Anemia - Coagulation disorders Flashcards
Laboratory picture of iron deficiency:
Decrease iron, decrease ferritin and increase total iron-binding capacity
Most common type of anemia
Microcytic hyphochromic anemia,by iron deficiency
Megaloblastic anemias are caused by what?
Deficiency of vitamin B12 and Folic acid - pernicious anemia is the most common type
Anemia that usually results from a defect in the synthesis of intrinsic factor or by surgical removal of that part of the stomach that secretes intrinsic factor
Pernicious anemia
Transport protein for iron
Transferrin
A storage protein for iron
Ferritin
Chronic iron overload results to?
Hemochromatosis, organ failure and death
Oral form of iron with higher iron content
Ferrous fumarate
Acute iron intoxication is common among _____due to accidental ingestion of iron supplementation tablets
Children - necrotizing gastroenteritis, shock, metabolic acidosis, coma and death
Antidote for Iron toxicity
Parenteral administration of DEFEROXAMINE, which chelates circulating iron
Triad of Hemochromatosis
Cirrhosis, Diabetes mellitus and skin pigmentation
With the presence of intrinsic factor, Vitamin B12 is absorbed where?
Distal ileum
Two available forms of Vitamin B12
Cyanocobalamin
Hydroxocobalamin
Folic acid is readily absorbed where?
Proximal jejunum
Deficiency during pregnancy results to neural tube defects in the the fetus
Folic acid
More stable form than the folate
Folic acid
Hematopoietic growth factor for anemia associated with chronic renal failure, HIV infection, cancer and prematurity. Performance-enchancing drugs in athletes (prohibited use)
Epoetin alfa - agonist if erythropoietin receptors expressed by red cell progenitor
Myeloid growth factor - for neutropenia associated with chemotherapy, myelodysplasia and aplastic anemia. SE: bone pain, fever, edema
Filgrastim (G-CSF)
Megakaryocyte growth factor for secondary prevention of thrombocytopenia in patients undergoing cytotoxic chemotherapy for nonmyeloid cancers
Oprelvekin (IL-11)
Mechanism for hemostasis
- Vasoconstriction
- Platelet plug formation
- Formation of clot via blood coagulation
- Fibrous organization
During 1st step of hemostasis, two important autocoids that play important roles for vasoconstriction
Thromboxane - platelet activator/powerful vasoconstrictor
Endothelin - potent endothelium derived vasoconstrictor
Platelet adhesion is mediated by____ by GpIb receptor in the platelet surface
vWF - essential for binding subendothelial collagen to platelets
____is the most common cause of acute myocardial infarction, ischemic stroke and limb gangrene
Arterial thrombosis
Antiplatelet drug, for prevention of arterial thrombosis also for inflammatory disorders. Associated with REYE Syndrome
Aspirin - acetylsalicylic acid
Toxic dose and lethal dose of Aspirin?
Toxic dose: 150mg/kg
Lethal dose: 500mg/kg
Triad of aspirin hypersensitivity
SAMTER triad
asthma, aspirin sensitivity, and nasal polyps
Acid base abnormality in salicylate poisoning?
Respiratory alkalosis with HAGMA
An anti-platelet drug used during PCI to prevent thrombosis
Arciximab - prevents vessel restenosis, reinfarction and death
An antiplatelet drug that irreversibly inhibits binding of ADP to platelet receptors, reducing platelet aggregation
Clopidogrel - Ticlopidine
What are the two major types of anticoagulants?
Indirect thrombin inhibitors
Direct thrombin inhibitors
Heparin, enoxaparin and lepirudin are example of what type of anticoagulant?
Indirect thrombin inhibitors
Coumarin derivatives like warfarin are examples of what type of anticoagulant?
Direct thrombin inhibitors
Anticoagulant drug, contraindicated for pregnancy?
Warfarin - heparin can be used in pregnancy
Antidote for heparin toxicity?
Protamine - while vitamin K and FFP is the antidote for warfarin toxicity
Anticoagulant given parenteral, with rapid onset and site of action in the blood?
Heparin
Anticoagulant that impairs post-translational modification of factors II, VII, IX and X
Warfarin - impairs the vitamin K dependent factors 1972
Site of action for warfarin
Liver
Laboratory test to assess extrinsic and intrinsic coagulation pathways
PTT for intrinsic pathway - heparin
PT for extrinsic pathway - warfarin
Anticoagulant for DVT, PE, MI. DOC for anticoagulation during pregnancy.
Heparin
Anticoagulant, for DVT, PE and MI with less risk of thrombocytopenia.
Does not require aPTT monitoring
Enoxaparin
A direct thrombin inhibitor for anticoagulation in patients with heparin induced thrombocytopenia. Used with caution in patients with renal insufficiency
Lepirudin
Anticoagulant with narrow therapeutic window. And an active ingredient in most rat poisons
Warfarin
Thrombolytic drug for acute MI, ischemic stroke and pulmonary embolism. With loss of effectiveness on 2nd use, and allergic reaction may be observed
Alteplase - SIMd: Streptokinase, Urokinase
Tissue plasminogen activator analog.
Antidote for Alteplase
Aminocaproic acid
Antiplasmin drug, for prevention and treatment of acute bleeding episodes in patients with high risk of bleeding. Contraindicated in DIC and genitourinary bleeding
Aminocaproic acid - SIMD: Tranexamic acid
A vasopressin V2 receptor agonist for hemophilia A, von Willebrand’s disease and central diabetic insipidus
Desmopressin - ADH agonist
