33_Hematopoietic Pharm Flashcards
What is microcytic anemia, what can’t be made, and what is the deficiency?
Small RBCs, Hgb can’t be made, due to Fe deficiency
What is megaloblastic anemia, what is there not enough of, and what is the deficiency?
Large RBCs, not enough DNA to divide (doesn’t go thru as many divisions so bigger) so its “overfilled” with Hgb, due to Vit B12 or folic acid deficiency
What is usually larger, TIBC or Fe level?
TIBC > Fe Level
What are the two types of Fe deficiency anemia and how are they treated? (duh)
Microcytic & Hypochromic
Low Hgb & Hct
Small RBCs (low MCV)
Low Hgb in each RBC (low MCHC)
Treat with Iron supp, either oral or parenteral
What form is oral iron supplements in?
SEs?
FERROUS SULFATE (most common)
Ferrous fumarate
Ferrous gluconate
SEs:
Mainly GI: Nausea, constipation, pain, diarrhea…all dose related
Also turns stool black so can be confused with Melena
When is parenteral iron indicated? Are there any reactions to worry about?
Indicated only in complicated anemia patients
Can’t give free iron, has to be bound to something
- IRON DEXTRAN (IM (painful) or IV)…can cause HYPERSENSITIVY REACTIONS
- Sodium ferric gluconate complex
- Iron Sucrose
When is iron in the body toxic?
What are the clinical symptoms if iron toxicity?
WHEN THE IRON IS FREE IN THE BODY!!! basically amount of iron outnumbers amount of transfer proteins
Symptoms:
- GI distress…N/V abd pain, GI bleeding from mucosal irritation
Later organ involvement
- Liver (high Fe in portal vein)
- Metabolic acidosis, shock, coma death
- Dyspnea or Kussmaul respirations
What are Kussmaul respirations?
This is dyspnea seen during severe metabolic acidosis
How is ACUTE Iron toxicity treated?
DE-FER-oxamine
- this is a parenteral iron chelator only used in acute toxicity, only removes a small fraction
Main treatment is supportive care
In what conditions will CHRONIC iron toxicity commonly be seen?
Hemachromatosis
Multiple blood transfusions with thallasemia major
Deferasirox (note the DE which means to take away, and the fer which means iron). This is an oral iron chelator
What ring structure is cobalamin or B12 similar to? What metal is it bound to?
On a molecular level, What is B12 needed for?
It has a heme like ring (corrin ring) and is bound to Cobalt
It is needed for 1 carbon methyl transfer reactions that support DNA synthesis. Takes a methyl group from Folate and gives it to Homocysteine
Deficiency of B12 and folate lead to what disorder?
Megaloblastic anemia
Has more Hgb than usual. There is not as much DNA, so doesn’t divide as much so cells are filled with Hgb while waiting so larger than usual.
How do you know if the megalablastic anemia is due to folate or B12 deficiency?
What is B12 deficiency due to?
How is it treated?
If the anemia is accompanied with neuro signs (folic acid doesn’t have this)
Usu due to malabsorption. This is pernicious anemia when there is not enough Intrinsic Factor from gastric mucosa. OR due to resected distal ileum
Treated with parenteral B12
Deficiency of folate can lead to which type of anemia and what effect does its deficiency have on fetal development?
Megaloblastic Anemia
Causes neural tube defects
Give it orally
What kind of hormones are hematopoietic hormones and how are they administered and why?
What are the types of of growth factors that can be given and what do they stimulate growth of?
Glycoprotein hormones. Must be given parenterally bc stomach acid will destroy them if given orally
Erythropoietin - Red Cells
G-CSF………………Granulocytes
GM - CSF…………Granulocytes & Macrophages
IL-11…………………..Platelets
