Haematinics

Vitamins and minerals essential for normal

erythropoiesis (haematinics) include iron, copper,
cobalt, vitamins A, B12, B6, C, E, riboflavin and
nicotinic acid.

Deficiency of any of these substances may be

associated with defective erythropoiesis, anaemia
and associated morbidity.
  Hematinic

A hematinic is a nutrient required for the formation of

blood cells in the process of hematopoiesis. The
main hematinics are iron, B12, and folate. Deficiency
in hematinics can lead to anaemia.
Anaemia
Classification of Haematinics

• Haematinics include iron, folic acid, vitamin B

12, erythropoietin, myeloid growth factors and
megakaryocytic growth factors.
 ROLE OF IRON

Iron in its ferrous form (Fe2+) combines with

protoporphyrin to form haem, a vital component of
haemoglobin (Hb) as well as myoglobin and enzymes
including cytochromes and peroxidases.
Iron
 Role of Vit B12

Vitamin B12 consists of a small group of compounds,

the cobalamins, which vary by the different chemical
groups attached to a central cobalt atom. Methyl
B12 is a cofactor in the methylation of homocysteine
to methionine by methyl tetrahydrofolate (THF), and
lack of B12 therefore leads to deficiency of folate
coenzymes necessary for DNA synthesis.
 Vitamin B12 and folate

vitamin B12 is required to activate folate; folate

therapy in a patient with incipient B12 deficiency will
further deplete B12 stores and may lead to acute
neurological deterioration
 Role of Folic acid

Folates are derived from folic acid by the addition of

extra glutamic acid residues, reduction to dihydro‐
and tetrahydrofolates (DHFs and THFs) or addition
of single carbon units.
They are needed for a variety of single carbon
transfer reactions in the body, especially purine and
pyrimidine synthesis, including that of thymidylate, a
rate limiting step in DNA synthesis 
 Vitamin B12 and folate

Vitamin B12 and folate are thus essential for DNA

synthesis, disruption of which leads to asynchronous
maturation of nucleus, cytoplasm and macrocytic
red cells, the features of megaloblastic anaemia. 
 IRON

Oral
• Iron gluconate
• Iron sulphate
• Iron fumarate
Parenteral
• Iron dextran (Imferon)
• Sodium ferric gluconate complex
• Iron sucrose (Venofer)
 Folic acid

• Reduced 5-formyl tetrahydrofolate

(Leucovorin/citrovorum)
 Causes of Iron deficiency

1. Reduced intake of Iron

• The daily iron requirement of an adult is ≈ 1 mg for men
and 2 mg for women.
• Although the average Western diet contains 10–15 mg
iron, only 5–10% is absorbed. I
• Iron deficiency is seen with increased demands, such as
premature infants, menstruating or pregnant women and
growing children.
 Vitamin B12

• The daily vitamin B requirement is 1–2μg and normal

12 
intake is between 10 and 20μg. Body stores are sufficient
for 2–4 years. Vitamin B12 is synthesized by
microorganisms and is only present in significant
quantities in food of animal origin. Vegetarians and
especially vegans, are therefore at high risk of dietary
vitamin B12 deficiency.
 Erythropoietin

• Recombinant –apoprotein
• Glycosylated –Darbipoietin alpha
• Megakaryocytic Growth Factor
• Interleukin II
• Operlvekin
• Thrombopoietin
 Megakaryocytic Growth Factor

• Interleukin II
• Operlvekin
• Thrombopoietin
 Myeloid Growth Factors

• G-CSF –Filgrastim, Peg Filgrastim

GM-CSF –Sargramostim
 Plasma expanders

• Plasma expanders are agents that have relatively high

molecular weight and boost the plasma volume by
increasing the osmotic pressure. They are used to treat
patients who have suffered hemorrhage or shock. Shock
occurs due to reduced blood volume (usually due to
hemorrhage) and it is necessary to get the blood volume
back to normal as quickly as possible.
 Plasma expanders

• The plasma expanders most widely used are isotonic crystalloids

and synthetic colloids.
• Albumin, due to its cost and the traceability requirements inherent
to all blood-derived products, is rarely prescribed as first-line
treatment.[
• The synthetic colloids most widely used are hydroxyethyl starch
(HES) solutions and gelatins.[
• In many countries, dextrans are no longer marketed because of their
adverse effects, especially anaphylactic reactions. [
 Plasma expanders

It should be noted that nonionic 5% or 10% dextrose solution is not

a plasma expander, as the volume remaining in the vascular
compartment after intravenous infusion is insignificant because of
rapid diffusion to all compartments of the body (Table 1). [5] These
solutions behave like free water and infusion of large volumes
induces a risk of hyponatremia and water intoxication with
potentially serious cerebral consequences
 Plasma expanders

• During blood loss, the amount of oxygen that can be delivered to

the tissues is reduced due to lost red blood cells and decreased
blood volume, which also causes a decrease in blood pressure.
• Although they cannot replace lost red blood cells, blood volume
expanders can help improve oxygen delivery in instances of blood
loss by increasing blood volume and blood pressure so that blood
can flow to the tissues.
• Survival is possible with low red blood cell and hemoglobin levels as
long as blood volume and blood pressure are maintained so blood
continues to reach tissues.
 Plasma expanders

• Hypovolemic shock occurs when tissue oxygenation drops due to a decrease in blood volume.
• Crystalloids volume expanders are aqueous solutions of mineral salts or other water-soluble molecules.
Although they decrease the osmotic pressure by diluting the red blood cells, they increase both vascular and
interstitial volume.
• Colloids volume expanders contain larger insoluble molecules, such as gelatin or hydroxyethyl starch, and
theoretically increase the intravascular volume but not interstitial and intracellular volumes.
Types of Volume Expanders

• There are two main types of volume expanders: crystalloids and

colloids. Crystalloids are aqueous solutions of mineral salts or other
water-soluble molecules. Colloids contain larger insoluble molecules,
such as gelatin; blood itself is a colloid. There are also a few other
volume expanders that may be used in certain situations:
• Colloids: These solutions preserve a high-colloid osmotic pressure
(protein-exerted pressure) in the blood, while this parameter is
decreased by crystalloids due to hemodilution. The higher osmotic
pressure from colloids draws fluids inward, preventing it from leaking
out into the tissues as easily, which increases intravascular blood
volume.
 Types of Volume Expanders

• Crystalloids: The most commonly used crystalloid fluid is normal saline,

a solution of sodium chloride at 0.9% concentration, which is close to
the concentration in the blood (isotonic). Saline solution is administered
intravenously (IV drips) and increases both intravascular and interstitial
volume. They decrease osmotic pressure by diluting the blood.
• Dextrose Water: This solution contains dextrose, a form of glucose. It
is given to patients who have dangerously low blood sugar levels
(important for cellular metabolism) as well as low blood volume.
 Plasma expanders

Another common volume expander includes hydroxyethyl

starch (HES/HAES, common trade names: Hespan, Voluven)
which is considered a colloid. An intravenous solution of
hydroxyethyl starch is used to prevent shock following severe
blood loss caused by trauma, surgery, or another problem. It
increases the blood volume, allowing red blood cells to
continue to deliver oxygen to the body. When tissue blood
perfusion is maintained, shock is averted as the dangerous
compensatory mechanisms of shock aren’t activated.