Hematinic

HAEMATINICS

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·       Hematinic are substances that are essential for the formation of blood cells and hemoglobin.

·       They are used primarily in the treatment of anemia and related conditions where there is a deficiency in blood components.

Definition

·       Hematinic are agents that improve the quality or quantity of blood by increasing the hemoglobin concentration and the number of red blood cells.

·       These agents often include iron, folic acid, vitamin B12, and other components vital for erythropoiesis (the production of red blood cells).

Classification

Haematinics can be classified based on the primary components they supply:

1.     Iron Supplements:

·        Examples: Ferrous sulfate, Ferrous gluconate, Ferrous fumarate, Iron dextran.

·        Function: Provide elemental iron needed for hemoglobin synthesis.

2.     Vitamin B12 Supplements:

·        Examples: Cyanocobalamin, Hydroxocobalamin.

·        Function: Essential for DNA synthesis and red blood cell production.

3.     Folic Acid Supplements:

·        Examples: Folic acid, Folinic acid.

·        Function: Necessary for DNA synthesis and repair, and red blood cell maturation.

4.     Combination Products:

·        Examples: Multivitamins with iron, Iron and folic acid tablets.

·        Function: Provide multiple hematinic components simultaneously for comprehensive treatment.

Pharmacokinetics

The pharmacokinetics of hematinic vary depending on the specific agent:

·        Iron Supplements:

·        Absorption: Primarily in the duodenum and upper jejunum. Enhanced by an acidic environment and inhibited by certain foods and medications.

·        Distribution: Bound to transferrin in the blood and transported to the bone marrow.

·        Metabolism: Iron itself is not metabolized but incorporated into hemoglobin or stored as ferritin and hemosiderin.

·        Excretion: Minimal; mainly through feces, with small amounts lost in urine, sweat, and exfoliated skin.

·        Vitamin B12:

·        Absorption: Binds to intrinsic factor in the stomach and absorbed in the ileum.

·        Distribution: Transported bound to transcobalamin II to various tissues, especially the liver.

·        Metabolism: Undergoes minimal metabolism.

·        Excretion: Primarily through bile; enterohepatic recirculation occurs.

·        Folic Acid:

·        Absorption: Rapidly absorbed in the jejunum.

·        Distribution: Widely distributed in tissues; stored in the liver.

·        Metabolism: Converted to active metabolites like tetrahydrofolate.

·        Excretion: Excreted via urine.

Mechanism of Action

·        Iron: Iron supplements provide the necessary iron for the synthesis of hemoglobin and other iron-containing enzymes. It is incorporated into hemoglobin within the bone marrow.

·        Vitamin B12: Acts as a coenzyme in the conversion of homocysteine to methionine and in the synthesis of S-adenosylmethionine, which is crucial for DNA synthesis and red blood cell maturation.

·        Folic Acid: Functions as a coenzyme in the synthesis of nucleic acids and the metabolism of amino acids, essential for DNA synthesis and repair, and cell division.

Uses

·        Treatment and prevention of iron deficiency anemia.

·        Treatment of megaloblastic anemia due to vitamin B12 or folic acid deficiency.

·        Management of anemia of chronic disease and anemia associated with chronic kidney disease.

·        Supplementation during pregnancy and lactation to prevent anemia.

Adverse Effects

·        Iron Supplements: Gastrointestinal upset (nausea, constipation, diarrhea), dark stools, and rarely, iron overload (hemochromatosis).

·        Vitamin B12: Generally well-tolerated; rare hypersensitivity reactions.

·        Folic Acid: Rarely causes adverse effects but can mask vitamin B12 deficiency.

Contraindications

·        Iron Supplements: Hemochromatosis, hemosiderosis, and hemolytic anemia (unless iron deficiency is present).

·        Vitamin B12: Hypersensitivity to cobalt or vitamin B12.

·        Folic Acid: Untreated vitamin B12 deficiency (as it can mask the deficiency).

Role of Nurse

1.     Assessment:

·        Evaluate patient's history and symptoms of anemia.

·        Perform diagnostic tests such as complete blood count (CBC), serum iron, ferritin, vitamin B12, and folate levels.

2.     Administration:

·        Administer hematinic as prescribed.

·        Educate patients on proper administration techniques, especially for iron supplements (e.g., taking with vitamin C for better absorption, avoiding certain foods and medications that inhibit absorption).

3.     Monitoring:

·        Monitor for therapeutic effects (e.g., improved hemoglobin levels, symptom relief).

·        Observe for adverse effects and manage accordingly.

·        Regularly check blood parameters to avoid complications like iron overload.

4.     Education:

·        Educate patients on dietary sources of iron, vitamin B12, and folic acid.

·        Advise on the importance of adherence to therapy.

·        Inform about the potential side effects and measures to mitigate them.

5.     Support:

·        Provide psychological support for patients with chronic anemia.

·        Coordinate care with other healthcare professionals for comprehensive management.

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