Hematinics Flashcards
What is the main regulator of erythropoiesis?
Tissue oxygenation
Erythropoietin dependent immature RBC:
Burst-forming unit (BFU-E)
Colony-forming unit (CFU-E)
Erythroblast
Iron dependent immature RBC:
Erythroblasts
Reticulocytes
Erythrocytes
Factors that decrease oxygenation:
Anemia
Poor blood flow/blood volume
Low hemoglobin
Pulmonary disease
Important nutrients/components of erythropoiesis:
Hematopoietic growth factors Erythropoietin Iron Cobalamin Folic acid
Growth factors stimulating granulocyte and stem cell formation:
Granulocyte-Colony stimulating factor (G-CSF)
Granulocyte-Monocyte Colony stimulating factor (GM-CSF)
Endogenous regulators of platelet production:
Thrombopoietin
IL-11
Combine to form heme:
Protoporphyrin
Ferrous iron
Most common hemoglobin form in humans:
Hemoglobin A
Types of anemia:
Hypoproliferative anemia
Megoblastic anemia
Hemolytic anemia
Types of hypoproliferative anemia:
Iron deficiency anemia Chronic inflammation anemia Metabolic defect Renal disease Infiltrative fibrosis/aplasia
Morphology of IDA:
Microcytic hypochromic
Causes of IDA:
Increased demand for iron/hematopoiesis
Increased iron loss
Decreased intake/absorption
1 mL RBC requires __ mg elemental Fe:
1
Amount of iron needed daily and percentage absorbed:
16-20 mg/day; 10-15% absorbed
Iron absorption needed in males, females and children:
Male: 1mg
Female: 1.4mg (x2 pregnancy)
Children: 1.5 mg
Stages of iron deficiency:
Negative iron balance
Iron deficient erythropoiesis
Iron deficiency anemia
First iron marker to decrease during negative iron balance stage:
Serum ferritin (20)
Iron marker profile during iron deficient erythropoiesis stage:
15 serum ferritin (no iron stores) 380 TIBC 50 SI 20% saturation 10 marrow sideroblasts 100 RBC protoporphyrin
By definition, marrow iron stores are absent when ____ level is below ___ g/L:
serum ferritin; 15
When serum iron falls below ___ mcg/dL, ___ begins to be affected:
50; hemoglobin synthesis
Normal iron markers:
1-3 marrow stores 50-200 serum ferritin 300-360 TIBC 50-150 SI 30-50% saturation 40-60 marrow sideroblasts 30-50 RBC protoporphyrin
Hemoglobin level where bone marrow remains hypoproliferative:
10-13 g/dL
In inflammation anemia TIBC is ___, Ferritin is ___ and serum iron is ___:
decreased; increased; decreased
Inflammation anemia is due to inhibition of ___ function in macrophages:
ferriportin
Protein stimulated by inflammation that inhibits ferriportin:
hepcidin
Iron is not affected in thalassemia, although ___ and ___ may be increased:
serum iron; serum ferritin
Type of anemia where the dysfunction is inability to utilize iron:
Sideroblastic anemia (iron not affected)
Iron is absorbed in which part of the small intestine:
Duodenum
Proximal jejunum
Causes increased absorption of iron:
ascorbic acid
Causes decreased absorption of iron:
tea, dairy, fish
Oral iron therapy gives ___ mg elemental iron/day:
300
When to use parenteral iron therapy:
Pt cannot tolerate oral iron
Condition is chronic
Pt has advanced chronic renal disease
Pt needs continuous iron
Administer iron with ___ to prevent neural tube defect:
folic acid
Type of iron toxicity exclusively in young children:
Acute
Drug and administration route used in acute iron toxicity:
Deferoxamine; parenteral
Chronic iron toxicity occurs when:
Excess iron deposits in hear, liver, pancreas, etc. (hemochromatosis)
Drug and administration route used in chronic iron toxicity:
Deferasirox; oral
Erythropoietin is increased when:
Decreased red cell mass
Impaired O2 loading
High Hgb O2 affinity
Impaired renal blood flow
Drug extends half life of EPO to 24-36hr:
Darbepoietin alfa
Normal EPO level:
10-25 U/L
EPO is increased when Hgb falls below:
10-12 g/dL
Indications for epoietin alpha:
Chronic renal failure
AIDS
Cancer
Megaloblastic anemia is due to a deficiency of:
Cobalamin (Vit B12)
Folic acid
Deficiency of Vit. B12 causes:
Anemia with neutropenia
Thrombocytopenia
GI symptoms
Neurologic abnormalities
Ultimate source of Vit B12:
Microbial synthesis
Needed for absorption of Vit. B12:
Intrinsic factor
Vit. B12 stores last for ___:
5 years
Preferred drug in megaloblastic anemia:
Hydroxycobalamin (more protein bound)
Main storage pool of Vit. B12 is located in:
Liver (3000-5000 ug)
B12 deficiency is mainly related to dysfunction in:
Malabsorption (pernicious anemia)
Megaloblastic anemia appears ___ after stopping folic acid:
1-6 months
Daily requirement of folic acid:
100 ug
GM-CSF is effective in treating neutropenia associated with:
Congenital neutropenia
Cyclic neutropenia
Myelodysplasia
Aplastic anemia
Better tolerated G-CSFs:
Filgrastim
Pegfilgrastim
GM-CSFs associated with more side effects:
Molgramostim
Sargramostim
Most severe adverse effect of G-CSF:
Splenic rupture
GM-CSF is associated with maturation of:
Monocytes
Macrophages
G-CSF is associated with maturation of:
Neutrophils
Recombinant myeloid GFs:
Sargramostim (GM-CSF)
Filgrastim (G-CSF)
Advantage of pegfilgrastim over filgrastim:
Longer acting (long serum half-life)
Recombinant thrombopoeitins:
Romiplostim
Eltrombopag (better tolerated)
Recombinant thrombopoetins are used in:
idiopathic thrombocytopenic purpura
Clotting factors dependent on Vitamin K:
II, VII, IX, X
vWF disease is treated by ____, a Factor ___ concentrate:
Humate P; VIII
Classic hemophilia is a deficiency in Factor ___:
VIII
Christmas or hemophilia B is a deficiency in Factor ___:
IX
Inhibits plasminogen activation:
Aminocaproic acid (EACA)
Orally administered analog of EACA:
Tranexamic acid
