anemia and blood growth factors- wolffe Flashcards
adverse effect of filgrastim, sagramostim, and erythropoietin makes sense given site of their effects
bone pain
example of oral iron pill
ferrous sulfate
folate deficiency may cause this, but it is not associated with the neurological problems caused by vitamin B12 deficiency
depression
infection that can cause pernicious anemia in the absence of autoantibodies
h. pylori
while alcohol is the most common cause of sideroblastic anemia, this environmental toxin can also block heme synthesis to cause it
lead
consequence of peripheral vasodilation due to oxygen-poor blood and reduced viscosity during anemia
low pressure
transports ~98.5% of the oxygen in the blood
hemoglobin
iron chelator administered as therapy for potentially lethal iron poisoning
deferoxamine
___ is the same as vitamin b-12
cobalamin
nanoparticle used to treat iron deficiency, can infuse faster than colloidal iron
ferumoxytol
glycoprotein secreted by parietal cells, complexes with cobalamin to facilitate its uptake via cubulin receptors in the ileum
intrinsic factor
use of this for analgesia during surgery can cause rapid onset of vitamin B12 deficiency symptoms
nitrous oxide
common in anemia due to decreased oxygen carrying capacity of blood causing elevated heart rate
angina
sign of anemia that can be evident from a distance
pallor
common symptom of anemia
fatigue
cause nausea an vomiting diarrhea or constipation, anorexia, heart burn, and dark spots
iron tablets
this for macrocytic anemia is aided by measuring plasma levels of folate, vitamin B12, homocysteine, and methyl-malonic acid
diagnosis
AKA c-kit, has potent synergistic actions on early progenitor cells, but cannot be used since this stimulatory effect extends to mast cells and gives rise to severe allergic reactions
stem cell factor
contributes to the reason that 2 of the 4 heme moieties of hemoglobin have a bound O2 molecule at 26.8 torr
positive cooperativity
this and sustained release formulations drastically reduces the bio availability of orally administered iron
enteric coating
frequently heard in anemia because of teh thinner blood leaks through the closed valves
murmur
recombinant granulocyte-colony stimulating factor, it increases growth and proliferation of neutrophil progenitor cells and also facilitate actions of mature neutrophils (i.e. phagocytosis, respiratory burst)
filgrastim
visible GI tract consequences of folate deficiency
mouth ulcers
approximately half-saturated with oxygen at 2 torr, reason oxygen can be stripped from hemoglobin and stored in muscles
myoglobin
indication from romiplostim or eltrombopag, after failure of first choice
ITP - immune thrombocytopenia purpura
although filgrastim can speed the recovery from severe neutropenia, there is less evidence of impact on this for this expensive drug
clinical outcomes
life-threatening complication of chemo; hypotension, COPD, dehydration and age >60 years are among the risk factors for underlying gram -, gram + and/or fungal
neutropenic fever
symmetric form of this +/- alterations in gait and cognition are common neuropsychiatric symptoms of vitamin B12 deficiency
parasthesia
in combination with poor dietary intake, is a common cause of folate deficiency
alocoholism
among the choices for IV administration of iron due to malabsorption or intolerance of oral forms, administration bypasses hepcidin regulation
iron dextran
can be severe with oral iron administration
GI irritation
can cause the elastin-rich eye to turn yellow
hemolysis
whether black and tarry, magneta or bright red, blood loss here can be significant
stool
appropriate route administration for vitamin b12 in pernicious anemia provided dose is ~500X the daily requirement
oral
refers to anemia associated with loss of intrinsic factor
pernicious
releases erythropoietin in response to hypoxia; failure of this organ causes a normochromic normocytic anemia
kidney
name means that polyethylene glycol was attached to filgrastim to prolong its half-life
pegfilgrastim
type of anemia caused by cancer chemotherapeutics, chloramphenicol and benzene
aplastic
production is decreased by thalassemic disorders
globins
anemia in which erythroblasts double protein but were unable to synthesize new DNA; extrusion of nucleus now leaves a large RBC
macrocytic
forms when Fe2+ has occupies its place in protoporphyrin IX=
heme
atypical form of this is an indication of eculizumab
HUS
only actively regulated pharmacokinetic process to control the amount of iron in the body
absorption
prevents formation of complement membrane attack complex, treat paroxysmal nocturnal hemoglobinuria cuased by insufficiency GPI-lniked CD59 and CD55 on the RBC cell surface that otherwise protects from this type of attack
eculizumab
among the causes of iron loss
sloughing of cells
adverse consequences of free heme or iron in the body
oxidative stress
peptide produced by the liver that regulates iron hemostasis, increased levels reduce blood levels
hepcidin
partial agonist at CXCR4 receptors important for homing hematopoietic stem cells, an expensive orphan drug administered when G-CSF or GM-CSF alone cannot mobilize enough stem cells of autologous transplant
plerixafor
cancer chemo agent approved for the treatment of sickle cells anemia because it somehow boosts the levels of (normal) fetal hemoglobin, thereby blocking aggregation of abnormal adult hemoglobin
hydroxyurea
reason to administer filgrastim +/- plerixafor to mobilize hematopoietic progenitor cells
leukapheresis
often expected within a few days after initiating appropriate therapy for microcytic or macrocytic anemia; increases in hematocrit and hemoglobin follow shortly thereafter
reticulocytosis
most common cause of drug induced immune thrombocytopenia
heparin
can, for example, block intrinsic factor cobalamin interaction or the receptor for it in the ileum, or target receptor for it in the ileum, or target H-ATPase or parietal cells
autoantibody
heme containing proteins
cytochrome p450
increases in part due to increased viscosity of blood caused by epoetin alfa
blood pressure
among good dietary sources of iron
meat
symptoms that, when present with macrocytic anemia, justify parenteral b12
neurological
potentially especially vulnerable to cognitive decline cause by vitamin b12 deficiency hat has been masked by the consumption of folate fortified foods
elderly
plasma levels of this micronutrient fall within 3 weeks inadequate intake from animal products and leafy vegetables
folate
blood doping with recombinant forms of this is banned by the olympics
erythropoietin
stimulates platelet production in vivo, but recombinant forms for treating thrombocytopenia were withdrawn from the market due to frequent autoantibody production leading to profound thrombocytopenia
thrombopoietin
considered severe if absolute count <500/microliter; low grade fever, sore mouth, severe pain from swallowing, upper and lower airway inflammation and perianal pain and irritation are among its sxs
neutropenia
can readily meet their daily needs of vitamin b12 by rating fortified breakfast cerals
vegetarians
orally active non-peptide thrombopoietin agonist approved for treatment of idiopathic thrombocytopenic purpura and the thrombocytopenia seen with hepatitis C
eltrombopag
vitamin b12 deficiency is suggested when this is red/inflamed and smooth
tongue
this use of filgrastim is considered warranted if calculated risk of getting neutropenic fever >220% or if its use permits timely administration of potentially curative chemo
prophylaxis
potential characteristic of neurological pathology due to vitamin b12 deficiency
irreversible
increased incidence of this is a predictable consequence of eculizumab therapy, and overwheming amount can also cause neutropenia
infection
recombinant erythropoiesis stimulating glycoprotein with AA sequence identical to erythropoietin administered to treat anemia secondary to chronic kidney disease or chemotherapy to reduce the need for allogenic RBC transfusions
epoetinalfa
needed to generate methionine from homocysteine and tetrahydrofolate from 5-methyltetrahydrofolate
vitamin b12
recombinant IL-11, early agent that increases platelet levels via unknown mechanism, no longer has a major clinical use
oprelvekin
has been one of the leading causes of death by toxilogical agents in children < 6 years old
iron poisoning
type of anemia frequently caused by cephalosporins and some penicillins
hemolytic
for sagramostim, this includes fluid retention, dyspnea due to sequestration of granulocytes in pulmonary circulation, fatal “gasping syndrome” in premature infants
adverse effects
antiarrhythmic drug, a classic cause of drug induced non immune thrombocytopenia
quinidine
recombinant GM-CSF, acts in the bone marrow to increase production of neutrophils, eosinophils, and monocyte/macrophages (i.e. after a transplant)
sargramostim
a “peptibody” has to igG constant regions linked by a peptide; has no homology to thrombopoietin but nevertheless stimulates the thrombopoietin receptor to promote platelet production
romiplostim
hypersegmented in macrocytic anemia
neutrophils
well known reason for folate intake to be increased
pregnancy
anemia in which teh MCV<80 fl; iron deficiency is the most common cause (i.e. due to heavy menstrual bleeding)
microcytic
period of time required to develop vitamin b12 deficiency, a reflection of daily need (micrograms) vs body stores (milligrams)
years
