Pharm 12-Anemia Flashcards
Anemia
Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues.
What’s required to produce RBCs?
kidney, bone marrow, iron, protein
Process which produces red blood cells
erythropoiesis
Describe the process of erythropoiesis.
- Kidney senses hypoxia (anemia) and increases endogenous erythropoietin production
- Erythropoietin acts on E-progenitor cells in bone marrow to produce new RBCs
- Kidney sense increased tissue oxygenation
- Kidney decreases erythropoietin production
What’s the life of a normal RBC?
100 days
What percent of your blood do you lose every day?
1%
Clinical Vampirism
HCT lowered; bone marrow hasn’t responded
What are some reasons that our patients will be anemic?
Renal failure, clinical vampirism, trauma, cancer, pregnant, “little old ladies”
How do perfusionists cause anemia?
Dilutional anemia, hemolysis, stupid perfusion practices
What can you do to combat anemia?
Start mannitol drip, but not much you can do as a perfusionist
What patients only want their own blood in their vasculature?
Jehovah’s Witness
What are the 4 anemia therapeutics?
- Iron
- B12
- Folic Acid (B9)
- Erythropoietin
What is required for the hemoglobin molecule to carry O2?
Iron
Where is iron stored?
Intestinal mucosal cells, liver, spleen, and bone marrow as ferritin
What causes iron deficiency?
Inadequate iron stores and/or intake
What’s a disadvantage of iron injections?
Extremely painful
What’s a disadvantage of oral iron supplements?
GI upset
What does iron deficiency anemia classically cause?
Hypochromic, microcytic anemia; improper red blood cell production
Microcytic
smaller cell than normal
Hypochromic
Hypochromic anemia is a generic term for any type of anemia in which the red blood cells (erythrocytes) are paler than normal.
What are some causes of folic acid deficiency?
Pregnancy, lactation, intestinal pathology (Crohn’s Disease) preventing absorption, alcoholism, certain drugs
What is required for DNA synthesis?
Folate
What is the rate limiting step for the formation of RBCs?
Ability to engage in DNA synthesis (not erythropoietin kicking in the bone marrow)
What does folate deficiency classically cause?
Megaloblastic anemia
Megaloblastic anemia
RBCs larger than normal
What is the most common cause of B12 deficiency?
Poor B12 absorption
What is the anemia caused by B12 deficiency called?
Pernicious anemia
Megaloblastic anemia
Pernicious anemia
Pernicious anemia is a decrease in red blood cells that occurs when your intestines cannot properly absorb vitamin B12
How is anemia from B12 deficiency treated?
B12 injections Folic acid (b/c of megaloblastic anemia)
What are some erythropoetin drugs?
Epogen, Procrit
Epogen and Procrit are both synthetic forms of what?
Erythropoetin-alfa; both have identical protein structure and vary in their glycosylation
What is the “albumin-free” erythropoetin?
Darbepoetin (Aranesp)
Why would an “albumin-free” erythropoietin drug be important?
Some people have rxns to albumin
Jehovah’s witness won’t take anything that has albumin in it; used as part of a comprehensive blood conservation/blood management program
How long does it take for Darbepoetin (Aranesp) to kick in?
Week (s); so it’s not appropriate for acute blood loss
What is Darbepoetin (Aranesp) usually giving with?
Iron; required for the hemoglobin molecule to carry oxygen
Why does erythropoetin have a high potential for abuse?
Athletic ability
What are some side effects of erythropoietin?
Stroke Increased tumor risk Thromboembolic events (DVT, etc) Severe HTN Death
What are the sickle cell drugs?
Hydroxyurea (Hydrea, Droxia)
Pentoxifylline (Trental)
Hydroxyurea (Hydrea, Droxia)
Failure effective in preventing painful, acute criss associated with sickling claudication
Causes sickle cell hemoglobin (HbS) to get diluted by an increased production of fetal Hgb (HbF) particularly when used with epo-alfa
How soon before surgery would you start Hydroxyurea (Hydrea, Droxia)?
A couple months before surgery
How does Hydroxyurea (hydrea, droxia) work?
Works by changing Hgb that bone marrow produces
Claudication
a condition in which cramping pain in the leg is induced by exercise, typically caused by obstruction of the arteries.
Pentoxifylline (Trental)
Rheologic modifier
Increases the flexibility of RBCs so they are less likely to clog capillaries
Decreases blood viscosity
Future possibilities for use of Pentoxylline (trental)
TIA
Strokes
Raynaud’s
Diabetic ulcers
Pica
a symptom of iron deficiency anemia; hunger or ice, dirt, paper, etc.
Koilonychias
a symptom of iron deficiency anemia; upward curvature of the finger and toe nails
