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Haematopoietic Agents and Erythropoeitin PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Haematopoietic agents & Erythropoeitin” by Dr. Rishi Pal.

This medical PowerPoint presentation is about haematopoietic agents and erythropoeitin (EPO).

Haematopoietic agents are substances that stimulate the production of blood cells in the body. One of the most important haematopoietic agents is erythropoietin (EPO), which is a hormone produced by the kidneys that stimulates the production of red blood cells (erythropoiesis) in the bone marrow.

EPO is a glycoprotein hormone that binds to erythropoietin receptors on the surface of erythroid progenitor cells in the bone marrow, stimulating their proliferation and differentiation into mature red blood cells. EPO is primarily used to treat anaemia, which is a condition characterized by a low red blood cell count, either due to decreased production or increased destruction of red blood cells.

In patients with chronic kidney disease, EPO production may be impaired, leading to anaemia. EPO replacement therapy can be used to correct this anaemia and improve quality of life. EPO is also used in the treatment of cancer-related anaemia, and in some cases of chemotherapy-induced anaemia.

However, the use of EPO is not without risks. In some cases, it can increase the risk of blood clots, which can be life-threatening. EPO can also stimulate the growth of tumours, so it should not be used in patients with certain types of cancer. Additionally, excessive use of EPO can lead to polycythemia, which is an overproduction of red blood cells that can cause blood thickening and lead to cardiovascular problems.

Overall, EPO is a powerful haematopoietic agent that plays an important role in the treatment of anaemia, but its use should be carefully monitored to minimize risks.

Tags : Haematopoietic agents, Erythropoeitin, production of blood cells, Hematology, Hematology PowerPoint presentation

Published on : May 29, 2023 | Views : 1460 | Downloads : 0

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Slide 1-

Haematopoietic agents & Erythropoeitin Dr. Rishi Pal Assistant Professor Department of Pharmacology
Slide 2-

Haematopoietic system Erythrocytes Leukocytes Thrombocytes Exogenous nutrients Endogenous nutrients
Slide 3-

Types of anaemia Microcytic hypochromic anaemia Megaloblastic anaemia Pernicious anaemia Haemolytic anaemia Aplastic anaemia Sickle cell anaemia Sideroblastic anaemia
Slide 4-

Iron deficiency anaemia Pallor Fatigue Dizziness Exertional dyspnoea Iron deficiency Dietary deficiency Faulty absorption, transport and storage Excessive blood loss Worm infestation
Slide 5-

Max iron absorption: duodenum & jejunum Haem iron & non haem iron (Fe+++) Ascorbic acid, SH, Succinic acid facilitate conversion of Fe+++ to Fe++ form
Slide 6-

ANEMIA? Anemia can be defined as a reduction in the hemoglobin, hematocrit or red cell number. In physiologic terms an anemia is any disorder in which the patient suffers from tissue hypoxia due to decreased oxygen carrying capacity of the blood
Slide 7-

Hematinics These are drugs used to treat anemia Iron Vitamin B12, Cyanocobalamin Folic acid Erythropoietin
Slide 8-

IRON FACTS All body cells need iron. It is crucial for oxygen transport, energy production, and cellular growth and proliferation. The human body contains an average of 3.5 g of iron (males 4 g, females 3 g). The typical daily normal diet contains 10–20 mg of iron. Only about 10% of dietary iron is absorbed (1–2 mg/day).
Slide 9-

Importance of Iron Iron forms the nucleus of the iron-porphyrin heme ring, This with globin chains forms hemoglobin. Function of Haemoglobin: Reversibly binds oxygen and provides the critical Mechanism for oxygen delivery from the lungs to other tissues. In the absence of adequate iron, small erythrocytes With Insufficient hemoglobin are formed, giving rise to Microcytic hypochromic anemia
Slide 10-

Iron absorption Iron is mainly absorbed in the duodenum and upper jejunum. A protein called divalent metal transporter 1 (DMT1) facilitates iron transfer across intestinal epithelial cells. Normally, individuals absorb less than 10% of dietary iron, or 1–2 mg per day balancing the daily loss from desquamation of epithelia. Most absorbed iron is used in bone marrow for erythropoiesis. Iron homeostasis is closely regulated via intestinal absorption. Once iron is absorbed, there is no physiologic mechanism for excretion of excess iron from the body other than blood loss (i.e., pregnancy, menstruation or other bleeding.)
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Iron transport Most absorbed iron is transported in the bloodstream bound to the glycoprotein transferrin. Transferrin is a carrier protein that plays a role in regulating the transport of iron from the site of absorption to virtually all tissues. Transferrin binds only two iron atoms. Normally, 20–45% of transferrin binding sites are filled (measured as percent transferrin saturation [TS]).
Slide 13-

Iron Transport
Slide 14-

Iron use in the body 75% of absorbed iron is bound to proteins such as hemoglobin that are involved in oxygen transport. About 10% to 20% of absorbed iron goes into a storage pool that is also recycled in erythropoiesis, so storage and use are balanced.
Slide 15-

Iron storage Iron is initially stored in ferritin molecules. A single ferritin molecule can store up to 4,000 iron atoms. When excess dietary iron is absorbed, the body responds by producing more ferritin to facilitate iron storage.
Slide 16-

Ferritin molecules store thousands of iron atoms within their mineral core. When excess dietary iron is absorbed, the body responds by producing more ferritin to facilitate iron storage.
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IRON FORMULATIONS ORAL: Ferrous sulfate Ferrous gluconate Ferrous fumarate PARENTERAL: Iron Dextran Iron-sucrose complex Iron sodium gluconate complex
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ORAL IRON THERAPY Treatment with oral iron should be continued for 3–4 months after correction of the cause of the iron loss. This corrects the anemia and replenishes iron stores. Common adverse effects of oral iron therapy include: Nausea epigastric discomfort abdominal cramps Constipation diarrhea. These effects are usually dose-related and can often be overcome by lowering the daily dose of iron or by taking the tablets immediately after or with meals
Slide 19-

Parenteral Iron Therapy Reserved for patients with documented iron deficiency who are unable to tolerate or absorb oral iron. For patients with extensive chronic blood loss who cannot be maintained with oral iron alone Postgastrectomy conditions Previous small bowel resection Inflammatory bowel disease Malabsorption syndrome
Slide 20-

Iron-dextran: iv or im (50mg/ml) Iron sucrose complex: iv or im Iron-sodium gluconate: iv or im Iron-sorbitol-citrate: only im
Slide 21-

A stable complex of ferric hydroxide and low-molecular-weight Dextran. Can be given by deep intramuscular injection or by intravenous Infusion Intravenous administration eliminates the local pain and tissue staining Adverse effects of intravenous iron dextran therapy include: Iron dextran:
Slide 22-

Side effects Headache, light-headedness, fever, arthralgias, nausea and vomiting, back pain, flushing, urticaria, bronchospasm, and, rarely, anaphylaxis and death. Hypersensitivity reactions may be delayed for 48–72 hours after administration. Owing to the risk of a hypersensitivity reaction, a small test dose of iron dextran should always be given before full intramuscular or intravenous doses.
Slide 23-

Iron-sucrose complex and iron sodium gluconate complex are alternative preparations. These agents can be given only by the intravenous route. These preparations appear to be much less likely than iron dextran to cause hypersensitivity reactions
Slide 24-

Body requirement of iron Hb has 33% of iron (50 mg in 100 ml of blood) Daily requirement Male: 0.5-1 mg Female: 1-2 mg Children: 25 mg
Slide 25-

Pharmacokinetics of iron Iron absorbs by active transport across intestinal mucosa. Converted Fe2+ to Fe3+ Apoprotein-iron complex (ferritin) Release on demand Absorption depends on apoprotein to ferritin ratio. Transferrin binds with free Fe2+ or Fe3+ from ferritin and carries to bone marrow
Slide 26-

Haemosiderin granules seen with iron overload & gives rise to haemosiderosis or bronze diabetes.
Slide 27-

Treatment of iron deficiency anaemia Oral iron therapy: ferrous salts of sulfate, fumerate, gluconate, lactate, succinate and glycine sulfate etc. Ferric salts: ferric ammonium citrate, iron polysaccharide and ferric hydroxide polymaltose complex. Ferrous salts better absorbed than ferric salts.
Slide 28-

Ferrous salts: 100mg provides 20% of elemental iron Ferrous fumerate: 33% Ferrous sulfate:19% Ferrous succinate: 12% Adult: 200mg of elemental iron administered in 2-3 divided doses after meal Children:3-5mg/kg in 3 divided doses 325mg tablets of ferrous sulfate, thrice a day
Slide 29-

Ferrous sulfate: FERSOLATE 200mg tab Ferrous fumerate: NORI-A 200mg tab Ferrous gluconate:FERRONICUM 300mg tab Collodial ferric hydroxide: NEOFERRUM 200 mg tab. 400mg/5ml syrup
Slide 30-

Vitamin B12 Cyanocobalamine Hydroxycobalamine Methylcobalamine 5’ deoxyadenosyl cobalamine
Slide 31-

Cobalamine… Pharmacokinetics of cobalamine Intrinsic factor (IF) Transcobalamine-II Metabolic functions Therapeutic uses Daily requirement: 2-3 μg/day Therapeutic dose: 100-1000ug/day i.m
Slide 32-

Cobalamine… Cyanocobalamine REDISOL, MACRABIN 100µg, 500µg/day Hydroxocobalamine REDISOL-H, MACRABIN-H 500µg, 1000µg per vial inj. Methylcobalamine METHYLCOBAL 500µg tab, NEUROKIND-OD 1500µg tab., 500µg/ml inj.
Slide 33-

Folic acid Pteroylglutamic acid Pharmacokinetics Metabolic functions Deficiency Therapeutic uses Daily requirement: 50µg Therapeutic doses: 1-5mg/day
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Slide 35-

Folic acid FOLVITE, FOLITAB 5mg tab Folinic acid RECOVORIN 15 mg tab., 75mg/ml, 10mg/ml inj.
Slide 36-

Haematopoietic growth factors Erythropoietin: epoietin 100 IU/kg s.c or i.v 3 times a week, darbepoetin. Preparations available EPOX, ZYROP,EPREX 2000IU, 4000IU/ml inj. Colony stimulating factor (CSF) G-CSF & GM-CSF Filgrastim & pegfilgrastim 300µg/inj.
Slide 37-

Megakaryocyte growth factors Interleukin-11
Slide 38-

Vitamins Fat soluble vitamins: A, D, E and K Water soluble vitamins B-complex group: B1,B2,B3,B5,B6 and Biotin Haematopoietic B-complex vitamins Folic acid and cyanocobalamin Non B-complex group: Ascorbic acid (vitamin-C)
Slide 39-

Ascorbic acid (Vitamin C) Dietary sources Physiological role Deficiency symptoms: Scurvy (defect in collegen formation) Prophylactic doses:50-500mg/day Therapeutic doses:1-1.5g/day As antioxidant:100mg/day Haematinic formulations 150mg/day Preparations available:CELIN,CHEWCEE,REDOXON 500mg tab
Slide 40-

Antioxidants
Slide 41-

Erythropoietin Cytokine produced in juxtatubular cells in the kidney and also in macrophages. Produced by recombinant technology. Available as epoeitin α and β. 25-100 IU/kg, s.c. or i.v. 3 times a week.
Slide 42-

Uses of Erythropoietin Anaemia due to: Chronic renal failure. Cancer chemotherapy. AIDS. Premature infants. Blood transfusion Adverse effects: flu-like symptoms, mild hypertension, encephalopathy, occasionally convulsions, risk of thrombosis due to hematocrit rises.
Slide 43-

Erythropoietin preparations available Erythropoietin, EPOX, ZYROL, EPREX 2000 IU, 4000 IU/ml inj.