Information-giving and prescribing: Haematinic supplements Flashcards
What are the 3 haematinics?
Iron
Folate
B12
How would you explain to a patient what a haematinic is?
A haematinic is a type of a nutrient that is needed to produce red blood cells in the bone marrow
The 3 haematinics are iron, folate and B12
How would you explain to a patient why haematinics can cause anaemia?
If you don’t have enough haematinics stored in your body, you won’t produce as many red blood cells, or you red blood cells won’t contain enough Hb to carry oxygen.
These both can cause anaemia
How would you explain to a patient what causes iron-deficiency anaemia?
Iron is used to produce haemoglobin, which is the the part in the red blood cell that sticks to oxygen and helps carry it in the bloodstream to other body parts
If you have less iron, less Hb will be produced and distributed in red blood cells. This causes iron-deficiency anaemia
How would you explain to a patient what B12 is and how is it usually absorbed?
B12 is a vitamin that is found in animal proteins, for example beef, eggs, salmon
When you eat these foods, the B12 binds to a molecule in the stomach called Intrinsic factor
The intrinsic factor and B12 then travel to the small intestine and is absorbed into the bloodstream
How would you explain to a patient what can cause B12 deficiency, in 3 ways?
Lack of B12 in your diet
Autoimmune conditions that cause a lack of intrinsic factor: For example, pernicious anaemia produces antibodies against IF
Malabsorption due to conditions like Crohn’s disease, or small intestine surgery
How would you explain why B12 is an important haematinic?
B12 is one of the key vitamins that is needed in the reactions that produce the DNA of red blood cells, otherwise they cannot properly develop and function to their full extent
How would you explain why folate is an important haematinic?
Folate is needed to produce the building blocks of DNA in red blood cells, which are called bases
How do you explain to a patient what the risk factors are of developing folate deficiency? (A FOLIC DROP)
A: Alcohol
F: Folic acid inhibitors eg. methotrexate, trimethoprim
O: Oral contraceptive pill
L: Low dietary intake
I: Infections
C: Coeliac disease
D: Dilantin (phenytoin)
R: Relative folate deficiency
O: Old age
P: Pregnancy
How to you explain to a patient what the risk factors are for developing B12 deficiency?
Pernicious anaemia
Low dietary intake eg. not eating enough meat, dairy, fish or having a vegan diet
Stomach conditions eg. surgery
Intestine conditions eg. Crohn’s, resection
Medications eg. metformin, PPIs
How do you explain to a patient what the risk factors are for developing iron deficiency? (5 Ds)
Diet - lacking iron, vitamin C, too much tea blocking iron absorption
Decreased Absorption - Diarrhea, Celiac, autoimmune atrophic gastritis, h pylori
Drugs - aspirin, NSAIDs, PPIs
Donating blood - blood / excess venesection
Drain (Blood loss) - GI bleeding, hematuria, menses, pregnancy, urinary, lactation
What is the first-line treatment for iron deficiency, and give 3 examples?
Oral iron salts
Ferrous fumarate
Ferrous gluconate
Ferrous sulfate
What are the 5 common side effects of iron tablets?
Constipation
Diarrhoea
Nausea
Stomach discomfort or heartburn
Stools are darker colour
How should a patient ideally take iron tablets, in 3 ways?
Take iron tablets on an empty stomach, best time is 1 hour before eating
Take tablet with a drink with vitamin c, such as orange juice (vitamin c increases absorption)
Avoid eating food, tea or milk for 1 hour after taking iron, as these can decrease absorption
If a patient is taking iron tablets and feels nauseous, how can they alleviate this side effect?
Take iron on a full stomach instead
What is the first-line treatment for B12 deficiency?
Cyanocobalamin
Hydroxocobalamin
What is the first-line treatment for folate deficiency?
Folic acid
