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Explore the components of the hemopoietic system, types and causes of anemia, symptoms, hematinics used in treatment, and the structure of hemoglobin and oxygen transfer. Learn about iron absorption, sources of iron, daily requirements, and iron loss mechanisms.
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The Hemopoietic system The system that forms the cells of blood is known as hemopoietic systems. Main componentsof hemopoietic system are: blood Bone marrow Lymph nodes and (Lymph nodes:Small round or bean shaped masses of lymphatic tissue surrounded by a capsule of connective tissue. Located in various places of body. It filter lymphatic fluid and store special cell that can trap cancer cells or bacteria. ) (iv) thymus (A Lymphoid organ) Accessory organs of hemopoietic system : (i) Spleen (ii)Liver and (iii) Kidney.
Anemia: • Anemia is defined as the reduced concentration of hemoglobin in blood. The commonest cause is blood loss related to menstruation and child bearing.
Types of anemia: • 1. Hypochromic microcytic anemia- small red cells with low hemoglobin; caused by iron deficiency. • 2. Macrocytic anemia- large red cells, few in number. May be megaloblastic anemia • 3. Normochromic normocytic anemia- Fewer normal sized red cells, each with normal hemoglobin content. • 4. Mixed pictures :There are some mixed picture also
Causes of anemia: • 1. Deficiency of nutrients necessary for hemopoiesis (Formation of blood) most importantly - iron, Folic acid and vit B12 , pyridoxin, vit-c, etc • 2. Depression of bone marrow, caused by - toxins - radiation therapy - diseases of bone marrow of unknown origin - reduced production of erythropoietin (RBC) • 3. Excessive destruction of RBC (Hemolytic anemia), this has many causes including -hemoglobinopathies (such as sickle cell anemia ) -adverse reaction to drugs and -inappropriate immune reactions.
Symptoms and signs of anemia: The sign symptoms of anemia are as follows: • Fatigue, • Faintness, • Headache, • Palpitations, • Angina of efforts, • Pallor, • Tachycardia (Rapid heart rate) • Systolic flow murmur, • cardiac failure, • Jaundice etc.
Hematinics : • Defination: Agents that are used in the treatment of anemia to increase the number of RBC or hemoglobin content of RBC or both to normal level when there is deficiency. • Important hematinics are: (i) Iron (ii) Vit. B12 (iii) Folic acid
Classification of hematinics (According to diseases) • A) Drugs used in iron deficiency anemia: i) Iron preparation: They are two types a) Oral prep. i) Ferrous sulphate(200-600 mg/day) (20% elemental iron) ii) Ferrous gluconate (300-1200 mg/day)(12% elemental iron) iii) Ferrous fumerate(200-600 mg/day) (33% elemental iron) iv) Ferrous succinate v) Ferrous cholinaccetate vi) Ferrous Carbonate vii) Ferric ammonium citrate b) Parenteral preparation: i) Iron dextran complex (1.5mg/Kg/day) ii) Iron sorbitol (1.5mg/Kg/day) iii) Dextroferon ii) Copper, Cobalt, Pyridoxine, Riboflavin • B. Drugs used in megaloblastic anaemia: 1. Vit B12 (cyanocobalamine) 2. Folic Acid 3. Vit C
Structure of hemoglobin and the basis of oxygen transfer: Hemoglobin is made up of four protein chain subunits globins, each of which contains one haem moiety. Haem consists of tetrapyrrole porphyring ring containing ferrous (Fe2+). The iron complexes molecular oxygen by utilizing a vacant orbital which can be used by a pair of non bonding electron from oxygen. Here iron picks up or donates electrons. This reversible binding is the basis of oxygen transport.
Site and process of iron absorption: • Site of absorption: The site of iron absorption is the duodenum and upper jejunum • Absorption Process:Absorption is a two stage process involving 1st rapid uptake across the brush boarder and then transfer into the plasma from the interior of the epithelial cells.
How ascorbic acid stimulate iron absorption. • ** Ascorbic acid stimulates iron absorption partly by forming soluble iron ascorbate chelates and partly by reducing ferric iron to more soluble ferrous form.
Sources of irons: Sources are as follows: 1. > 5 mg / 100 gm of food (*) Liver (**) Heart * Egg Yolk, beans, 2. = 1.5 mg / 100 gm - Muscles, - meats, - fish, - fowls, - green vegetables and - cereals 3. <1mg/ 100 gm of food Milk and milk-products, Non-green vegetables.
Daily requirement and loss of iron: • Daily requirements of iron Children: 10 - 15 mg Adult male: 5 - 10 mg Adult Female: 15 - 18 mg Pregnancy: 30 - 60 mg Lactating mother: 30-60 mg • Iron Loss:Mainly by desquamation from gut & skin Loss per d ay 0.5 - 1.0 mg Menstrual Loss: 13.5 mg/ period Pregnant women = 500 mg / full term pregnancy