test 2 part 2 Flashcards
What is Anemia?
•Below normal plasma hemoglobin concentration
normal hemoglobin values for males and females
- Males (Hgb)
* 13.5 – 17.5 g/dL - Females (Hgb)
* 12 – 16 g/dL
What is Hemoglobin (Hgb)?
• Iron-containing oxygen transport protein molecule inside RBCs
Symptoms of Anemia
- Fatigue
- Rapid heartbeat
- Shortness of breath
- Pale skin
- Dizziness
- Insomnia
- Poor concentration
Causes of Anemia
•Chronic blood loss •Bone marrow abnormalities •Increased hemolysis •Infections •Malignancy •Genetic •Nutritional •Renal failure •Drugs
Erythropoiesis
- Erythrocyte differentiation takes place in 8 stages
- Stages 1 – 7 occur in bone marrow
- After stage 7, reticulocyte is released into bloodstream, where it matures into an erythrocyte (stage 8)
Why Do You Care?
- Lots of your patients will be anemic
* Renal failure, cancer, trauma, “little old ladies” - YOU will cause anemia
* Dilutional anemia, hemolysis - Some of your patients want only their blood
* Jehovah Witness patients - Giving blood (because of anemia) is bad
Iron deficiency anemia causes
• Causes hypochromic (appear clear), microcytic (smaller) anemia
Symptoms: Iron Deficiency Anemia
- Pica
* Hunger for ice, dirt, paper, etc. - Upward curvature of finger and toe nails
* koilonychia - Soreness and cracking at corners of mouth
Iron availability and dosage
•Oral and parenteral formulations available
• Amount absorbed depends on current body stores (if iron depleted and take an iron supplement you absorb 95%)
• Relative percentage of iron absorbed decreases with
increasing dose
• Divided into two or three doses
• 150 – 180 mg/day: recommended dose
Iron: Adverse Effects
- Adverse effect is GI disturbances
* Abdominal pain
* Constipation
* Diarrhea - Parenteral formulations: iron dextran
* Fatal hypersensitivity reactions - Excessive iron toxicities
* Reversed using chelators (deferoxamine)
most common iron supplement
- ferrous sulfate
Iron
- Essential metallic component of heme
- Stored in:
* Intestinal mucosal cells, liver, spleen, and bone marrow as ferritin - Delivered to marrow for hgb production
- Iron deficiency anemia results from inadequate iron stores and/or intake
Folic Acid (Folate) used to treat
•Used to treat inadequate levels of the vitamin (B9)
Folate deficiencies may be caused by
1. Increased demand
• Pregnancy
• Lactation
2. Poor absorption
• Intestinal pathology
3. Alcoholism
4. Dihydrofolate reductase inhibitor drugsFolic Acid Deficiency causes
- Causes megaloblastic anemia
* Bone marrow produces unusually large, structurally abnormal, immature RBCs
Folic Acid used as a drug
- Oral and parenteral formulations available
* Minimal side effects
Cyanocobalamin (vitamin B12) Deficiencies result from:
- Low dietary intake
- Poor absorption (pernicious anemia) due to:
* Lack of intrinsic factor
* Most common cause - Loss of receptor activity needed for uptake
Cyanocobalamin (Vitamin B12)
- Hydroxocobalamin (preferred)
* IM formulation
* Rapid response
* Maintains higher plasma concentrations - Oral formulation
* Dietary deficiencies - IM or SC formulations
* Pernicious anemia
Vitamin B12 Deficiency: Symptoms
- Tingling (pins and needles)
* Hands
* Feet - Difficulty walking
- Dementia
- Hallucinations, paranoia, schizophrenia
* Extreme cases
Erythropoietin (EPO)
- Released by the kidneys in response to hypoxia
- Glycoprotein that stimulates stem cells to differentiate into proerythroblasts
* Promotes release of reticulocytes from marrow - EPO regulates RBC proliferation and differentiation
Erythropoietin or Epoetin Alfa (Epogen, Procrit) used to treat anemias caused by
- End-stage renal disease
- Bone marrow disorders
- HIV induced anemia
- Cancer induced anemia
- Both are synthetic forms of epoetin alfa
Darbepoetin
• Longer-acting version of epoetin alfa
• 3 times the half life of epoetin alfa
• Requires weeks to achieve steady state plasma
concentrations
• Not used in acute treatment of anemia
•Usually given with iron to ensure adequate response and support proper heme formation
Epoetin alfa/Darbepoetin
- Administered IV or SC
- Side effects
* Increased BP (because of increased viscosity)
* Joint pain - Hgb > 11 g/dL (hgb below 10 it needs to be discontinued)
* Stroke
* Severe HTN
* Embolic events
* Death - High potential for drug abuse
- Enhances endurance and recovery
Neutropenia
- Low levels of neutrophils
* Absolute neutrophil count (ANC) < 1500 neutrophils/ul blood
Agents Used to Treat
Neutropenia
- Myeloid Growth Factors
• Filgrastim, tbo-filgrastim, Sargramostim
• Dosed once daily
• 24-72 hr after chemotherapy
• Pegfilgrastim
• Single dose
• 24 hr after chemotherapy
• Sargramostim is Granulocyte-macrophage colony-stimulating factor (GM-CSF)how do the Myeloid Growth Factors work and what is the most common side effect
- All stimulate granulocyte production in marrow to increase neutrophil counts
- Bone pain is most common side effect
Sickle Cell Disease
- Inherited form of anemia
* High levels of hgbS
* HgbS red blood cells are sickle shape and are rigid and sticky - Sickle cells are destroyed rapidly in the bodies of people with the disease
- Sickled cells block flow of blood through vessels causing tissue damage
Hydroxyurea
- Sickle Cell Drug
- Increases fetal hgb levels which dilutes hgbS levels
* Several month process - Reduces painful sickle cell crises
- Side effects
* Bone marrow suppression
* Cutaneous vasculitis (inflammation of the blood vessels)
Pentoxifylline (Trental)
- Vasoactive drug that improves peripheral blood flow and enhances tissue perfusion
- Increases flexibility of red blood cells
- Decreases blood viscosity
- Used to treat claudication (cramps due to blockage of vessels)
- Side effects
* GI disturbances
