Lecture Hematopoesis

Question 1

Epoetin alfa (epogen, Procrit) is synthetic ___.

Answer 1

erythropoietin which increases Hct and Hgb.

Question 2

Epoetin alfa (procrit) is used to treat __.

Answer 2

anemia associated with chronic renal failure & Chemotherapy.

Question 3

Epoetin alfa is contraindicated when Hgb is ___.

Answer 3

11 d/t increased risk of adverse effects.

Hgb should not be increased more than 1g/dL in two weeks time (i.e. SLOWLY)

Question 4

AE of epoetin alfa include:

Answer 4

HTN, TIA, MI, thrombolic events

HTN must be controlled before epoetin is given!

Question 5

So before administration of epoetin alfa (Procrit) the nurse should:

Answer 5

Check for HTN ctrl
Check transferrin ≥ 20%
Check ferritin ≥ 100
(iron stores)

monitor for thrombosis!

Question 6

This medication will increase neutrophil production in the bone marrow.

Answer 6

Filgrastim (Neupogen)

Usually given SubQ, but can be given IV

Usually given 24 hours after a chemotherapy session because the antineoplastic drugs produce opposite effects

Question 7

Filgrastim (Neupogen) is usually discontinued when __.

Answer 7

ANC count is 10,000 or greater

it shortens the length of time of neutropenia

Question 8

Nursing 101 for Filgrastim

Answer 8

Adverse Effects:
N/V, bone pain (tx with analgesics), watch out for leukocytosis

Nursing 101
Notify if history of hypersensitivity to proteins derived from E. coli
Baseline laboratory tests, including
1. CBC with differential and
2. platelet count
Monitor patients with preexisting cardiac conditions
Monitor temperature every 4 hours
Assess the degree of bone pain
Do not shake the medication vial or syringe

Question 9

platelet enhancer that works by stimulating the synthesis and maturation of megakaryocytes into platelets

Answer 9

Oprelvekin (Neumega)

Dosing started 6-24 hours after chemo and daily until platelet count is > than 50,000..plts will remain elevated 7 days after the last dose.

Using this drug decreases the need for a platelet transfusion

Question 10

Nursing 101 for Oprelvekin (Neumega)

Answer 10

AE:
N/V, fluid retention, anaphylaxis, caution in patients with heart failure, papilledema (swelling of optic nerve…lead to blindness)

Nursing 101
Watch for HTN d/t fluid retention
Frequent eye exams may be needed r/t papilledema

Question 11

Iron deficient anemia can be caused by __.

Answer 11

Blood loss
Hemolysis
Bone marrow dysfunction - Deficiency of substances essential for RBC formation and maturation

anemia is a decrease in the number, size, or hemoglobin content of RBCs

Question 12

Choice of therapy for iron deficiency anemia depends on:

Answer 12

etiology and severity.

Mild anemia - Increase iron-rich foods

Moderate anemia - Oral iron supplements
s/s: pallor, fatigue

Severe anemia - Parenteral iron therapy
s/s: tachycardia, dyspnea, angina

Administration of iron salts can rapidly reverse symptoms of iron deficiency anemia.

Question 13

Ferrous sulfate

Answer 13

iron supplement

After absorption, most iron is used by the body to make hemoglobin

Give with Vit C to enhance absorption (OJ)

Interacts with
Antacids, proton pump inhibitors, or calcium supplements
also Tetracyclines, fluoroquinolones

Question 14

Adverse effects of Ferrous sulfate include:

Answer 14

Nausea and vomiting
Brown stains on teeth from liquid
Darkened stools
Constipation - Add fluid and fiber to diet to counteract this

Question 15

Instructions for administration of Ferrous sulfate

Answer 15

Give on an empty stomach, if possible. This is a hard medicine to take w/o food.

Better to lower dose than take with food!!

Monitor bowel movements. Monitor the older adult for constipation. Increase the amount of fluids and soluble fiber in the diet if occurs.

Keep iron preparations in a secured location if there are young children in the household

Watch for Toxicity

Dark green or black stools are a harmless side effect

Question 16

Ferrous sulfate toxicity

Answer 16

Deferoxamine (Desferal)

s/s: N/V/D, shock, acidosis, pulmonary edema, vasomotor death

Question 17

Ferrous sulfate cousin drugs:

Answer 17

Oral iron salts
Enteric coating so they dissolve in the intestine leading to less gastric irritation, but they may dissolved after the drug has passed the duodenum (site of iron absorption)

Parenteral iron salts
Malabsorption disorder
Intolerance to oral iron, CKD on chronic hemodialysis
Includes Iron Dextran [INFeD, DexFerrum], Sodium Ferric Gluconate Complex, iron sucrose, ferumoxytol

Question 18

Pernicious anemia

Answer 18

Megaloblastic anemia

Usually malabsorption of B12 with alcoholism or Crohn’s disease

Occurs when hematopoietic stem cells produce abnormally large erythrocytes that do not mature

Symptoms develop slowly and involve the nervous system.
Early s/s: paresthesia, decrease deep tendon reflexes
Later s/s: memory loss, mood changes, psychoses

Treated with vitamin B12 (Cyanocobalamin)

Question 19

Folic acid (folate)

Answer 19

essential for normal DNA and RNA synthesis.

Does not require intrinsic factor for intestinal absorption

Most common cause of deficiency is insufficient dietary intake usually d/t alcoholism

Question 20

Cyanocobalamin (Nascobal)

Answer 20

a vitamin supplement used to treat B12 deficiency anemia

AE include:
hypokalemia - so monitor Potassium level
Sodium retention - may worsen heart failure

Monitor for edema or s/s of HF

Question 21

It is important to ask about ___ before administration of Cyanocobalamin.

Answer 21

cobalt allergy and alcohol use

test dose for cobalt reaction

ETOH decreases absorption. 
Often decides form of administration/route:
1.	Oral – not for alcohol or Crohn’s
2.	Sublingual
3.	Intranasal
4.	Injection