Anemia/Hematopoietic growth factors Flashcards
oral iron therapy
type
response
adverse
ferrous
1-3 months
-nausea, vomiting, black stools
parenteral iron therapy (IM or IV)
type
indication
adverse
iron dextran, iron sucrose, iron gluconate
-indicated when oral iron is not tolerated, post GI resection, malabsorption syndromes
-adverse effects: pain, tissue staining (IM), headache, fever, nausea, vomiting, back/joint pain, allergic responses, anaphylaxis
What happens in acute iron toxicity and chronic iron toxicity? Treatment?
acute iron toxicity
-usually due to over ingestion of iron tablets
-could be fatal in children
-necrotizing gastroenteritis
Treat: gastric aspiration, gastric lavage-phosphate or carbonate solutions, iron chelation (deferoxamine)
chronic toxicity
-seen in hemochromatosis, multiple red cell transfusions
-organ failure: can deposit in heart, lung, liver
treatment:
intermittent phlebotomy (if no anemia)
-iron chelation (deferoxamine, deferasirox)
What are the active forms of B12?
deoxyadenosyl cobalamin, methylcobalamin
What are the prodrugs given if of B12, How are these drugs given?
Response time
cyanocobalamin
hydroxycobalamin
Parenteral injections (IM)
1-2 months
How is folic acid deficiency treated?
oral folic acid
How is oral B12 therapy?
works even with IF deficiency
really good
What is the relationship between erythropoietin normally, what is it in renal failure?
inverse relationship
-but both low in chronic renal failure
What are indications of erythropoietin therapy?
- chronic renal failure
- patients with aplastic anemia, leukemia, HIV/AIDS associated anemias, cancer
- anemia of prematurity
- post phlebotomy
How is epoetin alfa (epogen) administered? How long does it take to work? What are toxicities?
IV or subcutaneous injection
Retics 10 days
hemoglobin increase in 2-6 weeks
Toxicity: hypertension, thrombotic complications, allergic reactions, increased risk of tumor progression or recurrence
G-CSF and GM-CSF are growth factors that stimulate proliferation and differentiation of what?
myeloid cells
What does GM-CSF also stimulate?
proliferation and differentiation of erythroid and megakaryocytic cells
G-CSF also promotes what with hematopoietic stem cells?
promotes release of HSC from the bone marrow into the periphery
Recombinant G-CSF (filgrastim) is produced by a bacterial system, what is a drug that uses filgrastim?
pegfilgrastim
- filgrastim conjugated to polyethylene glycol
- longer half life
Recombinant GM-CSF (sargramostim) is produced by in what type of system?
yeast
When is G-CSF/ GM-CSF indicated?
- After intensive chemotherapy
- faster increase in neutrophil counts
- decreased duration of neutropenia
- decreased febrile neutropenia, antibiotic use, hospitalization - Chemotherapy for acute myeloid leukemia
- treatment of congenital neutropenia, cyclic neutropenia, neutropenia associated with myelodysplasia and aplastic anemia
- high dose chemo with autologous stem cell rescue
- mobilization of peripheral blood stem cells for autologous transplant (G-CSF preferred)
What are the toxicities for G-CSF and GM-CSF?
G-CSF: bone pain, rarely splenic rupture
GM-CSF: fever, arthralgia, myalgia, peripheral edema, pleural/pericardial effusion
Both: allergic reactions
In general G-CSF is preferred
What does Interleukin 11 do?
- promotes proliferation of megakaryocytic progenitors
- increases peripheral platelet counts
What are the indications for interleukin 11? toxicities?
- patients with thrombocytopepnia after chemo
- prevent adverse reactions of platetet transfusion
- if patients are refractory to platelet transfusion - usually given for 2-3 weeks after chemo or until platelets rise above 50,000
Toxicity: fatigue, headache, dizziness, dyspnea, arrhythmiasf, hypokalemia
Romiplostim
agent for thrombocytopenia-treat ITP
-peptibody-2 domains: peptide domain that binds the TPO receptor (Mpl) and an antibody Fc domain that increases half life
Eltrombopag
agent for thrombocytopenia-treat ITP
-small molecule throboproteitin-receptor agonist (Mpl)
What are adverse effects of romiplostim and eltrombopag?
headache, myalgia, and bone marrow fibrosis
-not a myeloproliferative disorder
What can treat aplastic anemia?
eltrombopag
- receptors also expressed on stem cells
- cells come back to bone marrow, and stay back when off the drug
- more of all types of cells because more stem cells?
