Treatment of Anemia Flashcards
Where is iron, folate and cobalamin absorbed?
Iron = duodenum and proximal jejunumFolate = proximal jejunumVitB12-intrinsic factor = terminal ileum
Why does the total iron binding capacity change in anemia?
Due to decrease in saturation
How is iron deficiency anemia treated?
By administering ferrous salts such as ferrous sulfate, ferrous gluconate and ferrous fumerate.Parental form of iron can be used, called iron dextran for patients that cannot tolerate oral iron or those with IBD
What are the signs of acute iron toxicity and what is its treatment?
Deferoxamine
What kind of anemia does this patient has?
Megaloblastic anemia
What is the role of Vitamin B12 in the folate cycle?
THF has to be methylated before it can participate in a purine or pyramidine synthesis pathway and be able to donate a carbon, methylation of THF requires Vitamin B12
What kind of anemia is alcoholism associated with?
Megaloblastic anemia due to folate deficiency
How long does it take to deplete folate and vitamin B12 stores?
Vitamin B12 -> 3-6 yearsFolate -> 6 months
What is the function of vitamin B12 in our body?
Required for purine, pyramidine synthesis and essential for maintaining myelin around peripheral nerves
How is vitamin B12 deficiency treated?
Administering cyanocobalamin and hydroxycobalamin.It is important to know that megaloblastic anemia due to B12 deficieny is also accompanied with peripheral neuropathy, administering folic acid such as Leucovirin can reverse megaloblastic anemia but will not help with peripheral neuropathy which can only be cured by administering B12.
Summary of the different drugs used in microcytic, macrocytic and normocytic anemias.
What are hematopoietic growth factors?
Name the different hematopoietic drugs that are used to treat anemia, their indications and side effects.
Epoetin alpha (Erythropoietin)
* A glycoprotein that stimulates red cell production, reticulocyte release Used in anemia patients with chronic renal failure, HIV infection, or in cancer patients receiving chemotherapy
* Adverse events include hypertension, thrombosis
Filgrastim (G-CSF)
* Recombinant colony stimulating factor
* Prevents and treats cytotoxic chemotherapy-related neutropenia
* Reduces time to engraftment after autologous stem cell transplantation
* Promotes mobilization of peripheral blood stem cells for transplantation
* Used to treat inherited disorders of myeloid cell production (e.g., congenital neutropenia)
* Causes temporary bone pain
Sargramostim (GM-CSF)
* Recombinant granulocytic-macrophage colony stimulating factor
* Uses similar to Filgrastim (G-CSF)
* Adverse events common, including fever, malaise, arthralgia. myalgia, capillary leak syndrome (peripheral edema, pleural and pericardial effusions)
* Less commonly used that filgrastim due to AE incidence and severity
Oprelvekin (IL-11)
* Promotes megakaryopoiesis
* Increases the number of peripheral platelets, decreases need for platelet transfusions
* Used in patients receiving cytotoxic chemotherapy for treatment of nonmyeloid cancers
* Adverse events include fatigue, dizziness, anemia, dyspnea
