Anemia and Hematopoietic Flashcards by Lloyd Leonell Labso

Anemia caused by deficiency of Vit B12 or Folic Acid

Megaloblastic Anemia

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What is the most common type of anemia?

Microcytic Hypochromic Anemia (Iron Deficiency)

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What is the typical laboratory picture of IDA?

Low Fer, Low Ferritin, High TIBC

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Transport protein of Iron

Transferrin

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Storage protein of Iron

Ferritin

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Which Iron Supplement has the highest Elemental Iron Content?

Ferrous Fumarate

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Excess iron causes what reaction?

Fenton Reaction

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Signs and symptoms of Acute Iron Overdose

Necrotizing gastroenteritis, 
abdominal pain, 
bloody diarrhea, 
shock, 
lethargy
dyspnea

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Effects of chronic iron overload

Hemochromatosis
Organ Failure
Death

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Treatment for Acute Iron Intoxication

Deforxamine
Correct acid-base abnormalities
Remove unabsorbed tablets from the gut

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What is triad of Hemochromatosis?

Cirrhosis
Diabetes Mellitus
Skin Pigmentation

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Oral form of Deferoxamine?

Deferasirox

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Which vitamin deficiency causes anemia and neurologic defecits?

Vitamin B12 deficiency

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What are the neurologic deficits of Pernicious Anemia?

Ataxic Gait
Impaired position and vibratory sense
Spasticity

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What part of the GIT is Vitamin B12 absorbed?

Distal Ileum

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What is needed to absorb vitamin B12?

Intrinsic Factor

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What protein transports Vit b12 in plasma?

Transcobalamin II

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What are the 2 forms of Vitamin B12?

Cyanocobalamin

Hydroxycobalamin

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Which is the synthetic and natural form of Vit B9?

Folate = Natural

Folic Acid = Synthetic

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Vitamin B12 is essential in what 2 reactions?

Conversion of methylnalonyl-CoA to Succinyl CoA

Conversion of Homocysteine to Methionine

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Folates accumulate as what metabolite?

N-Methyltetrahydrofolate

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Exogenous folic acid does not correct?

Neurologic deficits of Vit B12 Def

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Whatdo WBCs look like in Megaloblastic Anemia?

Hypersegmented Neutrophils (>5 lobes)

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Folic acid is absorbed in what part of the GIT?

Proximal Jejunum

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Enumerate the pathway of Folic Acid Synthesis

PABA -> (Dihydropteroate synthase) -> Dihydrofolic acid -> (Dihydrofolate reductase) -> Tetrahydrofolic Acid -> Purines -> DNA

What is Sargramostim or Pegfilgrastim?

G-CSF (Myeloid growth factor)

A megakaryocyte growth factor

Oprelvekin (IL-11)

What is Oprelvekin used for?

Secondary prevention of thrombocytopenia in patients undergoing cytotoxic chemotherapy for non-myeloid cancers

What are the 4 mechanisms of hemostasis?

1. Vasoconstriction 2. Platelet plug formation 3. Formation of clot via blood coagulation 4. Fibrous organization

Factors involved in 1st step: Vasoconstriction

Thromboxane A2 | Endothelin

Essential for binding subendothelial collagen to platelets by Gp1b receptor in the platelet surface

vWF

Factors involved in the Intrinsic Pathway or PTT

V, VIII, IX, X, XI, XII, Prothrombin, Fibrinogen

Factors involved in the extrinsic pathway or PT

V, VII, Prothrombin, Fibrinogen

The rate limiting factor in blood coagulation?

Prothrombin activator

Aspirin is asso. with what syndrome?

Reye Syndrome

What is the toxic dose of aspirin?

150 mg/kg

What is the lethal dose of aspirin?

500 mg/kg

What is the triad of aspirin hypersensitivity?

SAMTER TRIAD Asthma Aspirin Nasal Polyps

Effects of Aspirin intoxication

Increased respiratory drive leads to hyperventilation and respiratory alkalosis Uncoupling of oxidative phosphorylation leads to increased anaerobic metabolism via lactic acidosis and HAGMA

What is the expected acid-base abnormality in salicylate poisoning?

Respiratory Alkalosis with HAGMA

What is the difference in presentation if aspirin intoxication in children and adults?

Adults: mixed acid-base disorder (Respiratory Alkalosis with HAGMA) Children: pure acid-base disorder (HAGMA)

Inhibits platelet aggregation by interfering with GPIIb/IIIa binding to fibrinogen and other ligands

Abciximab / Eptifibatide / Tirofiban

What is the MOA of Abciximab / Eptifibatide / Tirofiban?

Inhibits platelet aggregation by interfering with GPIIb/IIIa binding to fibrinogen and other ligands

What is Abciximab used for?

Used during PCI to prevent thrombosis | Acute Coronary syndromes

Irreversibly inhibits binding of ADP to platelet receptors, reducing platelet aggregation

Clopidogrel

What is the MOA of Clopidogrel?

Irreversibly inhibits binding of ADP to platelet receptors, reducing platelet aggregation

Inhibits phosphodiesterase III and increases cAMP in platelets and blood vessels

Dipyridamole

MOA of Dipyridamole?

Inhibits phosphodiesterase III and increases cAMP in platelets and blood vessels

Side effects of Dipyridamole?

Headache because its a vasodilator, Palpitations

What are the 2 major types of anticoagulants?

Indirect Thrombin Inhibitors: Heparin, Enoxaparin, LMWH Direct Thrombin Inhibitors: Coumarin Derivatives

Describe the structure of Heparins and Warfarins

Heparin: large acidic polysaccharide Warfarin: small lipid-soluble molecule

How is Heparin and warfarin given?

Heparin: parenteral Warfarin: Oral

Where is the site of action of Heparin vs Warfarin?

Heparin: blood Warfarin: liver

Compare the onset of heparin vs warfarin

Heparin: rapid (minutes) Warfarin: slow (days)

Compare the MOA of heparin vs warfarin

Heparin: activates antithrombin III Warfarin: impairs posttranslational modification of factors II, VII, IX, X (Vit K dependent) Protein C and S

Which is safe in pregnancy? heparin vs warfarin

Heparin

What is the antidote of heparin and warfarin?

Heparin: Protamine Warfarin: vitamin k, FFP

What is the similar drug of Dipyridamole?

Cilostazol

Another drug for Clopidogrel

Ticlopidine, Prasugel

What is the difference between an inhibitor and an uncoupler of oxidative phosphorylation?

Inhibitors completely halt ETC Uncouplers dissipate proton gradient without interrupting the ETC

Give 8 examples of CYP450 Inducers

``` Ethel Booba takes Phen-Phen and reduces greasy carb shakes ETHANOL BARBITURATES PHENYTOIN RIFAMPICIN GRISEOFULVIN CARBAMAZEPINE ST JOHN's WORTH SMOKING ```

Give 9 examples of CYP450 inhibitors

``` Inhibitors stop cyber kids from Eating GRApefruit Q ISONIAZID SULFONAMIDES CIMETIDINE KETOCONAZOL ERYTHROMYCIN GRAPEFRUIT JUICE RITONAVIR AMIODARONE QUINIDINE ```

Warfarin inhibits what enzyme?

Epoxide reductase

Which anticoagulant does not require aPTT monitoring?

Enoxaparin, Fondaparinux

Which has a narrow therapeutic window, Heparin or Warfarin?

Warfarin

What is the antidote for Lepirudin?

No reversal agent exists