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Neonatal Pharmacology > Hematologic > Flashcards

Hematologic Flashcards

1
Q

the bone marrow of a healthy fetus produces _________ of cells every day

A

Billions

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2
Q

What is the challenge of the bone marrow in a fetus vs. an adult?

A

The marrow must produce enough cells to maintain a stable cell number per body mass as the infant grows

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3
Q

Preterm birth is a/w additional hematologic stressors which can result in _______ or __________

A

Anemia

Neutropenia

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4
Q

What is Erythropoetin?

A

Glycoprotein that regulates erythrocyte production (RBC’s).

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5
Q

What is the pathway of erythropoetin synthesis in the fetus/NB?

A

Yolk sac–>Liver–>Kidneys

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6
Q

Where is Epo production much of fetal life?

A

Liver

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7
Q

When does Epo production change to the kidneys?

A

Around time of birth

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8
Q

Epo maintains RBC production by inhibiting ______ of erythroid progenitors and stimulating their _________ & ________ into normoblasts

A

Apoptosis

Proliferation & Differentiation

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9
Q

Does EPO cross the placenta?

A

No, Fetus produces their own

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10
Q

To maintain the increase in RBC volume a/w fetal growth, it is estimated ______ erythrocytes/day must be produced

A

50 x 10 to the 9th power

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11
Q

Erythropoetin production is stimulated by ________ induceable Factor __ & __, and regulated by ______ requirements for oxygenation

A

Hypoxia
Factor 1 & 2
Tissue requirements

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12
Q

In healthy, term infants, serum erythropoetin concentrations reach Nadir between ___-___wks.

By ___-___ wks, they reach adult concentrations.

A

4-6 wks

10-12 wks

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13
Q

In preterm infants, the fallen erythropoetin is more _______ and lasts ______—>what?

A

profound
longer
Anemia of prematurity

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14
Q

What does rEPO stand for?

A

Recombinant EPO (the med)

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15
Q

What medication is widely used to treat or prevent Anemia due to a variety of causes including Renal failure and prematurity?

A

rEPO

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16
Q

Name the 4 clinical trials w/EPO currently under way

A
  1. Anemia of prematurity
  2. Anemia from Rh-hemolytic Dz
  3. Anemia of BPD
  4. CHD
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17
Q

Name the other medication that is an erytrhopoesis stimulating protein.
Advantages?
Disadvantages?

A
  • Aranesp
  • Single 1x/wk injection
  • Well-studied (in adults)
  • Very few studies in preterm or term babies re: Pharmacokinetics, efficacy, risks/benefits of use
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18
Q

What other med must be given w/EPO?

A

Iron

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19
Q

Neonates require ______ dosing of rEPO/kg and more _______ dosing to achieve an equivalent hematopoetic repsonse r/t…?

A

Higher
Frequent
Increased plasma clearance, high vol. of distribution, short fractional elimination time

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20
Q

Garcia et. al showed that for doses at _____ u/kg/wk rEPO, the average # tranfusions per pt decreased by 3/4 of a transfusion.

A

500 u/kg/wk

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21
Q

What lab level may be helpful in assessing Fe stores?

A

Ferritin

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22
Q

What are the adverse effects of rEPO in adults?

A

Hypertension, thrombus formation, polycythemia, red cell aplasia

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23
Q

Early, high-dose rEPO may have a _______ effect on the retina by ameliorating the first stage of ROP .

A

Protective effect

–but one study suggested an increased risk of ROP in pts started on early high-dose rEPO and Iron.

24
Q

In 2008, the FDA put out a warning for pts getting rEPO at higher than recommended doses w/what Dz?
What were the effects?

A

Chronic Kidney Failure

Increased risk blood clots, stroke, death

25
Q

In preterm infants, rEPO for treatment of Anemia has been very ____ with ____ adverse side effects of adults.

A

Safe

none

26
Q

What is a potential side effect of EPO?

A

an effect on Iron balance

27
Q

Preterm babies are at risk for Iron deficiency r/t …?

A

Bulk of Iron transfer is during 3rd trimester

28
Q

Iron is required for normal ______ & _______

A

growth and development

29
Q

Iron deficiency can lead to?

A

Adverse Neurodevelopmental consequences: Deficits in executive function & memory

30
Q

T/F: Administration of Iron in the 1st 2 weeks of life is NOT advised d/t potential oxidative effects in the face of deficient anti-oxidant mechanisms.

A

True

31
Q

The actual side-effects of rEPO are what we are __________ to see-including:

A

Hoping
Increasing Erythropoesis
Possible Megakaryocytopoesis

32
Q

What is a nutritional source of highly bio-available Iron?

A

Breastmilk

33
Q

Iron is a required mineral in transfer of _____from the lungs to the tissues for storage for use during muscle contraction.

A

Oxygen

34
Q

Iron contained in cow’s milk is less well ___________.

A

Absorbed-a reason it is not recommended until 1 yr/life

35
Q

Iron is found as _____ iron in animal-based foods (meats). This is the most ____-______ form vs. plant-based (grains, fruits, vegetables)

A

Heme iron

Bio-available

36
Q

Preterm formulas only provide ___ mg/kg/day iron. Supplemental iron is required

A

1.8 mg/kg/kday

37
Q

____ overdose is the most common cause of poisoning death in children

A

Iron

6 y/o

38
Q

Endogenous Iron stores are used up by ___ months of age.

A

6 months

39
Q

Preterm, LBW, & breastfeeding: Iron supplement via gtts at ____ mg/kg/day. Start __-__ wks/age until 12 months.

A

2 mg/kg/day

2-4 wks/age

40
Q

Healthy, term breastfeeding babys: supplement w/___ mg/kg/day iron.
Starting at __-__ months add iron from complimentary foods.

A

1 mg/kg/day

4-6 months

41
Q

Infants < 12 months should be given only ___ fortified formulas.

A

Iron-fortified

42
Q

What other possible effects might EPO have?

A

Neuroprotection

Protection of other organs: Heart, Kidneys

43
Q

Fer-in-sol supplement provides more/less iron per dose than multi-vitamin product?

A

More~25 mg/mL vs. 10 mg/mL

44
Q

Studies show children Anemic in early childhood continue to have _____ ________ & motor development and depressed school achievement into middle childhood.

A

Poor Cognitive

45
Q

What does G-CSF stand for?

A

Granulocyte Colony Stimulating Factor

46
Q

G-CSF is a physiologic _______ of ______production and function.

A

Regulator of Neutrophil

47
Q

G-CSF has multiple effects on what type of cell’s maturation and function?

A

WBC

48
Q

How does G-CSF enhance Neutrophil functions?

A

Chemotaxis
Phagocytosis
Superoxide Production
Bacteriocidal activity

49
Q

Administration of G-CSF has long been used to prevent _______ in pts w/non-myeloid malignancies receiving Anti-CA drugs and suffering Febrile Neutropenia.
It is also used to supplement _________after bone marrow transplant.

A

Infection

Recovery

50
Q

Name the 5 G-CSF clinical trials in process

A
  1. Infants w/bacterial sepsis
  2. Infants whose mothers had PIH
  3. Alloimmune Neutropenia
  4. Autoimmune Neutropenia
  5. Chronic Idiopathic Neutropenia
51
Q

What are the 3 adverse effects (rare) of G-CSF?

A
  1. Thrombocytopenia
  2. Osteoporosis
  3. Contrandicated w/known hpersensitivity to e-coli derived proteins or any components of the product.
52
Q

What is rGM-CSF?

A

Recombinant Granulocyte Macrophage Colony Stimulating Factor

53
Q

What does rGM-CSF do?

A

Increases Neutrophil counts and may decrease mortality due to sepsis when used prophylactically.
–Significant increase in ANC w/in 48 hrs of administration.

54
Q

Name the 2 clinical trials w/rGM-CSF?

A
  1. Neonatal sepsis

2. Prophylaxis against Nosocomial Infections

55
Q

What adverse effects are there w/rGM-CSF?

What is needed?

A

No serious adverse effects reported

Long-term studies needed.

Neonatal Pharmacology (17 decks)

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