Agents used in Anemia and Hematopoietic Growth Factors

Question 1

hematopoietic growth factor
used for IRON DEFICIENCY ANEMIA
side effects: black stools
acute overdose: necrotizing gastroenteritis, abdominal pain, bloody diarrhea, shock, lethargy, dyspnea
chronic iron overload: HEMOCHROMATOSIS, organ failure, death

Answer 1

Ferrous Sulfate

oral: ferrous gluconate, ferrous fumarate, ferrous carbonate
parenteral: iron dextran, sodium ferric gluconate complex, iron sucrose

Question 2

iron content of some oral iron preparations (% w/w):
Fe carbonate/carbonyl ion?
Fe fumarate?
Fe sulfate, dried?
Fe sulfate, hydrated?
ferric ammonium sulfate?
Fe gluconate?

Answer 2

Fe carbonate/carbonyl ion: 100%
Fe fumarate: 33%
Fe sulfate, dried: 30%
Fe sulfate, hydrated: 20%
ferric ammonium sulfate: 18%
Fe gluconate: 12%

Question 3

usually occurs in children secondary to accidental ingestion of iron supplementation tablets

Answer 3

acute iron intoxication

Question 4

acute iron intoxication clinical manifestations

Answer 4

necrotizing gastroenteritis, shock, metabolic acidosis, coma, death

Question 5

treatment of acute iron intoxication

Answer 5

1. removal of unabsorbed tablets from gut
2. correction of acid-base and electrolyte abnormalities
3. parenteral administration of DEFEROXAMINE (chelates circulating iron)

Question 6

triad of hemochromatosis

Answer 6

1. cirrhosis
2. DM
3. skin pigmentation

Question 7

heavy metal chelator
chelates excess iron
used for ACUTE IRON POISONING, HEMOCHROMATOSIS not adequately treated by phlebotomy
side effects: hypertension, ARDS, neuropathy, increased susceptibility to infections

Answer 7

Deferoxamine

Deferasirox

Question 8

neurological manifestations of vitamin B12 deficiency

Answer 8

ataxic gait
impaired position and vibratory sense
neurologic deficits

Question 9

vitamin B12 is essential in what 2 reactions?

Answer 9

1. conversion of methylmalonyl-CoA to succinyl CoA

2. conversion of homocysteine to methionine

Question 10

hematopoietic growth factor
cofactor required for essential enzymatic reactions that form tetrahydrofolate, convert homocysteine to methionine, and metabolise methylmalonyl-CoA
used for VITAMIN B12 DEFICIENCY, MEGALOBLASTIC ANEMIA

Answer 10

cyanocobalamin (vit. B12)

hydroxycobalamin

Question 11

vitamin B12 is absorbed in what part of small intestine?

Answer 11

distal ileum

Question 12

folic acid is absorbed in what part of small intestine?

Answer 12

proximal jejunum

Question 13

hematopoietic growth factor
precursor of an essential donor of methyl groups used for synthesis of amino acids, purines, and deoxynucleotide
used for MEGALOBLASTIC ANEMIA, prevention of neural tube defects, prevention of coronary artery disease

Answer 13

folic acid

folacin (pteroylglutamic acid), folinic acid

Question 14

hematopoietic growth factor
agonist of erythropoietin receptors expressed by red cell progenitors
used for ANEMIA, esp. associated with CHRONIC RENAL FAILURE
considered a PERFORMANCE ENHANCING DRUG IN ATHLETES

Answer 14

epoietin alfa

darbepoietin alfa, methoxy polyethylene, glyco-epoeitin beta

Question 15

myeloid growth factor
binds receptors on myeloid progenitors and stimulates cell maturation and proliferation
accelerates neutrophil recovery and reduces incidence of infection
used for NEUTROPENIA
side effect: bone pain (arthralgia), fever, edema, splenic rupture

Answer 15

Filgrastim (G-CSF)

sargramostim (GM-CSF), pegfilgrastim, plerixafor

Question 16

megakaryocyte growth factor
recombinant form of endogenous cytokine
activates IL-11 receptors
used for secondary prevention of thrombocytopenia in patients undergoing cytotoxic chemotherapy for non-myeloid cancers

Answer 16

oprelvekin-11 (IL-11)

thrombopoietin, eltrombopag, romiplastim