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Hypochromic microcytic
Iron is essential in the formation of haemoglobin
Factors affecting absorption of iron:
A. Diet:
Tannic acid, phosphates form relatively insoluble and
consequently unabsorbable complexes with iron.
Reducing substances in food e.g. ascorbic acid and certain
fatty acids such as succinates and the -SH groups of amino
acids, help reduction of ferric salt (non absorbable) to
the ferrous iron (absorbable).
Meat increases absorption of iron through stimulating
production of gastric acid .
The iron in meat protein is more available for absorption
and can be more efficiently absorbed, since haem iron in
meat haemoglobin and myoglobin can be absorbed intact
as haemin without first being broken down into free iron.
B. Diseases
Absorption of iron is hindered in cases of achlorohydria,
coeliac disease,malabsorption syndrome
Decreased absorption
(e.g. malabsorption syndrome)
Increased requirement:
Baby: premature (not well developed iron stores).
Pregnant women:
The fetus takes up 600 mg of iron from his mother even if she is
deficient. Iron must be given from the fourth month of pregnancy
Increased loss
Menstruating women
Occult blood loss (piles, peptic ulcer)
Symptomatic treatment:
Intravenous fluids to treat collapse and dehydration.
Sodium bicarbonate for metabolic acidosis
Barbiturates to counteract convulsions
Indications:
These are indicated only in emergencies or when oral
therapy is impractical
Iron sorbitol
50 mg/ml given by deep i.m.i. It is a complex of low
molecular weight sorbitolt hat can be rapidly
absorbed from the site of injection
VITAMIN B12 (CYANOCOBALAMIN)
DEFICIENCY ANAEMIA
Normochromic Macrocytic
Functions
Dose:
Children: 1 mg daily.
Adverse effects:
X Xa X Xa
Ca+2 Ca+2
Prothrombin activator
Prothrombin
Ca+2 activator
Prothrombin Thrombin Prothrombin Thrombin
(factor II) (factor II)
Activation of certain factors (VII, II, X and protein C and S) is essential for
coagulation. This activation requires vit K (reduced form)
1-36
The coagulation of blood may be interfered with
due to
They include sodium citrate and edetate, which form soluble but
non-ionizable chelates with calcium. 3.8% sodium citrate may be
used to maintain the fluidity of blood for tranfusion processes
Parenteral Anticoagulants
HEPARIN
Heparin was originally obtained from the liver, but is also present in the
lungs and other tissues and in the mast cells.
It is normally present in the blood and is one of the main factors which
maintains its normal fluidity.
Mechanism of action of heparin
Heparin prevents fibrin formation in the process of
coagulation as follows:
Subcutaneous administration:
Dose:
They are given orally as they are absorbed from the gut
There are two main groups:
a) Coumarin derivatives:
Warfarin(prototype)
Dicoumarol
They are the safest and most commoly used preparations especially
warfarin which has the lowest incidence of adverse effects
b) Indandione derivatives:
Phenandione(Dindevan)
Diphenadione.