Haematinics – Anaemia is due to deficient numbers of circulating red blood cells or reduction in hemoglobin content per unit of blood volume. Important causes of anaemia are blood loss, nutritional deficiency or complex hereditary deficiencies. Aplastic anaemia occurs due to failure of bone marrow to produce red blood cells.
Haematinics or antianaemics are the agents which are required for the proliferation and maturation of red blood cells. They are iron, folic acid and vitamin B. Anaemia may develop as a result of deficiency of any of these haematinics. Further, some haemopoietic growth factors also play very special function.
The rational treatment of anaemias depends on proper diagnosis of the type so that specific therapy can be given. Indiscriminate use of blood transfusion should be avoided.
Nutritional anaemias occur due to deficiency of Haematinics that is inadequate ingestion, or absorption or utilization, or increased excretion or increased requirement of iron. These anaemias can be treated by giving the deficient nutrient such as iron, vit&min B12, folic acid or vitamin C in appropriate form and dosage.
Elective oral surgical or periodontal procedures should not be performed on patients with marked anaemia in order to maintain Haematinics because of the potential for increased bleeding, risk of bacterial infection (particularly with anaerobic bacteria, due to tissue hypoxia) and impaired wound healing. General anesthesia should not be administered unless the hemoglobin is at least 10 g/dL. Such patients should never be treated with iron for Haematinics until the cause of the microcytic hypochromic anaemia is found and corrected or until a thorough search for the cause has proved fruitless.
The severity of anaemia owing to hemolysis (G6PD def.) and its correction should be evaluated before major dental interventions because the decline in haemoglobin (Hb) can reach 3—4 g/dL during haemolytic episodes. Blood transfusion may be used prior to dental treatment in severe cases. Drugs that maintain Haematinics that might induce hemolysis, such as dapsone, sulfasalazine and phenacetin should be avoided. However, non-narcotic analgesics and antibiotics can be given safely in therapeutic doses.
Elective dental procedures involving the soft tissues should not be performed in with poorly controlled sickle cell disease unless absolutely necessary because of increased risk of complications secondary to chronic anaemia and delayed wound healing.
The two most common oral manifestations of cyclic neutropenia to maintain Haematinics are oral mucosal ulcers and periodontal disease (marginal gingivitis) to rapidly advancing periodontal bone loss caused by bacterial infection of the dental supporting structures. The use of colony stimulating factors has reduced oral ulcers and periodontal disease in these patients.
Avoid use of narcotic analgesics in presence of anaemia because there will occur grave side effects of respiratory depression.
Total body iron is about 45 g m adult males and 2.5 g in adult females. Deficiency of iron will lead to iron deficiency anaemia (hypochromicmicrocytic anaemia). Absorption of iron for Haematinics is facilitated by gastric juice, reducing substances such ascorbic acid and SH-containing amino acids and is decreased by antacids, phosphates, maize, wheat and tetracydines.
Vitamin B12 and folic acid are required for the maturation of the large, nucleated erythrocyte-precursor blood cells (megaloblasts). So deficiency of these substances will lead to megaloblasticmacrocytic anaemia. When deficiency of vitamin B1, is due to absence of intrinsic factor, it is called pernicious anaemia.
Of the two therapeutically used cobalamins, hydroxy cobalamin is more protein bound, and therefore better retained than cobalamin. In case of vitamin B12 deficiency, administration of folic acid alone is contraindicated because neurological manifestations appear or aggravated thus maintaining Haematinics.