Hematopoietic Growth Factors

Question 1

Nutritional growth factors

Answer 1

• Ferrous Iron
• Folic Acid
• Hydroxocobalamin (b12)

Question 2

Hormonal Growth factors

Answer 2

• Epoeitin alpha, Darbopoetin
• G-CSF
• GM-CSF

Question 3

Who is must susceptible to anemia?

Answer 3

*women-childbearing age

Question 4

What type of anemia does B12 cause?

Answer 4

Megaloblastic

Not macrocytic?

Question 5

Erythropoiesis

required nutrients

Answer 5

• iron
• folic acid
• Hydroxycobalamine

Question 6

Erythropoiesis

Required growth factors

Answer 6

G-CSF
GM-CSF
Epoetin

Question 7

Most common anemia?

Answer 7

Iron deficiency

Question 8

Non-heme iron in non-meat foods must be

Answer 8

Reduced to ferrous iron (ascorbate/Vit C + HCl helps)

Question 9

Iron

Absorption

Answer 9

• duodeunum + proximal jejunum

* increases w/ low stores

Question 10

Iron

Elimination

Answer 10

• no excretion MOA
• regulate - change absorption/storage
• body iron stores high = stored
• body iron stores low = transported ot bone marrow for Hb production

Question 11

Apoferritin

Answer 11

• Free iron low = synthesis inhibited, iron to transferrin

* Free iron high = synthesis stimulated, iron to ferritin (no toxicity)

Question 12

Iron toxicity
(Kills gut lining)

Acute Tx

Answer 12

Deferoxamine

Bowel irrigation

Question 13

Iron toxicity
(Heart, liver, pancreas, other)

Chronic

Answer 13

Deferoxamine
Deferasirox - oral

Phlebotamy

Question 14

Iron salts

Answer 14

• 1/4 absorbed

* cheap

Question 15

Iron salts

S.E.

Answer 15

• Epigastric distress

* Abdominal cramps

Question 16

Iron Dextran

Answer 16

• can’t tolerate oral iron
• IV - ferric hydroxide (IV can metab)
• other preps (less anaphylaxis) - Na Ferric gluconate, iron sucrose

Question 17

B12 deficiency

S.E.

Answer 17

Neuro

Question 18

Folate pathway

Answer 18

Dietary folate –> 5me-THF to Tetrahydrofolic acid BY B12 COFACTOR w/ enzyme
Methianine created in process
5,10 MeTHF to purines to DNA OR Dihydrofolate (to make DNA)
**B12 Deficient = Folate Deficient

Question 19

Folate deficiency

Tx

Answer 19

Folic acid supplements

• enters to Dihydrofolate reductase
• prevent anemia of Vitamin B12 (sidestepping cofactor step)

Question 20

Vitamin B12

Storage

Answer 20

*5 yrs worth stored in Liver

*

Question 21

B12 in what?

Answer 21

Meat, eggs, dairy

Question 22

Vitamin B12

Absorption

Answer 22

Intrinsic factor (parietal cells in stomach)

• distal ileum
• watch GI disorders! Stomach removal!

Question 23

Vitamin B12

Tx

Answer 23

• IV - hydroxycobalamin

* folic acid - correct anemia ONLY (no neuro)

Question 24

Folate stores

Answer 24

1-6 months

Liver

Question 25

Folate prevents

Answer 25

Neural tube defects

Question 26

Folate sources

Answer 26

Green veges, liver, fruits

Question 27

Folic Def Tx

Answer 27

Folic acid

Question 28

EPO responsive cells

Answer 28

* Committed progenitors - Blast cell --> colony forming unit -->pro/erythroblast * causes dividing + differentiation

Question 29

Epoetin alpha Use

Answer 29

* Anemia - chronic renal failure | * Anemia - due to AZT in HIV patients

Question 30

Epoetin alpha S.E.

Answer 30

* iron deficiency - give supplement * retics up from marrow * HTN/clotting

Question 31

Darbepoetin alpha

Answer 31

* clearance slowed from Epoetin (chronic renal patients) | * SE more severe (longer t1/2)

Question 32

G-CSF

Answer 32

* stimulates neutrophil (granulocyte) lineage | * Chemokyne = attracts stem cells for autologous stem cell transplant

Question 33

GM-CSF

Answer 33

*stimulates Neutrophils + erythroid + megakaryocyte

Question 34

Thrombopoietin

Answer 34

* up megakaryocytes

Question 35

Interleukin II

Answer 35

*up megakarycytes + thormbocytes