Agents used in anemias and hematopoietic growth factors

Question 1

Iron supplements

Answer 1

• Ferrous sulfate, ferrous gluconate, ferrous fumarate
• PO
• tox: acute - necrotizing gastroenteritis, abdominal pain, bloody diarrhea, shock, lethargy, dyspnea; chronic - hemochromatosis
• Iron dextran, iron sucrose complex, sodium ferric gluconate complex
• parenteral

Question 2

Deferoxamine, deferasirox

Answer 2

• Iron chelators, IM/SC administration
• Deferasirox
• PO for hemochromatosis

Question 3

Vitamin B₁₂

Answer 3

• Cyanocobalamin
• Hydroxycobalamin
• preferred due to longer t_1/2
• Parenteral

Question 4

ESAs

Answer 4

• Epoetin alfa
• agonist of EPO receptors expressed by red cell progenitors
• erythroid proliferation & release of RTCs from marrow
• IV/SC
• tox: hypertension, thrombotic complications - keep hb <12g/dL
• Darbepoietin alfa
• long-acting glyosylated form administered weekly
• Methoxy PEG epoetin beta
• long-acting form administered monthly

Question 5

Filgastrim, pegfilgastrim

Answer 5

• Stimulation of G-CSF receptors expressed on mature neutrophils and their progenitors
• neutrophil progenitor proliferation & differentiation
• activates phagocytic activity of mature neutrophils and extends their surivival
• mobilizes hematopoietic stem cells
• SC daily
• tox: bone pain, rarely splenic rupture
• Pegfilgastrim
• long-acting form