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Blood & Haematinics - Pharmacology (Easy Table Guide)

Sources: Katzung's Basic and Clinical Pharmacology, 16e | Goodman & Gilman's Pharmacological Basis of Therapeutics

What Are Haematinics?

Haematinics are drugs that promote formation of blood cells - mainly red blood cells. The word comes from "haema" (blood) + "tonic." They correct anaemia by supplying what the bone marrow needs to make healthy red cells.

PART 1 - Iron Preparations (For Iron-Deficiency Anaemia)

Drug	Form	Elemental Iron %	Dose	Key Notes
Ferrous sulfate	Oral	~20%	325 mg TDS	First choice - cheap, effective
Ferrous gluconate	Oral	~12%	300 mg TDS	Less GI upset than sulfate
Ferrous fumarate	Oral	~33%	200 mg BD	Highest % elemental iron orally
Carbonyl iron	Oral	~100%	Lower dose	Slow release, safer in OD
Iron sucrose	IV	-	Per protocol	Used in CKD, malabsorption
Ferric carboxymaltose	IV	-	Single large dose	Less frequent infusions
Iron dextran	IV/IM	-	Per protocol	Risk of anaphylaxis

Iron Absorption Tips (Easy Memory):

Absorbed in duodenum + proximal jejunum as Fe²⁺ (ferrous form)
Vitamin C increases absorption (converts Fe³⁺ → Fe²⁺)
Tea, milk, antacids reduce absorption
Give on empty stomach for best effect (take with food if GI upset occurs)
Continue therapy 3-6 months after Hb normalizes to replenish stores

Side Effects of Oral Iron:

Nausea, constipation, dark stools, epigastric pain
GI side effects are dose-dependent

PART 2 - Vitamin B12 (Cobalamin) - For Megaloblastic Anaemia

Aspect	Details
Drug	Cyanocobalamin, Hydroxocobalamin
Deficiency cause	Pernicious anaemia (lack of Intrinsic Factor), strict vegans, gastrectomy
Mechanism	Needed for DNA synthesis (thymidine synthesis) and myelin formation
Route	IM injection (if pernicious anaemia / malabsorption); oral if dietary deficiency
IM dose	1000 mcg/day x 7 days → weekly x 4 weeks → monthly lifelong
Key finding	Megaloblastic (macrocytic) anaemia + neurological signs (subacute combined degeneration)
Trap!	Giving folate alone in B12 deficiency corrects anaemia but WORSENS neuro damage

PART 3 - Folic Acid - For Megaloblastic Anaemia

Aspect	Details
Drug	Folic acid (Vitamin B9)
Deficiency cause	Poor diet, pregnancy, alcohol, methotrexate/phenytoin use
Mechanism	Needed for purine and thymidine synthesis (DNA formation)
Route	Oral (well absorbed)
Dose	1-5 mg/day orally
Prevention	400 mcg/day in women planning pregnancy (prevents neural tube defects)
Key finding	Megaloblastic anaemia WITHOUT neurological signs

PART 4 - Erythropoiesis-Stimulating Agents (ESAs)

These drugs mimic erythropoietin (EPO) - the hormone made by kidneys that tells bone marrow to make red cells.

Drug	Frequency	Main Use	Key Warning
Epoetin alfa	3x/week SC/IV	Anaemia in CKD, chemotherapy	↑ CV risk if Hb >11 g/dL
Darbepoetin alfa	Weekly or 2-weekly	Same as epoetin	Longer half-life, less frequent dosing
Methoxy PEG-epoetin beta	Monthly	CKD anaemia	Longest duration

Golden Rule: Use the lowest dose to avoid transfusion. Never target Hb >11 g/dL.

PART 5 - Colony Stimulating Factors (CSFs) - For WBC/Neutrophil Deficiency

Drug	Type	Main Use	Key Point
Filgrastim (G-CSF)	Granulocyte CSF	Chemotherapy neutropenia, bone marrow transplant, chronic neutropenia	Given 24h after chemo; prophylactic if fever risk >20%
Pegfilgrastim	Long-acting G-CSF	Prevention of chemo-induced neutropenia	Given once per chemo cycle (longer acting)
Sargramostim (GM-CSF)	Granulocyte-Macrophage CSF	Bone marrow transplant, AML recovery	Stimulates both neutrophils and monocytes

PART 6 - Thrombopoietin Receptor Agonists (Platelet Boosters)

For when platelet count is dangerously low (thrombocytopenia).

Drug	Route	Main Use	Key Point
Romiplostim	SC injection	ITP (chronic)	Peptide TPO mimetic; weekly dosing
Eltrombopag	Oral	ITP, severe aplastic anaemia, HCV thrombocytopenia	Monitor liver function; can cause portal thrombosis
Avatrombopag	Oral	Chronic ITP, pre-procedure in liver disease	5-day course before procedure
Lusutrombopag	Oral	Chronic liver disease thrombocytopenia pre-procedure	Similar to avatrombopag
Fostamatinib	Oral	Chronic ITP (failed other therapies)	SYK inhibitor; side effects: diarrhea, hypertension

Shared Warnings: Do NOT target normal platelet counts - just enough to reduce bleeding risk (>50,000/µL). Risk of marrow fibrosis and rebound thrombocytopenia on stopping.

PART 7 - Anticoagulants (Blood Thinners) - Quick Summary

Drug	Class	Mechanism	Use	Monitor
Heparin (UFH)	IV/SC	Activates antithrombin III → ↓ thrombin + Xa	DVT, PE, ACS (acute)	aPTT
LMWH (enoxaparin, dalteparin)	SC	Mainly anti-Xa	DVT prophylaxis/treatment	Anti-Xa level
Warfarin	Oral	Inhibits Vit K-dependent factors (II,VII,IX,X)	Chronic AF, mechanical valves, DVT	INR (target 2-3)
Dabigatran	Oral DOAC	Direct thrombin inhibitor	AF, VTE	No routine monitoring
Rivaroxaban / Apixaban	Oral DOAC	Direct factor Xa inhibitor	AF, VTE, PE	No routine monitoring

PART 8 - Antiplatelet Drugs

Drug	Mechanism	Use	Key Note
Aspirin	Irreversibly inhibits COX → ↓ TXA2	ACS, stroke prevention, post-stent	Low dose (75-325 mg); lifelong after MI
Clopidogrel	ADP receptor (P2Y12) blocker	ACS, stents	Prodrug - requires CYP2C19; genetic variability
Ticagrelor	Reversible P2Y12 blocker	ACS	Faster onset than clopidogrel; causes dyspnea
Prasugrel	Irreversible P2Y12 blocker	ACS with PCI	More potent; avoid in stroke history
Abciximab / Eptifibatide	GPIIb/IIIa antagonist	High-risk PCI	IV only; blocks final platelet aggregation

PART 9 - Thrombolytics (Clot Busters)

Drug	Type	Use	Time Window
Streptokinase	Non-specific	STEMI, DVT, PE	Within 12h of MI
Alteplase (tPA)	Fibrin-specific	Ischemic stroke, STEMI, PE	Stroke: within 4.5h; STEMI: within 12h
Tenecteplase	Fibrin-specific, long-acting	STEMI	Single IV bolus (convenient)

PART 10 - Haemostatics (Stop Bleeding)

Drug	Mechanism	Use
Tranexamic acid	Inhibits fibrinolysis (anti-plasmin)	Trauma, surgical bleeding, menorrhagia
Aminocaproic acid	Same as above	Post-surgical bleeding
Vitamin K	Replenishes clotting factors	Warfarin reversal, Vit K deficiency bleeding
Protamine sulfate	Binds and neutralizes heparin	Heparin overdose antidote
FFP / Cryoprecipitate	Replaces all/specific clotting factors	DIC, massive transfusion
Desmopressin (DDAVP)	↑ release of vWF from endothelium	Mild haemophilia A, vWD

Quick Memory Summary

Anaemia Type	Deficiency	Drug
Microcytic (small cells)	Iron	Ferrous sulfate / IV iron
Macrocytic (big cells) + neuro signs	Vitamin B12	Cyanocobalamin IM
Macrocytic (big cells), no neuro	Folate	Folic acid oral
Normocytic in CKD	Low EPO	Epoetin alfa / Darbepoetin
Bone marrow failure	Multiple	G-CSF + transfusion

Sources: Katzung's Basic and Clinical Pharmacology 16e (Chapter 33) | Goodman & Gilman's Pharmacological Basis of Therapeutics (Hematopoietic Agents chapter)

No no trach mefrom basic

Got it! You want me to teach from the very basics - step by step, simple language, easy tables. Let me build this properly from scratch.

🩸 Blood & Haematinics — From ZERO to HERO

STEP 1 — What is Blood Made Of?

Component	What It Does
Red Blood Cells (RBC)	Carry oxygen using hemoglobin
White Blood Cells (WBC)	Fight infection (immunity)
Platelets	Stop bleeding (clotting)
Plasma	Liquid part — carries everything

STEP 2 — What is Haemoglobin (Hb)?

Hb is a protein inside RBCs that carries oxygen
Normal Hb: Men = 13-17 g/dL | Women = 12-15 g/dL
Hb is made of Iron + Protein (globin) + Heme ring
No iron = No Hb = Anaemia

STEP 3 — What is Anaemia?

Anaemia = Low Hb = Less oxygen to body

Symptoms: Tiredness, pale skin, breathlessness, fast heartbeat, dizziness

STEP 4 — Types of Anaemia + Which Drug Treats Each

This is the MOST important table 👇

#	Type of Anaemia	What is Missing	RBC Appearance	Drug to Give
1	Iron Deficiency Anaemia	Iron	Small, pale (Microcytic, Hypochromic)	Ferrous Sulfate / Iron
2	Megaloblastic Anaemia	Vitamin B12	Large (Macrocytic) + Nerve damage	Cyanocobalamin (B12) injection
3	Megaloblastic Anaemia	Folic Acid	Large (Macrocytic) - NO nerve damage	Folic Acid tablet
4	Anaemia of CKD	Erythropoietin hormone low	Normal size	Epoetin alfa injection
5	Aplastic Anaemia	Bone marrow not working	All cells low	G-CSF (Filgrastim)

STEP 5 — IRON DRUGS (Most Common in Exams!)

Where does Iron come from?

Food → Iron enters intestine → Absorbed as Fe²⁺ (Ferrous) → Goes to blood → Makes Hb

Iron Preparations — Easy Table

Drug Name	Route	Elemental Iron	Remember As
Ferrous Sulfate	Oral (tablet)	20%	Cheapest, first choice
Ferrous Gluconate	Oral	12%	Less GI side effects
Ferrous Fumarate	Oral	33%	Highest oral iron %
Iron Sucrose	IV injection	—	Used in kidney disease
Ferric Carboxymaltose	IV injection	—	Single large dose, convenient
Iron Dextran	IV/IM	—	Risk of allergic reaction

How to Take Iron Tablet — Rules

Rule	Reason
Take on empty stomach	Better absorption
Take with Vitamin C / lemon juice	Vit C converts Fe³⁺ → Fe²⁺ (absorbable form)
Avoid with tea, milk, antacids	These reduce absorption
Continue 3-6 months after Hb is normal	To refill body iron stores

Side Effects of Iron

Side Effect	Tip
Nausea, stomach pain	Take with food (less absorption but tolerable)
Black/dark stools	Normal! Tell the patient not to worry
Constipation	Take stool softener if needed
Overdose in children → Toxic	Keep tablets away from children

STEP 6 — VITAMIN B12 (Cyanocobalamin)

Simple Story:

Stomach makes a protein called Intrinsic Factor (IF). IF grabs B12 from food and helps absorb it. If stomach is diseased → No IF → No B12 absorption → Pernicious Anaemia

Feature	Details
What it does	Makes DNA + Maintains nerve myelin sheath
Deficiency causes	Pernicious anaemia, Vegans, Gastrectomy, Crohn's disease
Blood picture	Macrocytic (big RBCs) + Low Hb
Unique sign	Nerve damage — tingling, weakness, walking problems
Route	IM injection (because oral won't absorb if IF is absent)
Dose schedule	1000 mcg IM daily x 7 days → Weekly x 4 → Monthly (lifelong)
Important trap!	If you give ONLY folic acid in B12 deficiency → Anaemia improves BUT nerve damage gets WORSE

STEP 7 — FOLIC ACID (Vitamin B9)

Feature	Details
What it does	Makes DNA — needed for cell division
Deficiency causes	Poor diet, Pregnancy, Alcohol, Drugs (methotrexate, phenytoin)
Blood picture	Macrocytic anaemia (same as B12) BUT NO nerve damage
Route	Oral tablet (well absorbed)
Dose	1-5 mg/day
Prevention dose	400 mcg/day for pregnant women — prevents Neural Tube Defects (spina bifida)

B12 vs Folic Acid — Exam Favourite Comparison

Feature	Vitamin B12	Folic Acid
RBC size	Big (Macrocytic)	Big (Macrocytic)
Nerve damage	YES	NO
Route	IM injection	Oral tablet
Special cause	Pernicious anaemia	Pregnancy, alcohol
Giving only folate in B12 deficiency	Dangerous (worsens nerves)	—

STEP 8 — ERYTHROPOIETIN DRUGS (EPO)

Simple Concept:

Kidneys make a hormone called Erythropoietin (EPO) → tells bone marrow "make more RBCs" In Kidney disease (CKD) → Kidneys fail → No EPO → Anaemia

Drug	How Often	Route	Use
Epoetin alfa	3x per week	SC or IV	CKD anaemia, Chemo anaemia
Darbepoetin alfa	Once a week or 2-weekly	SC or IV	Same uses, longer acting

Golden Rule: Never raise Hb above 11 g/dL — increases risk of heart attack and stroke!

STEP 9 — G-CSF (White Cell Boosters)

These drugs tell bone marrow: "Make more neutrophils (infection-fighting WBCs)"

Drug	Use	Key Point
Filgrastim	Neutropenia after chemotherapy, bone marrow transplant	Give 24h after chemo
Pegfilgrastim	Same — but lasts longer	One injection per chemo cycle

STEP 10 — PLATELET DRUGS (Thrombopoietin Agonists)

When platelets are very low → bleeding risk → give these drugs

Drug	Route	Use
Romiplostim	Injection	Chronic ITP (immune platelet destruction)
Eltrombopag	Oral	ITP, Aplastic anaemia
Avatrombopag	Oral	ITP, Liver disease before surgery

STEP 11 — VERY EASY FINAL SUMMARY TABLE

Drug	Deficiency Fixed	Route	Key Side Effect / Note
Ferrous Sulfate	Iron	Oral	Black stool, constipation
Ferric Carboxymaltose	Iron	IV	Safe in CKD
Cyanocobalamin (B12)	Vitamin B12	IM injection	Lifelong in pernicious anaemia
Folic Acid	Folate	Oral	Must give in pregnancy
Epoetin alfa	EPO (CKD)	SC/IV	Don't raise Hb >11
Filgrastim (G-CSF)	Neutropenia	SC	Bone pain common
Romiplostim	Platelets (ITP)	SC	Weekly injection
Eltrombopag	Platelets	Oral	Check liver function

MEMORY TRICK — "I B Fine Every Day"

Letter	Stands For	Drug
I	Iron	Ferrous Sulfate
B	B12	Cyanocobalamin
F	Folate	Folic Acid
E	Erythropoietin	Epoetin
G	G-CSF	Filgrastim

Want me to go even deeper on any one drug (like iron absorption step-by-step, or pernicious anaemia in detail)? Just ask! 😊

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