Hematopoietic Growth Factors Flashcards
Nutritional growth factors
- Ferrous Iron
- Folic Acid
- Hydroxocobalamin (b12)
Hormonal Growth factors
- Epoeitin alpha, Darbopoetin
- G-CSF
- GM-CSF
Who is must susceptible to anemia?
*women-childbearing age
What type of anemia does B12 cause?
Megaloblastic
Not macrocytic?
Erythropoiesis
required nutrients
- iron
- folic acid
- Hydroxycobalamine
Erythropoiesis
Required growth factors
G-CSF
GM-CSF
Epoetin
Most common anemia?
Iron deficiency
Non-heme iron in non-meat foods must be
Reduced to ferrous iron (ascorbate/Vit C + HCl helps)
Iron
Absorption
- duodeunum + proximal jejunum
* increases w/ low stores
Iron
Elimination
- no excretion MOA
- regulate - change absorption/storage
- body iron stores high = stored
- body iron stores low = transported ot bone marrow for Hb production
Apoferritin
- Free iron low = synthesis inhibited, iron to transferrin
* Free iron high = synthesis stimulated, iron to ferritin (no toxicity)
Iron toxicity
(Kills gut lining)
Acute Tx
Deferoxamine
Bowel irrigation
Iron toxicity
(Heart, liver, pancreas, other)
Chronic
Deferoxamine
Deferasirox - oral
Phlebotamy
Iron salts
- 1/4 absorbed
* cheap
Iron salts
S.E.
- Epigastric distress
* Abdominal cramps
Iron Dextran
- can’t tolerate oral iron
- IV - ferric hydroxide (IV can metab)
- other preps (less anaphylaxis) - Na Ferric gluconate, iron sucrose
B12 deficiency
S.E.
Neuro
Folate pathway
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
Folate deficiency
Tx
Folic acid supplements
- enters to Dihydrofolate reductase
- prevent anemia of Vitamin B12 (sidestepping cofactor step)
Vitamin B12
Storage
*5 yrs worth stored in Liver
*
B12 in what?
Meat, eggs, dairy
Vitamin B12
Absorption
Intrinsic factor (parietal cells in stomach)
- distal ileum
- watch GI disorders! Stomach removal!
Vitamin B12
Tx
- IV - hydroxycobalamin
* folic acid - correct anemia ONLY (no neuro)
Folate stores
1-6 months
Liver
Folate prevents
Neural tube defects
Folate sources
Green veges, liver, fruits
Folic Def
Tx
Folic acid
EPO responsive cells
- Committed progenitors - Blast cell –> colony forming unit –>pro/erythroblast
- causes dividing + differentiation
Epoetin alpha
Use
- Anemia - chronic renal failure
* Anemia - due to AZT in HIV patients
Epoetin alpha
S.E.
- iron deficiency - give supplement
- retics up from marrow
- HTN/clotting
Darbepoetin alpha
- clearance slowed from Epoetin (chronic renal patients)
* SE more severe (longer t1/2)
G-CSF
- stimulates neutrophil (granulocyte) lineage
* Chemokyne = attracts stem cells for autologous stem cell transplant
GM-CSF
*stimulates Neutrophils + erythroid + megakaryocyte
Thrombopoietin
- up megakaryocytes
Interleukin II
*up megakarycytes + thormbocytes
