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Iron Deficiency Anaemia (IDA) (=Sideropenic anaemia) Folic Acid Vitamin B12 (Cobalamin) Erythropoietin
Sources Functions Functions Function (hormone )
Low Medium High Production of RBCs in bone marrow Normal functioning of Brain & Nervous system Controls RBC production
Fruits Red meats Organ tissues Neural tube formation Formation of blood
Vegetables Chicken Fish Sources
Fats Eggs Green Leafy green vegetables
Whole wheat vegetables Fish, Meat, Poultry
flour Tomatoes Whole grains
Iron Metabolism Pharmacokinetics Absorption & Distribution Production
Absorption in Duodenum & Jejunum (proximal) Absorbed in small intestine (primarily Proximal) Intrinsic Factor (IF) produced by cell in stomach
Absorption ↑ when Appears in plasma approx. 15-30 mins IF + B12
• Iron stores ↓ Metabolised in liver Form IF-B12 comple x, absorbed in intestines
• Iron requirements ↑ (7,8-dihydroFolic acid then to 5,6,7,8-tetrahydroFolic acid)
Absorbed better in Ferrous (Fe2+) – via active transport TetrahydroFolic acid derivates – distributed to all body Deficiency of IF
Stored in tissues (primarily stored in Liver) Cause abnormal formation of erythrocytes
• Ferritin (mucosa) Excreted in urine (small amounts in feces ) (failure of B12 absorption)
• Transferrin (plasma) Excreted in milk of lactating mothers
Haemosiderin (alternative storage) = Ferritin + extra
Iron loss – 1mg/ day
• Urine
• Faeces
Endogenous erythropoietin produced by kidney
• Shed cells
(response to anaemia, hypoxia)
• Menstruation – 20mg/ month
RBCs are destroyed by RES (reticuloendothelial system) Signal BM to produce more RBC
after 120 days – iron returned to Transferrin & Ferittin
Hypochromic Megaloblastic Pernicious Anaemia
Microcytic anaemia (lack of gastric IF)
(autoimmune disease )
abnormal, Abnormally large RBC
immature (macrocytes)
erythrocytes Abnormal WBC
(abnormal nuclei)
Causes Deficiency Causes Deficiency Causes Failure to respond to erythropoietin
Excessive blood loss • Folate need ↑ (pregnancy, lactation) Failure of IF secretion Concurrent iron deficiency (corrected with oral iron)
Inadequate intake of iron • Intake ↓ (poor diet, alcoholics) Absense of IF intestinal receptors
Women Men Children • Malabsorption syndromes Gastrectomy (achlorhydria, lack of IF)
Menstruation Blood loss Nutrition diet • Treatment with drugs – DHF (dihydrofolate) Malabsorption syndrome
Pregnancy Gastric ulcer reductase inhibitors (eg. Trimethoprim) Lack of B12 binding protein in plasma
Neoplasm • Renal dialysis (Folate removed during dialysis) (transcobalaimin II, α, β globulin)
↓ stomach acidity (inability to remove B12 from meat)
• Liver disease (diminished hepatic storage Folate)
Liver disorders (interfere with storage of B12)
• Cancer, Leukaemia, Myeloproliferative disorders
Clinical Clinical
Tissue hypoxaemia – easy fatiguability Mild jaundice
Cardiopulmonary compe nsation – palpitation, Glossitis
dyspnoea Angular stomatitis
Metaboolic consequences – O2 dissociation curve
Glossitis, Angular stomatitis, Brittle nails, Dysphagia
Pica (crave to eat non-food) | Medicine
Iron Deficiency Anaemia (IDA) (=Sideropenic anaemia) Folic Acid Vitamin B12 Erythropoietin
Iron Preparation Oral supplements Cyanocobalamin (synthetic form of B12 ) Therapeutic uses (Treating anaemia)
Oral Parenteral (IV, IM) Megaloblastic anaemia Chronic Kidney Disease & Myelodysplasia
Corrects IDA as rapidly Given only when oral Folic acid deficiency Oral Parenteral Cancer patients receiving chemotherapy & radiation
as parenteral therapy failed Pernicious anaemia can be Cyanocobalamin Critical illness (heart failure)
Should not be used • Cannot take oral drugs 1mg dose sufficient to treated entirely AIDS patient receiving zidovudine (AZT)
(affe ct absorption) • Experience GIT Remove megaloblastic anaemia (1000 ug/ day) 1° Bone Marrow
SR (sustained release) intolerance to oral Restore normal serum folate levels Hydroxocobalamin
EC (enteric-coated) Replenish body stores of folate (↑ protein-bound)
Types Types (remain longer in blood)
Ferrous sulfate Iron Dextran (IM, IV) Side Effects Side Effects Side Effects
Ferrous gluconate Dextriferron (IV) Allergic hypersensitivity (parenteral) Itching, Rash Rapid ↑ Haematocrit & Hb
Ferrous fumarate Saccharated iron oxide (IV) Mild diarrhoea Hypertension, Thrombotic compli cations
Side Effects Side Effects Peripheral vascular thrombosis, ↑ RBC production Influenza-like symptoms
Black stools Local pain, tissue staining (can be reduced if IV injection given over 5 mins)
Nausea Headache Allergic reaction (infrequent, mild)
Epigastric pain Diarrhea, Nausea, Vomiting
Constipation Bronchos pasm
Diarrhoea Anaphylaxis (*test dose)
Side effects are dose “Z track” injection
dependent. Avoid local tissue staining
Overcome by (brown discoloration)
• ↓ Daily dose Prevent escape of solution
• Taking after/ with from mus cle tissue
Contraindications Contraindications Darbepoetin alfa
Hypersensitivity to drug Pernicious anaemia (long acting, synthetic form of erythropoietin)
Hemochromatosis/ Hemolytic anaemia Aneamis which B12 is deficient
Anaphylatic-type reaction (parenteral) Treatment of
Interactions Interactions Chronic renal failure (IV, subcutaneous injection)
(form insol uble complex, ↓ absorption) Phenytoin (antagonize anticonvulsant action) Anaemia in cancer patients undergoing chemotherapy
Tetracycline (antibiotic)
Methyldopa Epilepsy patient require ↑ dose of Phenytoin if Folic Acid Risks of use
Levodopa given Cardiovascular problems
Bisphosphonates Cardiac arrest
Quinolones Arrhythmia
Calcium (food) Hypertension
Absorption (Better at ↓ pH) Decreased when taking Hypertensive encephalopathy
Antacids, Phosphates, Tannins (from tea) Congestive heart failure
Toxicity Folinic Acid (Not the same as Folic Acid) Supplements Vascular thrombosis/ ischemia
Acute (children common) Chronic (= leucovorin)(Calcium folinate/ Leucovorin calcium) Supplement in processed foods Myocardial infarction
Necrotising gastroenteritis = Haemosiderosis • Treat folate deficiency megaloblastic anaemia Vitamin pill form (multi-vitamins) Edema
Nausea, Vomiting, = Haemochromatosis • Adjuvant – cancer chemotherapy (involve
Diarrhoea Methotrexate) (rescue/ reverse toxic effects of Mode
Acidosis, Cyanosis, Excess deposits in Heart, methotrexate) Liquid
Circulatory collapse Liver, Pancreas • Used synergistically with 5-fluorouracil Transdermal patch
Gastric scarring (organ failure) (chemotherapy agent) Nasal spray
Pyloric stenosis Injection
Treatment Treatment
Induce vomiting, lavage Intermittent phelebotomy
(phosphate, carbonates) Desferrioxamine
Hasten evacuation (if involve iron overload –
(catharsis/ purging) ocular haemosiderosis,
Sodium bicarbonate haemochromatosis)