Topic 12

Question 1

Erythropoiesis step 1

Answer 1

kidneys sense hypoxia (anemia) and increase endogenous erythropoietin production

Question 2

Erythropoiesis step 2

Answer 2

Erythropoietin acts on the E-progenitor cells in the bone marrow to produce new RBCs

Question 3

Erythropoiesis step 3

Answer 3

Kidney senses increased tissue oxygenation

Question 4

Erythropoiesis step 4

Answer 4

Kidney decreases erythropoietin production

Question 5

Lots of your patients will be anemic from…

Answer 5

renal failure, clinical vampirism, trauma, cancer, pregnant, “little old ladies”

Question 6

YOU will cause anemia from…

Answer 6

dilutional
anemia,
hemolysis,
stupid perfusion practices

Question 7

Giving blood (because of anemia) is incredibly

Answer 7

horribly bad. Really bad. Expensive and bad.

Bad. Life-threatening bad. Walter White bad

Question 8

Anemia Therapeutics include:

Answer 8

Iron
B12 injection
Folic Acid
Epogen

Question 9

Iron is required for the

Answer 9

hemoglobin molecule to carry O₂

Question 10

Iron is stored in

Answer 10

intestinal mucosal cells as ferritin

Question 11

Iron deficiencies result from

Answer 11

inadequate iron stores &/or intake.

Question 12

Iron Injections ____ and Oral iron supplements can cause _______

Answer 12

HURT!

“GI upset”

Question 13

*Iron deficiency anemia classically causes a

Answer 13

hypochromic, microcytic anemia

Question 14

B9 Folic Acid deficiencies causes

Answer 14

pregnancy, lactation, intestinal pathology (Crohn’s Disease, etc.) preventing absorption, alcoholism, certain
drugs.

Question 15

Folate is required for

Answer 15

DNA Synthesis

Question 16

Folate deficiency anemia classically causes a

Answer 16

megaloblastic anemia

Question 17

Most common cause of deficiency is poor B₁₂ absorption…this is called

Answer 17

“pernicious anemia”

Question 18

B₁₂ deficiency also causes a ________….So B12 injections are usually given with ________

Answer 18

megaloblastic anemia

Folic Acid

Question 19

Erythropoietin [drug names]

Answer 19

(Epogen, Procrit)

Question 20

(Epogen, Procrit): both are

Answer 20

1. synthetic forms of erythropoietin-alfa

2. have identical protein structure and vary in their glycosylation

Question 21

A longer-acting cousin of Epogen and is “albumin-free”

Answer 21

Darbepotin (Aranesp)

Question 22

Darbepotin (Aranesp) Part of a comprehensive

Answer 22

conservation/blood management program

Question 23

Darbepotin (Aranesp) Require week(s) to

Answer 23

“kick in” bone marrow– so not appropriate for acute blood loss

Question 24

Darbepotin

Answer 24

(Aranesp)

Question 25

Darbepotin (Aranesp) is usually given with

Answer 25

Iron

Question 26

Darbepotin (Aranesp) has a high potential for

Answer 26

abuse

Question 27

Darbepotin (Aranesp) side effetcs

Answer 27

``` Stroke Increased tumor risk Thromboembolic events Severe HTN Death ```

Question 28

Sickle cell drugs

Answer 28

Hydroxyurea (Hydrea, Droxia) | Pentoxifylline (Trental)

Question 29

Hydroxyurea

Answer 29

(Hydrea, Droxia)

Question 30

Pentoxifylline

Answer 30

(Trental)

Question 31

Hydroxyurea: Fairly effective in preventing

Answer 31

painful acute “crises” associated with sickling claudication.

Question 32

Hydroxyurea: causes sickle cell hemoglobin (HbS) to get

Answer 32

diluted by an increased production of fetal hemoglobin (HbF.) particularly when used with epo-alfa

Question 33

Pentoxifylline is a

Answer 33

rheologic modifier

Question 34

Pentoxifylline increases the

Answer 34

“flexibility” of RBC’s so they are less likely to clog capillaries

Question 35

Pentoxifylline decreases the

Answer 35

blood viscosity so interesting future possibilities...TIA, strokes, Raynaud’s, diabetic ulcers, etc