Blood Question And Answers

Blood Important Notes

1. Heparin

• It is a powerful anticoagulant
• Effective both in vivo and vitro
• Present in all tissues containing mast cells
• In high doses, inhibits platelet aggregation and prolongs bleeding time
• Activates plasma antithrombin III
• This inactivates dotting factors of common and intrinsic pathways
• It does not cross the blood-brain barrier or placenta
• Thus it is safer during pregnancy

2. Styptics:

• They are local hemostatic agents
• Particularly effective on oozing surfaces
• Examples: thrombin, fibrin, gelatin foam, astringents like tannic add, vasoconstrictors like adrenaline

3. Drugs and anticoagulant action

4. Contraindications of vasoconstrictors

• Hypertension
• Hyperthyroidism
• Angina
• Patients receiving beta-blockers
• During anesthesia with halothane

3. Antiplatelet drugs

• Uses
  • Coronary artery disease
  • Cerebrovascular disease
  • Coronary angioplasty, bypass implants
  • Prosthetic heart valves
  • Venous thromboembolism
  • Peripheral vascular diseases
• Examples
  • Aspirin
  • Dipyridamole
  • Ticlopidine
  • Clopidogrel
  • Abcbdmab
  • Glycoprotein receptor antagonist

4. Vitamin K

5. Anticoagulants

• In vitro – Citrate, oxalate, EDTA
• In vivo – Coumarin, warfarin
• Both Vivo and vitro – heparin

6. Antifibrinolytics

• Epsilon amino Caproic acid
• Tranexamic acid

7. Iron preparation

8. Blood substitutes

• Blood products
  • Whole blood
  • Plasma
  • Plasma proteins
• colloidal plasma substitutes
  • Dextran
  • Gelatin
• Fluid plasma substitutes
  • 0.9% saline
  • 5% dextrose

9. Daily dose of iron

• Adult male – 0.5-1 mg
• Adult female – 1-2 mg
• Pregnancy – 3-5 mg in the last two trimesters

10. Megaloblastic anemia

• Occurs due to deficiency of vitamin B12 or folic acid
• Treatment includes vitamin B12 + folic acid
• Folic acid given alone may worsen the neurological deficit

Read And Learn More: Pharmacology Question and Answers

Blood Long Essays

Question 1. Explain the mechanism of iron absorption in the body. Add a note on different iron preparations
Answer:

Iron Absorption:

• Dietary iron is in the ferric form bound to proteins or organic acids
• The acidic medium of gastric juice releases this ferric ion
• Later it is converted to ferrous form by reducing substances like ascorbic acid and cysteine
• The ferrous form is soluble and is readily absorbed by mucosal cells
• It is oxidized to ferric form by ferroxidase
• This ferric form then combines with apoferritin and forms ferritin
• Iron from the mucosal cells may enter the bloodstream
• The ferric form is- Fe3+
• The ferrous form is Fe2+
• Gastric acid, reducing substances, and amino acids facilitate iron absorption
• Antacids, tetracyclines, phosphates, and phytates decrease iron absorption

Iron Preparations:

1. Oral iron preparations

It is the preferred route of administration

Oral iron Preparations:

• Ferrous sulfate -200 mg tab
  • Contains 20% hydrated salt and 32% dried salt
  • It is inexpensive
  • Produces a metallic taste in the mouth
• Ferrous gluconate -300 mg tab
  • Contains 12% of iron
  • Causes less gastric irritation
• Ferrous fumarate -200 mg tab
  • Contains 33% iron
  • It is less water soluble and tasteless
• Ferrous succinate -100 mg tab, 35% iron
  • Better absorbed and expensive
• Iron calcium complex -5% iron
  • Better absorbed and expensive
• Ferric ammonium citrate -45 mg tab
  • Better absorbed and expensive

Iron Dose:

• Total -200 mg given daily in 3 divided doses
• Prophylactic dose -30 mg daily

Iron Indications:

• Iron deficiency anemia

Iron Preparations Adverse Effects:

• Nausea, vomiting, epigastric pain
• Heartburn
• Staining of teeth
• Metallic taste
• Constipation

2. Parenteral iron preparations

• Intramuscular injection of iron is given deep in the gluteal region using the Z technique
• Intravenous is given slowly over 5-10 minutes

Parenteral Preparations:

• Iron dextran
  • It is a colloidal solution containing 50 mg of elemental iron
  • It is given intravenously and Intramuscularly
• Iron sorbitol citric acid complex
  • Contains 50 mg of elemental iron
  • Can be given only IM
  • If given IV it quickly saturates transferrin stores
  • Due to it free iron levels in the plasma rise and cause toxicity

Parenteral Dose:

• It is calculated using the formula:
• Iron requirement (in mg] = 4.4 * body weight (in kg) * Hb deficit (in g/dl)

Parenteral Indications:

• When oral iron is not tolerated
• Failure of absorption of oral iron
• Noncompliance
• In the presence of severe deficiency with chronic bleeding
• Along with erythropoietin

Parenteral Adverse Effects:

• Pain at the site of injection
• Pigmentation of skin
• Sterile abscess
• Fever
• Headache
• Joint pain, flushing, palpitation
• Chest pain, dyspnoea
• Anaphylactic reaction

2. Systemic agents

Question 2. Enumerate the agents used to control bleeding. Discuss their actions and uses.
Answer:

• Agents that help in controlling bleeding and are used in preventing or treating hemorrhagic conditions are known as coagulants

Control bleeding Classification:

1. Local agents or styptics

Control bleeding Actions:

• These materials provide a meshwork
• This activates the clotting mechanism and checks bleeding.

Question 3. Classify Anticoagulants. Discuss the mechanism of action, uses, and adverse effects of the coumarin derivatives.
Answer:

Anticoagulants:

• Anticoagulants are drugs used to reduce the coagulability of blood

Anticoagulants Classification:

• Used in vivo

1. Parenteral Anticoagulant

• • Heparin, low molecular weight heparin, heparan sulfate

2. Oral Anticoagulants .

• • Coumarin derivatives- Dicoumarol, warfarin, acenocoumarol, ethylbiscoumacetate
  • Indandione derivative- Phenindione
• Used in vitro

1. Heparin

2. Calcium complexing agents

• • Sodium citrate, sodium oxalate, sodium edetate.

Anticoagulants Coumarin Derivatives:

• Coumarin derivatives are
• Bishydroxycoumarin- Dicoumarol
• Warfarin
• Acenocoumarol- nicoumalone
• Ethylbiscoumacetate

Anticoagulants Mechanism of Action:

• They act only in vivo
• They interfere with the synthesis of vitamin K-dependent clotting factors in liver
• Act as a competitive antagonist of vitamin K
• Reduces plasma levels of clotting factors
• Interferes with the regeneration of the active hydro, quinone form of vitamin K.
• Blocks the gamma-carboxylation of glutamate residues in prothrombin, factors VII, IX, and X
• This gamma-carboxylation is needed by these factors for coagulation

Anticoagulants Uses:

• Deep vein thrombosis and pulmonary embolism
• Myocardial infarction
• Unstable angina,
• Rheumatic heart disease, atrial fibrillation
• Vascular surgery, prosthetic heart valves, retinal vessel thrombosis, extracorporeal circulation, hemodialysis

Anticoagulants Adverse Effects:

• Bleeding- ecchymosis, epistaxis, hematuria, bleeding in the GIT, intracranial bleeding
• Gastrointestinal disturbances
• Teratogenicity
• Skin necrosis

Question 4. Classify styptics. Describe the role of vitamin K when bleeding is due to oral anticoagulant therapy.
Answer:

Styptics:

• Styptics are local hemostatic substances used to stop bleeding from a local approachable site
• Commonly used styptics are
  • Thrombin
  • Fibrin
  • Oxidized cellulose
  • Gelatin foam
  • Adrenaline
  • Astringents

Role of Vitamin K

• Oral Anticoagulants interfere with the synthesis of vitamin K-dependent clotting factors in liver
• Act as a competitive antagonist of vitamin K
• Reduces plasma levels of clotting factors
• Interferes with the regeneration of the active hydroquinone form of vitamin K.
• Blocks the gamma-carboxylation of glutamate residues in prothrombin, factors VII, IX, and X ‘
• This gamma-carboxylation is essential for the ability of the clotting factors to bind Ca ions and to get the bound phospholipid surface necessary for the coagulation sequence to proceed
• Vitamin K acts as an antidote for Warfarin
• Administration of vitamin K by competitive antagonism with oral Anticoagulants reduces the anticoagulant action and brings about carboxylation of glutamate residues of prothrombin and factor VII, IX, and X necessary for the coagulation sequence to proceed.
• Hence vitamin K is used for bleeding due to oral Anticoagulants

Question 5. Describe how heparin and dicumarol act as Anticoagulants. Indicate their route of administration, duration of action and name their antagonists.
Answer:

• Heparin
  • It is a mucopolysaccharide found in the mast cells of the liver, lungs, and intestinal mucosa

Heparin Mechanism of Action:

• Heparin activates plasma antithrombin III
• Anti-thrombin III binds and inhibits activated Thrombin and coagulation factors Xa and IXa
• Heparin antithrombin III complex inhibits activated factor X and thrombin
• Low molecular weight heparin inhibits only factor X and not thrombin

Heparin Route of Administration:

• Heparin is given IV or SC

Heparin Duration of Action:

Heparin Antagonists:

• • Protamine sulfate is an antagonist of heparin
  • It is a low molecular-weight protein
  • When given IV it neutralizes heparin
  • It is used when heparin action needs to be terminated rapidly
• Dicoumarol:
  • Dicoumarol is a Coumarin derivative

Dicoumarol Mechanism of Action:

• It interferes with the synthesis of vitamin K-dependent clotting factors in liver
• Act as a competitive antagonist of vitamin K
• Reduces plasma levels of clotting factors
• Interferes with the regeneration of the active hydro-quinone form of vitamin K
• Blocks the gamma-carboxylation of glutamate residues in prothrombin, factors VII, IX, and X
• This gamma-carboxylation is needed by these factors for coagulation

Dicoumarol Route of Administration:

• It is given orally

Dicoumarol Duration of Action:

• Duration of action -4-7 day

Dicoumarol Antagonists:

• Vitamin K acts as an antagonist for Dicoumarol
• Administration of vitamin K by competitive antagonism reduces the anticoagulant action and brings about carboxylation of glutamate residues of prothrombin and factor VII, IX, and X necessary for the coagulation sequence to proceed

Question 6. Explain in detail about pharmacological action, pharmacodynamics, therapeutic uses, and toxicity of heparin.
Answer:

Anticoagulants:

• Anticoagulants are drugs used to reduce the coagulability of blood

Heparin

• It is a mucopolysaccharide found in the mast cells of the liver, lungs, and intestinal mucosa

Heparin Pharmacological Actions:

1. Anticoagulants

• Heparin is a powerful anticoagulant
• It is effective in vivo and in vitro
• At low concentrations, it prolongs activated partial thromboplastin time
• At high concentrations, it prolongs prothrombin time as well as partial thromboplastin time

2. Antiplatelet action

• Heparin inhibits platelet aggregation
• this prolongs the bleeding time

3. Lipaemia clearing

• Heparin activates lipoprotein lipase
• This hydrolyses triglycerides present in the plasma and thus clears the plasma of lipids

Heparin Pharmacodynamics:

• Heparin activates plasma antithrombin III
• Anti-thrombin III binds and inhibits activated Thrombin and coagulation factors Xa and IXa
• Heparin antithrombin III complex inhibits activated factor X and thrombin
• Low molecular weight heparin inhibits only factor X and not thrombin

Heparin Uses:

Heparin Low molecular weight heparin is used in:

• Prophylaxis of deep vein thrombosis and pulmonary embolism
• Treatment of established deep vein thrombosis
• Unstable angina
• To maintain patency of cannula and shunts in dialysis patients

Heparin Toxicity:

• Bleeding
• Thrombocytopenia
• Osteoporosis
• Alopecia
• Hypersensitivity reactions
• Hypoaldosteronism

Blood Short Essays

Question 1. Cyanocobalamin
Answer:

Coenzyme Forms:

• 5′- Deoxyadenosyl cobalamin
• Methylcobalamin

Functions:

1. Synthesis of methionine from homocysteine

• Vitamin B12 is used as Methylcobalamin in this reaction

2. Isomerization of methyl malonyl CoA to succinyl CoA

• It occurs in the presence of vitamin B12 Coenzyme, deoxy adenosylcobalamin

Cyanocobalamin Dietary Requirements:

• Adults- 3 micrograms/day
• Children-0.5-1.5 microgram/day
• During pregnancy and lactation- 4 micrograms/day

Cyanocobalamin Uses:

• Prevention and treatment of B12 deficiency
• Mega doses used in neuropathies, psychiatric disorders, cutaneous sarcoid

Question 3. List two Anticoagulants acting by different mechanisms. Mention any two uses of them.
Answer:

• Heparin
  • It is a mucopolysaccharide found in the mast cells of the liver, lungs, and intestinal mucosa

Heparin Mechanism of Action:

• Heparin activates plasma antithrombin III
• Anti-thrombin III binds and inhibits activated Thrombin and coagulation factors Xa and IXa
• Heparin antithrombin III complex inhibits activated factor X and thrombin
• Low molecular weight heparin inhibits only factor X and not thrombin

Heparin Uses:

Heparin Low molecular weight heparin is used in:

• • Prophylaxis of deep vein thrombosis and pulmonary embolism
  • Treatment of established deep vein thrombosis
  • Unstable angina
  • To maintain patency of cannula and shunts in dialysis patients
• Dicoumarol
  • Dicoumarol is a Coumarin derivative

Dicoumarol Mechanism of Action:

• It interferes with the synthesis of vitamin K-dependent clotting factors in liver
• Act as a competitive antagonist of vitamin K
• Reduces plasma levels of clotting factors
• Interferes with the regeneration of the active hydro-quinone form of vitamin K.
• Blocks the gamma-carboxylation of glutamate residues in prothrombin, factors VII, IX, and X
• This gamma-carboxylation is needed by these factors for coagulation.

Dicoumarol Uses:

• Deep vein thrombosis and pulmonary embolism
• Myocardial infarction.
• Unstable angina.
• Rheumatic heart disease, atrial fibrillation
• Vascular surgery, prosthetic heart valves, retinal vessel thrombosis, extracorporeal circulation, hemodialysis

Question 4. Iron-sorbitol-citric acid
Answer:

• Iron sorbitol citric acid complex is parenteral iron preparation.
• Contains 50 mg of elemental iron
• Can be given only IM
• If given IV it quickly saturates transferrin stores
• Due to it free iron levels in the plasma rise and cause toxicity

Iron-sorbitol-citric acid Dose:

• It is calculated using the formula:
• Iron requirement ( in mg) = 4.4 * body weight (in kg) * Hb deficit (in g/dl)

Iron-sorbitol-citric acid Indications:

• When oral iron is not tolerated
• Failure of absorption of oral iron
• Noncompliance
• In the presence of severe deficiency with chronic bleeding
• Along with erythropoietin

Iron-sorbitol-citric acid Adverse Effects:

• Pain at the site of injection
• Pigmentation of  skin
• Sterile abscess
• Fever
• Headache
• Joint pain, flushing, palpitation
• Chest pain, dyspnoea
• Anaphylactic reaction

Question 5. Anticoagulants
Answer:

• Anticoagulants are drugs used to reduce the coagulability of blood

Anticoagulants Classification:

• Used in vivo

1. Parenteral Anticoagulant

• • Heparin, low molecular weight heparin, heparan sulfate

2. Oral Anticoagulants

• • Coumarin derivatives- Dicoumarol, warfarin, acenocoumarol, ethylbiscoumacetate
  • Indandione derivative- Phenindione
• Used in vitro

1. heparin

2. Calcium complexing agents

• • Sodium citrate, sodium oxalate, sodium edetate.

Question 6. Compare heparin and oral anticoagulants.
(or)
Compare heparin and dicumarol
Answer:

Question 7. Explain the mechanism of action of streptokinase and mention one use of it.
Answer:

Streptokinase:

• Streptokinase is a fibrinolytic drug

Streptokinase Mechanism of Action:

• Streptokinase is antigenic
• It combines with plasminogen to form tissue plasminogen activator complex
• This complex then causes limited proteolysis of other plasminogen molecules to plasmin
• Plasmin degrades fibrin thereby dissolving the clot

Streptokinase Uses:

• Acute Myocardial infarction
• Deep vein thrombosis
• Pulmonary embolism

Question 8. Name two oral anticoagulants. Mention one drug treating toxicity of oral anticoagulants.
(or)
Dicumoral poisoning
Answer:

Oral Anticoagulants:

1. Coumarin derivatives- Dicoumarol, warfarin, acenocoumarol, ethylbiscoumacetate

2. Indandione derivative- Phenindione

Drug Used to Treat Toxicity of Oral Anticoagulants:

• Vitamin K is used to treat toxicity of oral anticoagulant
• Administration of vitamin K by competitive antagonism with oral Anticoagulants reduces the anticoagulant action and brings about carboxylation of glutamate residues of prothrombin and factor VII, IX, and X necessary for coagulation sequence to proceed

Question 9. Heparin and Warfarin.
Answer:

Blood Short Question And Answers

Question 1. Drugs for anemia.
Answer.

Question 2. Ferrous sulfate.
Answer:

Ferrous sulfate is oral iron preparation

Ferrous sulfate Dose:

• 200 mg tab, 3-4 tablets daily

Ferrous sulfate Indication:

• Prophylactic use in iron deficiency Anemia

Ferrous sulfate Adverse Effects:

• Nausea, vomiting, epigastric pain
• Heartburn
• Staining of teeth
• Metallic taste
• Constipation

Question 3. Folic acid
Answer:

Folic acid is important in one-carbon metabolism

Folic acid Sources:

• Green vegetables, liver, yeast, egg, milk, and some fruits

Folic acid Functions:

• The Coenzyme of it, tetrahydrofolate( THF], serves as an acceptor or donor of one carbon units
• It is involved in the synthesis of important compounds like
• Purines- Incorporated into DNA and RNA
• Pyrimidine nucleotide- deoxythymidylic acid- Involved in the synthesis of DNA
• Aminoacids- Glycine, serine, ethanolamine, and choline
• N-Formylmethionine- Initiator of protein biosynthesis

Folic acid Deficiency Manifestations:

• Megaloblastic anemia
• Glossitis
• Diarrhea
• Weakness

Question 4. Drugs used in microcytic anemia.
Answer.

1. Oral iron preparation

• Ferrous sulfate-200 mg tab
• Ferrous fumarate -200 mg tab

2. Parenteral iron preparation

• Iron dextran containing 50 mg of elemental iron
• Iron sorbitol citric acid complex containing 50 mg of elemental iron

Question 5. Drugs used for pernicious anemia.
Answer:

1. Vitamin B12 supplements
2. 1-5 mg of folic acid and iron preparation

Question 8. Indications for parenteral use of iron.
Answer:

• When oral iron is not tolerated
• Failure of absorption of oral iron
• Noncompliance
• In the presence of severe deficiency with chronic bleeding
• Along with erythropoietin

Question 6. Mention two oral and parenteral preparations.
Answer:

Oral Preparations:

• Ferrous sulfate
• ferrous gluconate
• Ferrous fumarate
• Colloidal ferric hydroxide

Parenteral Preparations:

• Iron dextran
• Iron sorbitol citric acid complex

Question 7. Vitamin C is given with iron in the treatment of anemia.
Answer:

• Vitamin C Improves Absorption Of Iron In The Intestine
• It maintains ferrous salts in a reduced state
• So vitamin C is used in the treatment of anemia along with iron,

Question 8. Vitamin K deficiency.
Answer:

Causes of Vitamin K Deficiency:

• Liver diseases
• Obstructive jaundice
• Malabsorption
• Long-term antimicrobial therapy altering intestinal flora

Vitamin K Deficiency Manifestations:

• Bleeding tendencies- hematuria, GIT bleeding, epistaxis, ecchymosis

Question 9. Heparin
Answer:

• It is a mucopolysaccharide found in the mast cells of the liver, lungs, and intestinal mucosa

Heparin Uses:

• Low molecular weight heparin is used in:
• Prophylaxis of deep vein thrombosis and pulmonary embolism
• Treatment of established deep vein thrombosis
• Unstable angina
• To maintain patency of cannula and shunts in dialysis patients

Heparin Toxicity:

• Bleeding
• Thrombocytopenia
• Osteoporosis
• Alopecia
• Hypersensitivity reactions
• Hypoaldosteronism

Question 10. Vitamin K
Answer:

• It is a fat-soluble vitamin

Vitamin K Sources:

Vitamin K

1. Animals sources

• Egg yolk, meat, liver, cheese and dairy products

2. Plant sources

• Cabbage, cauliflower, tomatoes, alfa, spinach

Vitamin K Functions:

• It helps in blood coagulation

Vitamin K Daily Requirements:

• 70-140 micrograms/day

Question 11. Fibrinolytic
Answer:

• Fibrinolytic are drugs that lose the clot or thrombus by activating the natural fibrinolytic system
• Fibrinolytic agents are:
  • Streptokinase
  • Urokinase
  • Alteplase
  • Replace
  • Tenecteplase

Fibrinolytic Uses:

• Acute Myocardial infarction
• Deep vein thrombosis
• Pulmonary embolism

Fibrinolytic Adverse Effects:

• Bleeding
• Hypotension
• Fever
• Anaphylactic reactions

Fibrinolytic Contraindications:

• In recent surgeries
• Injury
• GIT bleeding
• Stroke
• Severe hypertension
• Bleeding disorders

Question 12. Hemostasis
Answer:

• Hemostasis is the process of stopping bleeding postsurgically or from a site of injury
• It can be achieved by
  • Applying pressure at the bleeding site
  • Suturing
  • Use of styptics
• It occurs by
  • Contraction of the injured vessel wall
  • Adhesion and aggregation of platelets to form a plug
  • Formation of a blood clot
  • Dissolution of the clot by fibrinolysis

Question 13. Warfarin sodium
Answer:

• It is a Coumarin derivative

Warfarin sodium Uses:

• Deep vein thrombosis and pulmonary embolism
• Myocardial infarction
• Unstable angina
• Rheumatic heart disease, atrial fibrillation
• Vascular surgery, prosthetic heart valves, retinal vessel thrombosis, extracorporeal circulation, hemodialysis

Warfarin sodium Adverse Effects:

• Bleeding- ecchymosis, epistaxis, hematuria, bleeding in the git, intracranial bleeding
• Gastrointestinal disturbances
• Teratogenicity
• Skin necrosis

Question 14. Oral anticoagulants
Answer:

• Oral anticoagulants are:
  • Coumarin derivatives- Dicoumarol, warfarin, acenocoumarol, ethylbiscoumacetate
  • Indandione derivative- Phenindione

Question 15. Uses of vitamin K
Answer:

• Act as a cofactor for the synthesis of coagulation proteins- Ffrothrombin, factor VII, IX, and X
• Required for carboxylation of glutamic acid residues of osteocalcin
• Participates in the coagulation cascade

Question 16. Vitamin K used in the overdosage of Warfarin
Answer:

• Warfarin interferes with the synthesis of vitamin K-dependent clotting factors in liver
• Act as a competitive antagonist of vitamin K
• Reduces plasma levels of clotting factors
• Interferes with the regeneration of the active hydro-quinone form of vitamin K
• Blocks the gamma-carboxylation of glutamate residues in prothrombin, factors VII, IX, and X v
• This gamma-carboxylation is essential for the ability of the clotting factors to bind Ca ions and to get the bound phospholipid surface necessary for the coagulation sequence to proceed
• Vitamin K acts as an antidote for Warfarin
• Administration of vitamin K by competitive antagonism with Warfarin reduces the anticoagulant action and brings about carboxylation of glutamate residues of prothrombin and factor VII, IX, and X necessary for the coagulation sequence ta proceed

Question 17. Adverse effects of vitamin B12.
Answer:

• Vitamin B12 is used
• In the treatment of vitamin B12 deficiency
• Cyanacobalamine -100 ml in. daily
• Hydroxocobalamin -100-500,1000 mg daily
• Multivitamins for oral use
• B12 deficiency – Prophylaxis 3-10 mg daily
• Treatment of megaloblastic anemia
  • B12 neuropathies, psychiatric disorders, cutaneous sarcoid, and as a general tonic to allay fatigue and improve growth

vitamin B12 Adverse Effects:

• Anaphylactoid reaction on IV injection occurs due to sulfite contained in the formulation

Question 18. Name two oral anticoagulants. Mention two adverse effects.
Answer: