Hematinics Lecture PDF Flashcards
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Ferritin
Storage form of iron in mucosal and liver cells, apoferrin becomes this upon binding iron
Trasnferrin
Iron binding protein for distribution throughout body
Physiologic needs of iron require diet to contain ___ more iron than body needs because of how little is abosrbed (think about what the RDA represents)
10x
Observations of cells of iron deficiency anemia (2)
- microcytic
- hypochromatic
Ferrous sulfate info and what is it DOC for?
- Least expensive PO oral iron replacement therapy
- DOC for iron deficiency anemias or sometimes used prophylactically
Ferrous sulfate ADR’s (9)
- nausea
- heartburn
- bloating
- constipation
- diarrhea
- peptic ulcers
- dark green stool
- staining of teeth
- toxicity
Ferrous sulfate drug interactions (2)
- Antacids reduce absorption
- tetracyclines forms chelates decreasing absorption of both agents
2 ways food affects PO iron therapy and recommendation
- Food helps protect iron induced GI upset
- Food decreases absorption of iron by 50-70%
Recommended to administer between meals
Ferrous gluconate/fumarate/aspartate function
Salts which are alternatives to ferrous sulfate, only difference is percent of iron content, produce same pharm effects, therapeutic responses, and ADRs
Carbonyl iron function
Pure elemental iron in microparticles to enhance bioavailability and can be administered at an increased dosage safely (good for children)
Iron dextran administration, function, indications
- IV or IM, preferabely IV, Iron preparation consisting of ferric hydroxide and dextrans
- reserved for those who cannot tolerate oral iron (such a those with intestinal disease or blood loss)
Iron dextran ADR’s (4)
- anaphylaxis
- arthralgia
- circulatory failure
- localized discoloration if administered IM
2 examples of Iron dextran
Infed, DexFerrum
Sodium ferric gluconate complex (ferrlecit) indication
Iron deficiency anemia in CKD patients undergoing long term hemodialysis
Sodium ferric gluconate complex (ferrlecit) ADR’s (2)
- anaphyaxis
- flank pain and malaise
Iron sucrose (venofer) indications
Iron deficiency anemia patients with CKD
Iron sucrose (venofer) ADR’s (2)
Hypotension and cramps
Ferumoxytol (feraheme)function
Indicated for iron deficiency anemia in patients with CKD regardless of receiving erythopoietin or dialysis
Ferumoxytol (feraheme) ADR (2)
- generally well tolerated
- can interfere with MRI up to 3 months after dosing
B12 essential metabolic functions (2)
- DNA synthesis
- catalyze folic acid allowing for cell growth and division
B12 absorption pathway
- Requires intrinsic factor secreted by parietal cells of stomach to form complex
- complex dissociates after absorption
- transported by transcobalamin II into tissues
- most B12 stored in liver, years to develop deficiency
2 major causes of B12 deficiency
- impaired absorption due to enteritis or celiac disease
- lack of intrinsic factor (perhaps from gastric bypass!)
Pernicious anemia
Atype of megaloblastic anemia where B12 deficiency due to lack of intrinsic factor resulting in low RBC count
Consequences of B12 deficiency at a cellular level
-Tissues that undergo rapid growth and division are impacted
Megaloblastic anemia/macrocytic anemia definition, how can we reverse it?
-Occurs due to b12 deficiency resulting in erythroblasts maturing but division being prevented, most likely fatal, can reversed with large doses of folic acid except for irreversible neurologic damage
finish b12 preparations and replacements,
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Erythroblasts are different from proerythroblasts in that they have ____
hemoglobin
Anemia definition
Decrease in erythrocyte number, size, or hemoglobin content either due to blood loss, hemolysis, bone marrow dysfunction, or nutritional deficiences
During pregnancy, what happens to iron requirements?
They increase very high, often requiring supplementation
Vegans run the risk of this vitamin deficiency because it is only obtained from animal products or fortified foods
B12
Megaloblastic/macrocytic anemia definition
Appears as numbers of megaloblasts in the blood because of impaired DNA synthesis (as a result of B12 deficiency)
Some folic acid can be…
…activated by an alternative pathway independent of B12 permitting DNA synthesis to proceed
Parasthesias of extremities and reduction in DTR’s indicates…
…neurologic damage from B12 deficiency
The neurologic effects of B12 defiency cannot be reversed with…
….Folic acid supplementation and activation via the alternative pathway, it is unrelated to the effects on folic acid
Cyanocobalamin function and DOC for what?
Purified crystalline form of vit B12 and DOC for B12 deficiency
Cyanocobalamin administration (what do you do for patients with severe neurologic defect?
-Parenteral administration
