 for parenteral injection is available as
cyanocobalamin or hydroxocobalamin
Administered im
Initial therapy should consist of 100–1000 mcg of
vitamin B12
Maintenance therapy consists of 100–1000 mcg
intramuscularly once a month for life
neurologic abnormalities are present, maintenance
therapy injections should be given every 1–2 weeks for
6 months before switching to monthly injections
oral doses of 1000 mcg of vitamin B12 daily are usually
sufficient to treat patients with pernicious anemia
26. Dose:
In india both oral and injectables vit B12 is available
mostly or combination preparation along with other
vitamines, with or without iron.
27. 1.Treatment and prophylaxis of vitamin B12 deficiency
(megaloblastic anemia)
2. Vit B12 injection in pernicious anemia (condition where
Vit B12 is not absorbed from the stomach)
Uses of vitamin B12
