Hematopoietic Growth Factors Flashcards

1
Q

nutritional growth factors

A

ferrous iron (Fe2+)
folic acid
hydroxocobalamin (B12)

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2
Q

hormonal growth factors

A

Epoetin alpha; Darbepoetin
G-CSF
GM-CSF

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3
Q

what does erythropoiesis require

A
nutrients (iron, folic acid, vit B12) and
growth factors (G-CSF, GM-CSF, Epoetin)
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4
Q

what is iron needed to make

A

hemoglobin

each of the four heme groups has a central iron

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5
Q

source of iron

A

dietary- meat

non-heme iron in foods like veggies must be reduced to ferrous iron for absorption

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6
Q

form of body absorbable iron

A

ferrous iron (Fe2+)

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7
Q

what increases absorption of iron

A

vit C and HCL

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8
Q

what is the storage form of iron

A

ferritin

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9
Q

what is the transport form of iron

A

transferrin

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10
Q

how is iron eliminated

A

no excretion mechanisms
regulation of iron balance is achieved by changing absorption and storage of iron
when body iron stores are high: iron stored as ferritin
when body iron stores are low: iron transported to bone marrow for hemoglobin production

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11
Q

role of apoferritin

A

if free iron is low, synthesis is inhibited and iron binding shifts to transferrin
if free iron is high, synthesis stimulated and iron is sequestered as ferritin to protect organs from iron’s toxic effects

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12
Q

treatment of acute iron toxicity

A

Deferoxamine

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13
Q

treatment of chronic iron toxicity AKA iron overload AKA hemochromatosis

A

phlebotomy or chelation therapy

chelators: Deferoxamine or Deferasirox

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14
Q

adverse affects of iron salts AKA oral iron supplements

A

epigastric distress
abdominal cramps
etc

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15
Q

what is used if patient can’t tolerate/absorbe oral iron supplements

A

stable complex of ferric hydroxide and low molecular weight dextran given via muscular infection or IV infusion
other preps=sodium ferric gluconate, iron sucrose-less likely to produce anaphylaxis

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16
Q

iron balance is predominantly regulated by

A

absorption from diet

17
Q

what does deficiency of vit B12 or folic acid lead to

A

megaloblastic anemia

18
Q

vit B12 and folic acid deficiency has lots of the same effects but what additional thing does vit B12 deficiency lead to

A

neurologic syndorme because degeneration of myelin sheath

19
Q

what is dietary folate dependent on

A

dietary use of folate is dependent on B12

so if B12 deficient there is a functional deficiency of dietary folate

20
Q

where is vit B12 stored and how long are stores

A

liver

5 years to deplete

21
Q

what population can you see vit B12 deficiency

A

strick vegetarians

22
Q

what is vitamin B12 dependent on

A

intrinsic factor (pernicious anemia)

23
Q

because supplemental folic acid enters the pathway at a different place than dietary folate, large amounts of folic acid can correct the anemia due to vit B12 but what can it not correct

A

cannot correct the neurologic damage

24
Q

partial removal of which part of the GI tract could result in B12 deficiency

A

Illium

but also stomach due to intrinsic factor

25
Q

how soon can anemia develop with deficiency of folic acid

A

1-6 months

26
Q

what erythrocyte precursors are effected by EPO (Epoetin alpha) response

A

BFU-E
CFU-E
pro erythroblast
basophilic erythroblast

27
Q

where is epoetin alpha made

A

kidneys (senses tissue hypoxia)

28
Q

what does epoetin alpha do

A

induces release of reticulocytes from marrow

29
Q

indications of epoetin alpha and anemia

A

anemia due to chronic renal failure

anemia due to AZT in HIV patients (HIV patients are being treated with AZT which dec EPO)

30
Q

what is a better drug to use than epoetin alpha when patient has chronic renal failure

A

Darbepoetin alpha cuz clearance is slowed because longer half life

31
Q

G-CSF

A

stimulates progenitor cells already committed to neutrophil lineage
mobilizes stem cells of all lineages into peripheral blood stem cells for easy collection for autologous stem cell transplantation

32
Q

GM-CSF

A

stimulates proliferation and differentiation of granulocytic progenitor cells as well as erythroid and megakaryocytic progenitors