In this Chapter:
18.1. Drugs affecting erythropoiesis
18.2. Drugs affecting leukopoiesis
The drugs that affect hemopoiesis can be subdivided into the following groups.
I • Drugs affecting erythropoiesis
= Drugs stimulating erythropoiesis
A □ Drugs used for the treatment of hypochromic anemia
a) + Iron deficiency anemia
1. + Iron agents
- Ferrous sulfate
- Ferrum Lek
- Fercovenum
2. + Cobalt agents
- Coamidum
b) + In anemia occurring in some chronic diseases
- Epoetin alpha
B □ Drugs used for the treatment of hyperchromic anemia
- Cyanocobalamine
- Folic acid
= Drugs suppressing erythropoiesis
- Na2H32PO4
II • Drugs affecting leukopoiesis
= Drugs stimulating leukopoiesis
- Sodium nucleinate
- Pentoxylum
- Molgramostim
- Filgrastim
= Drugs suppressing leukopoiesis
- Mustine
- Busulphan
- Mercaptopurin
- Dopanum, etc.
18.1. DRUGS AFFECTING ERYTHROPOIESIS
The main agents that are used to stimulate erythropoiesis in hypochromic anemia are preparations of iron.
The basic mechanism of development of hypochromic anemia is the insufficient production of hemoglobin by bone marrow erythroblasts, which is caused by an iron deficiency or abnormal iron metabolism.
The human organism contains 2-5 gram of iron. The major part of this (2/3) is contained in hemoglobin. The rest of the iron is stored in tissue depots (in the bone marrow, liver and spleen). Iron is also a part of myoglobin and some enzymes.
Only ionized iron can be absorbed from the gastrointestinal tract, divalent iron is absorbed best of all (see Fig. 18.1). Therefore, iron absorption occurs faster in the presence of hydrochloric acid (it converts elemental iron into an ionized form) and ascorbic acid [it converts ferric iron (Fe+3) into ferrous iron). Absorption takes place mostly in the small intestine (especially, in the duodenum) via active transport and, perhaps, via diffusion. Apoferritin, a protein contained in the mucous membrane of the intestine, binds to the absorbed iron and they form the ferritin-complex. Having passed through the intestinal barrier, iron interacts with transferrin, a β1-globulin, in the serum. In the form of the transferrin complex, iron passes through to different tissues where it is released again. In the bone marrow, iron participates in hemoglobulin formation. In tissue depots, iron is stored in a bound form (in the form of ferritin or hemosiderine).