Agents used in anemias & hematopoietic growth factors
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Agents used in anemias &hematopoietic growth factorsBy: S.Bohlooli, Ph.D.
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Agents used in anemias
Iron Vitamin B12 Folic acid
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Iron
Iron deficiency most common nutritional cause of anemia result from inadequate iron intake, malabsorption,
blood loss, or an increased requirement, as with pregnancy
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The Body Content of Iron
MG/KG OF BODY WEIGHT
Male Female
Essential iron Hemoglobin 31 28Myoglobin and enzymes 6 5
Storage iron 13 4Total 50 37
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Pathways of iron metabolism in human beings
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Absorption, transport, and storage of iron
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Iron Requirements for Pregnancy AVERAGE, mg RANGE, mg
External iron loss 170 150-200Expansion of red cell mass 450 200-600
Fetal iron 270 200-370Iron in placenta and cord 90 30-170
Blood loss at delivery 150 90-310Total requirement* 980 580-1340Cost of pregnancya 680 440-1050*Blood loss at delivery not included. aIron lost by the mother; expansion of red cell mass not included. SOURCE: Council on Foods and Nutrition. Iron deficiency in the United States. JAMA 1968, 203:407-412. Used with permission
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Daily Iron Intake and Absorption SUBJECT IRON
REQUIREMENT, mg/kg
AVAILABLE IRON IN POOR DIET-GOOD DIET, mg/kg
SAFETY FACTOR, AVAILABLE IRON/REQUIREMENT
Infant 67 33-66 0.5-1Child 22 48-96 2-4Adolescent (male) 21 30-60 1.5-3Adolescent
(female)20 30-60 1.5-3
Adult (male) 13 26-52 2-4Adult (female) 21 18-36 1-2Mid-to-late
pregnancy80 18-36 0.22-0.45
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Clinical pharmacology
Indication for the use of iron Treatment or prevention of iron deficiency anemia
Treatment Oral iron therapy Parenteral iron therapy
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Some Commonly Used Oral Iron Preparations
Preparation Tablet Size Elemental Iron per Tablet
Usual Adult Dosage (Tablets per Day)
Ferrous sulfate, hydrated
325 mg 65 mg 3–4
Ferrous sulfate, desiccated
200 mg 65 mg 3–4
Ferrous gluconate 325 mg 36 mg 3–4
Ferrous fumarate 100 mg 33 mg 6–8
325 mg 106 mg 2–3
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Oral iron therapy adverse effects Nausea Epigastric discomfort Abdominal cramps Constipation Diarrhea
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Clinical toxicity
Acute iron toxicity Necrotizing gastroenteritis Vomiting, abdominal pain, bloody diarrhea Followed by shock, lethargy, dyspnea Severe metabolic acidosis, coma, death
Chronic iron toxicity (hemochromatosis) Deposit of iron in the heart, liver, pancreas Can lead to organ failure and death
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Vitamin B12
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The absorption and distribution of vitamin B12
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Enzymatic reactions that use vitamin B12
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Enzymatic reactions that use folate
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Vitamin B12: clinical pharmacology Treat or prevent deficiency
Megaloblastic anemia Neurologic syndrome
Degeneration of myelin sheaths Disruption of axons in the dorsal and lateral horns of
spinal cord and in peripheral nerves Most cause of deficiency:
Pernicious anemia, partial or total gastroctomy Disease affect the distal ileum:
Inflammatory bowel disease Small bowel resection
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Folic Acid
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Enzymatic reactions that use folate
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Folic acid: Clinical pharmacology Deficiency
result in megaloblastic anemia Often caused by inadequate dietary intake
Pregnant woman has increased folate requirement
A dose of 1 mg is sufficient
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Hematopoietic growth factors Erythropoietin Granulcyte colony-stimulating factor (G-CSF) Granulcyte-macrophage colony stimulating
factor (GM-CSF) Interleukin 11
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Clinical Uses of Hematopoietic Growth FactorsHematopoietic Growth Factor Clinical Condition Being Treated
or PreventedRecipients
Erythropoietin, darbepoetin alfa Anemia Patients with chronic renal failure
HIV-infected patients treated with zidovudine
Cancer patients treated with myelosuppressive cancer chemotherapy
Patients scheduled to undergo elective, noncardiac, nonvascular surgery
Granulocyte colony-stimulating factor (G-CSF; filgrastim)
Neutropenia Cancer patients treated with myelosuppressive cancer chemotherapy
Granulocyte-macrophage colony-stimulating factor (GM-CSF; sargramostim)
Patients with severe chronic neutropenia
Stem cell transplantation Patients with nonmyeloid malignancies treated with stem cell transplantationMobilization of peripheral blood
progenitor cells (PBPCs) Mobilization of peripheral blood progenitor cells (PBPCs)
Patients with nonmyeloid malignancies
Donors of stem cells for allogeneic or autologous transplantation
Interleukin-11 (IL-11, oprelvekin) Thrombocytopenia Patients with nonmyeloid malignancies who receive myelosuppressive cancer chemotherapy
Romiplostim Thrombocytopenia Patients with idiopathic thrombocytopenic purpura