Hematinics and iron chelators

Hematinics: Boosting Blood Health and Beyond

When it comes to maintaining optimal blood health, hematinics play a pivotal role. These agents are essential for treating and preventing anemia and ensuring the body has an adequate supply of vital blood components. Dive into the world of hematinics with this comprehensive guide.

What Are Hematinics?

Hematinics, often referred to as blood tonics, are drugs and supplements that provide the body with essential substances required for blood formation. They are primarily used to treat various forms of anemia, a condition characterized by a reduced number of red blood cells or hemoglobin.

Key Components of Hematinics

  1. Iron: A crucial component of hemoglobin, iron is vital for transporting oxygen in the blood. Iron supplements, such as ferrous sulfate and ferrous gluconate, are commonly prescribed for iron-deficiency anemia.
  2. Vitamin B12: Essential for red blood cell formation, Vitamin B12 deficiency can lead to pernicious anemia. Cyanocobalamin is a commonly used form of Vitamin B12 in supplements.
  3. Folic Acid: This B vitamin is vital for DNA synthesis and maturation of red blood cells. A deficiency can result in megaloblastic anemia.

Benefits of Hematinics

  • Combatting Anemia: Hematinics address the root cause of anemia, whether it’s due to iron, Vitamin B12, or folic acid deficiency.
  • Boosting Energy: By improving oxygen transport in the blood, hematinics can alleviate fatigue and increase energy levels.
  • Supporting Pregnancy: During pregnancy, the demand for blood components increases. Hematinics ensure that expecting mothers and their babies receive adequate nutrients.

Potential Side Effects

While hematinics are generally safe, they can cause side effects. Iron supplements might lead to constipation, nausea, or stomach upset. It’s essential to take them as prescribed and be aware of any adverse reactions.

Natural Sources of Hematinics

In addition to supplements, several foods are rich in hematinic components:

  • Iron: Red meat, spinach, lentils, and fortified cereals.
  • Vitamin B12: Animal products like fish, meat, eggs, and dairy.
  • Folic Acid: Leafy greens, citrus fruits, beans, and fortified bread.


Hematinics are indispensable allies in the fight against anemia and in maintaining optimal blood health. Whether through diet, supplements, or a combination of both, ensuring an adequate intake of these vital components can lead to improved well-being and vitality.

Iron Chelators

Iron chelating agents are drugs used to remove excess iron from the body, particularly in patients with iron overload conditions such as thalassemia, hemochromatosis, and transfusional iron overload. The following is a classification of iron-chelating agents with examples, individual drug actions, uses, and adverse effects.

I. Oral iron chelators

A. Deferiprone
B. Deferasirox

II. Parenteral iron chelators

A. Deferoxamine

Individual drug actions use, and adverse effects:


Mechanism of Action: Deferiprone is an orally administered iron chelator that forms a stable complex with iron (Fe3+), allowing its excretion in the urine.

Uses: Deferiprone is used to treat iron overload in patients with thalassemia, sickle cell disease, and other transfusion-dependent anemias. It may also be used in combination with deferoxamine for enhanced iron removal.

Adverse effects: The most common side effects of deferiprone include gastrointestinal disturbances (nausea, vomiting, abdominal pain), joint pain, and a transient increase in liver enzymes. Agranulocytosis, a potentially life-threatening decrease in white blood cells, is a rare but serious side effect that requires close monitoring.


Mechanism of Action: Deferasirox is an oral iron chelator that binds to iron (Fe3+) with high affinity, promoting its excretion through the feces.

Uses: Deferasirox is used for the treatment of chronic iron overload due to transfusions in patients with thalassemia, sickle cell disease, and other transfusion-dependent anemias. It may also be used in patients with non-transfusion-dependent thalassemia and iron overload from other causes.

Adverse effects: Common side effects of deferasirox include gastrointestinal disturbances (nausea, vomiting, diarrhea, abdominal pain), skin rash, and an increase in liver enzymes. Serious side effects may include kidney injury, liver failure, and gastrointestinal hemorrhage requiring close monitoring.


Mechanism of Action: Deferoxamine is a parenteral iron chelator that binds to iron (Fe3+) and forms a stable complex, which is then excreted in urine and bile.

Uses: Deferoxamine is used to treat acute and chronic iron overload due to transfusions, thalassemia, and other conditions. It is also used as an antidote for acute iron poisoning.

Adverse effects: Side effects of deferoxamine include injection site reactions, allergic reactions, gastrointestinal disturbances, and transient increases in liver enzymes. Long-term use may cause ocular and auditory toxicity and growth retardation in children, which require regular monitoring.

In conclusion, iron-chelating agents are essential in the management of iron overload disorders, preventing the toxic effects of excess iron on various organs. The choice of iron chelator depends on the specific clinical situation, patient preference, and potential side effects. Careful monitoring of iron levels, organ function, and potential adverse effects is crucial for the safe and effective use of these drugs.

Key points of Hematinics:

  1. Iron, folic acid, and Vitamin B12 are the main haematinics required for the formation of blood and treatment of anaemia.
  2. Good sources of iron include liver, egg yolk, beans, and dry fruits. Milk and its products are poor sources.
  3. Iron is absorbed mostly in the duodenum in the ferrous form and increasing substances like ascorbic acid and gastric acid (HCl) increase absorption.
  4. Iron is stored as ferritin or transported with transferrin to form blood. In the case of iron deficiency, transferrin receptors increase, leading to brisk erythropoiesis.
  5. Oral preparations of iron include ferrous sulfate, gluconate, and succinate. The dosage for treatment of iron deficiency is 200 mg of elemental iron per day for 3-6 months.
  6. Parenteral preparations include iron-dextran and iron-sorbitol-citrate. The total iron requirement can be calculated using a formula.
  7. Common side effects of oral iron include gastrointestinal problems, while the parenteral route can cause pain and pigmentation of the skin.
  8. Desferrioxamine is the antidote for acute iron poisoning. Deferiprone is used for chronic iron overload in thalassemia patients.
  9. Folic acid consists of pteridine, PABA, and glutamic acid. It is converted to methyl tetrahydrofolate for transport in the blood and participates in one-carbon transfer reactions.
  10. Deficiency of folic acid results in megaloblastic anemia, which is treated by oral folic acid supplementation.

Hemopoietic Growth Factors:

  • Erythropoietin stimulates RBC production and is used for anemia due to chronic renal failure and chemotherapy.
  • G-CSF and GM-CSF are used for leucopenia induced by chemotherapy and for harvesting peripheral blood stem cells. Filgrastim is better tolerated, but both can cause bone pain, and GM-CSF is associated with capillary leak syndrome.
  • IL-11 (in the form of oprelvekin) is used for the prevention and treatment of thrombocytopenia induced by chemotherapy.
  • Romiplostim is a new drug in the “peptibodies” class, acting as a thrombopoietin receptor agonist for Idiopathic Thrombocytopenic Purpura (ITP), with a half-life proportional to serum platelet count.
  • Eltrombopag is a new orally active thrombopoietin agonist approved for ITP.

All of these growth factors except Eltrombopag are administered subcutaneously.

These medications are important in treating various medical conditions related to anemias. Understanding how they work, what they are used for, and any potential side effects are crucial for healthcare providers to provide the best care for their patients.

Disclaimer: This article is for informational purposes only and should not be taken as medical advice. Always consult with a healthcare professional before making any decisions related to medication or treatment.

I recommend testing yourself with a self-assessment quiz or test to reinforce your knowledge. This will allow you to practice and reinforce important aspects of these drugs without collecting any user data.

Please use desktops/laptops for a better experience of the quiz.

[qsm quiz=4]

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always seek the advice of a healthcare provider with any questions regarding a medical condition.

Leave a Reply

Your email address will not be published. Required fields are marked *