Anemia and Hematopoietic Drugs

Question 1

What is hematopoiesis?

Answer 1

The process by which blood cells are replaced in the body.

Question 2

What controls the self-replication, growth, and differentiation of pluripotent stem cells?

Answer 2

Colony stimulating factors (CSFs).

Question 3

What are the main types of anemia?

Answer 3

Decreased production of red blood cells, blood loss, increased destruction of red blood cells, inherited anemias, chronic illnesses, and deficiency anemias.

Question 4

What are some examples of inherited anemias?

Answer 4

Sickle cell anemia and Cooley’s anemia.

Question 5

What can RBC morphological changes indicate?

Answer 5

Pathology.

Question 6

What is the most common cause of decreased red blood cell production?

Answer 6

Mineral and vitamin deficiency.

Question 7

What are the sources of iron deficiency anemia?

Answer 7

Dietary deficiency, impaired absorption, pregnancy, and bleeding.

Question 8

What are the forms of oral iron therapy?

Answer 8

Ferrous sulfate, ferrous fumarate, and ferrous gluconate.

Question 9

What are some adverse effects of oral iron therapy?

Answer 9

Metallic taste, nausea, epigastric pain, flatulence, constipation, diarrhea, vomiting, itching, and black/green stool.

Question 10

What is a major risk associated with oral iron therapy in young children?

Answer 10

Acute toxicity

Question 11

What is a serious risk of acute toxicity from oral iron therapy?

Answer 11

Necrotizing gastroenteritis, lethargy, vomiting, abdominal pain, bloody diarrhea, and shock.

Question 12

What are some symptoms of acute iron toxicity?

Answer 12

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

Question 13

What are some strategies to improve the tolerability of oral iron therapy?

Answer 13

Dose reduction, increase dosing interval, dietary modifications, switch to formulation with less elemental iron, switch from tablet to liquid, switch to IV iron

Question 14

When is IV iron therapy preferable to oral iron?

Answer 14

Low tolerance of GI side effects, ongoing blood loss, conditions that interfere with oral iron absorption, co-existing inflammatory state

Question 15

What are some conditions that indicate the use of IV iron?

Answer 15

Advanced chronic kidney disease, patients who have undergone gastric resection, cancer-associated anemia

Question 16

What factors may influence the choice of IV iron therapy?

Answer 16

Cost, time for administration, number of required doses

Question 17

What are some potential severe reactions to IV iron therapy?

Answer 17

Severe allergic reactions, shortness of breath, difficulty swallowing or breathing, swelling, hives, fainting, dizziness, bluish discoloration, rapid weak pulse, loss of consciousness, seizures

Question 18

What are the advantages of oral iron therapy?

Answer 18

Effective for most patients, extremely low risk of serious adverse events, initial costs very low

Question 19

What are the disadvantages of oral iron therapy?

Answer 19

GI side effects common, adherence may be low, may be inadequate for severe or ongoing blood loss, may require administration for several months, total costs may be higher

Question 20

What are the advantages of IV iron therapy?

Answer 20

Effective for most patients, more rapid correction of anemia, can administer large doses in a single infusion, adherence assured, no GI side effects

Question 21

What are the disadvantages of IV iron therapy?

Answer 21

Requires monitored infusion, rare cases of allergic or infusion reactions, requires equipment and personnel, initial costs may be higher

Question 22

What are common causes of decreased red blood cell production?

Answer 22

Mineral and vitamin deficiency

Question 23

What is the role of folic acid in the body?

Answer 23

Required for synthesis of purines, pyrimidines, and amino acids

Question 24

What are some causes of folic acid deficiency?

Answer 24

Poor diet, heat labile folates, increased demand during pregnancy, alcohol dependence, liver disease, hemolytic anemia, drug-induced, renal dialysis

Question 25

What is the most common manifestation of cobalamin deficiency?

Answer 25

Megaloblastic anemia

Question 26

What are some causes of cobalamin deficiency?

Answer 26

Pernicious anemia, partial/total gastrectomy, IBD