Agents used in Anemias

Question 1

what small bowel diseases are associated with B12 deficiency?

Answer 1

• Crohn’s
• Celiac
• fish tapeworm infestation

Question 2

which parenteral iron formulations has the highest risk of type 1 HS reaction

Answer 2

iron dextran

Question 3

what are some adverse effects of iron therapy?

Answer 3

• black stools

- GI upset: nausea, abdominal cramps, constipation, diarrhea

Question 4

folate should never be given by itself in patients with macrocytic meagloblatic anemia. it should be given with ____

Answer 4

B12

Question 5

what is the function of B12 in the creation of methionine?

Answer 5

accepts the methyl group from methyl THF

methylcobalamin (methyl B12) then passes the methyl group to homocysteine to create methionine

Question 6

the storage form of iron is:

Answer 6

ferritin; Fe2+ (ferrous)

Question 7

transferrin binds to what form of iron

Answer 7

Fe3+ (ferric) takes the iron from the enterocyte to other storage sites such as bone marrow or the liver

Question 8

what is the function of hepcidin?

Answer 8

released from the liver when the liver iron stores are full and so hepcidin will inhibit the ferroportin on the enterocytes which transport iron out of them to the liver/bone marrow

Question 9

the main storage site of B12 is ___

Answer 9

liver;

takes 5 years to develop B12 deficiency after not eating anything with B12 in it so folate deficiency is more common

Question 10

what are iron chelators and their routes of administration

Answer 10

• deferoxamine: given via IV
• deferasirox: given via orally but must be given within 1 hour of iron ingestion because patients might later vomit and not take it down

Question 11

effect of sargramostin

Answer 11

stimulate all myeloid lines: WBC and RBC (also ↑ platelets)

Question 12

what are some effects on other organs due to the pro oxidant effect of chronic iron toxicity?

Answer 12

• cardiomyopathy
• cirrhosis
• “bronze diabetes”

Question 13

what drugs can inhibit the absorption of B12?

Answer 13

• metformin, neomycin: alter gut microflora
• NO anesthesia
• PPI’s, histamine 2 receptor antagonists: ↑ gastric pH

Question 14

the largest source of iron in people is ______

Answer 14

iron cycling from dead RBC’s

Question 15

pernicious anemia leads to ______ deficiency

Answer 15

B12 deficiency

Question 16

clinical presentations of b12 deficiency

Answer 16

• neurological symptoms: paraparesis, sensory loss

- osteoporosis

Question 17

iron toxicity can lead to metabolic _______

Answer 17

ACIDosis

Question 18

what are two available preparations for B12 therapy ?which one is preferred

Answer 18

hydroxocobalamin and cyanocobalamin

hydroxocobalamin is preferred because it remains in the circulation for a longer time

Question 19

describe the transferrin saturation, ferritin levels and total iron binding capacity in iron deficiency

Answer 19

↓ transferrin saturation
↓ ferritin levels
↑ TIBC

Question 20

methyl folate trap is seen with _____ deficiency

Answer 20

B12 deficiency;

Question 21

what are the three effects of hydroxyurea

Answer 21

1. ↑ HbF
2. ↓ expression fo neutrophil adhesion molecules
3. ↑ endothelial production of vasodilatory NO

Question 22

effect of filgrastim:

Answer 22

only stimulates the WBC lines and is better tolerated than sargramostin
(no ↑ in platelets)

Question 23

______ is given for isolated thrombocytopenia

Answer 23

IL-11 because it situates the growth of primitive megakaryocytic progenitors.