Anemia and Hematopoietic Drugs Flashcards
What is hematopoiesis?
The process by which blood cells are replaced in the body.
What controls the self-replication, growth, and differentiation of pluripotent stem cells?
Colony stimulating factors (CSFs).
What are the main types of anemia?
Decreased production of red blood cells, blood loss, increased destruction of red blood cells, inherited anemias, chronic illnesses, and deficiency anemias.
What are some examples of inherited anemias?
Sickle cell anemia and Cooley’s anemia.
What can RBC morphological changes indicate?
Pathology.
What is the most common cause of decreased red blood cell production?
Mineral and vitamin deficiency.
What are the sources of iron deficiency anemia?
Dietary deficiency, impaired absorption, pregnancy, and bleeding.
What are the forms of oral iron therapy?
Ferrous sulfate, ferrous fumarate, and ferrous gluconate.
What are some adverse effects of oral iron therapy?
Metallic taste, nausea, epigastric pain, flatulence, constipation, diarrhea, vomiting, itching, and black/green stool.
What is a major risk associated with oral iron therapy in young children?
Acute toxicity
What is a serious risk of acute toxicity from oral iron therapy?
Necrotizing gastroenteritis, lethargy, vomiting, abdominal pain, bloody diarrhea, and shock.
What are some symptoms of acute iron toxicity?
Necrotizing gastroenteritis, lethargy, vomiting, abdominal pain, bloody diarrhea, shock
What are some strategies to improve the tolerability of oral iron therapy?
Dose reduction, increase dosing interval, dietary modifications, switch to formulation with less elemental iron, switch from tablet to liquid, switch to IV iron
When is IV iron therapy preferable to oral iron?
Low tolerance of GI side effects, ongoing blood loss, conditions that interfere with oral iron absorption, co-existing inflammatory state
What are some conditions that indicate the use of IV iron?
Advanced chronic kidney disease, patients who have undergone gastric resection, cancer-associated anemia
What factors may influence the choice of IV iron therapy?
Cost, time for administration, number of required doses
What are some potential severe reactions to IV iron therapy?
Severe allergic reactions, shortness of breath, difficulty swallowing or breathing, swelling, hives, fainting, dizziness, bluish discoloration, rapid weak pulse, loss of consciousness, seizures
What are the advantages of oral iron therapy?
Effective for most patients, extremely low risk of serious adverse events, initial costs very low
What are the disadvantages of oral iron therapy?
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
What are the advantages of IV iron therapy?
Effective for most patients, more rapid correction of anemia, can administer large doses in a single infusion, adherence assured, no GI side effects
What are the disadvantages of IV iron therapy?
Requires monitored infusion, rare cases of allergic or infusion reactions, requires equipment and personnel, initial costs may be higher
What are common causes of decreased red blood cell production?
Mineral and vitamin deficiency
What is the role of folic acid in the body?
Required for synthesis of purines, pyrimidines, and amino acids
What are some causes of folic acid deficiency?
Poor diet, heat labile folates, increased demand during pregnancy, alcohol dependence, liver disease, hemolytic anemia, drug-induced, renal dialysis
What is the most common manifestation of cobalamin deficiency?
Megaloblastic anemia
What are some causes of cobalamin deficiency?
Pernicious anemia, partial/total gastrectomy, IBD
