Week 4 Flashcards
what is the main stimulus for erythropoises?
hypoxia
what is the prototype drug for anemia associated with renal failure?
Epoiten Alfa (Epogen, Eprex)
what are the serious adverse effects of Epoiten Alfa (Epogen, Eprex)?
Thromboembolic events, hypertension, pure red cell aplasia and seizures
what are the indications of the prototype drug Filgrastim (Neupogen, Grastofil)
neutropenia, severe bacterial and fungal infections, and AIDS related immunosuppression
what is the normal RBC count for Men?
4.7 - 6.1 million mcL
What is the normal RBC count for women?
4.2 - 5.4 million mcL
what is the normal Hb level for women?
> 120g/L
What is the normal Hb level for men?
> 140g/L
What is the normal hematocrit level for women?
37% - 47%
What is the normal hematocrit level for men?
40% - 54%
Why might the hematocrit be deceptive?
because it varies with the quantity of extracellular fluid, so it rises with dehydration and falls with overexpansion of extra cellular fluid volume
Normal ferritin levels for males?
12 - 300 ng/mL
Normal ferritin levels for females?
12 - 150 ng/mL
what are some adverse effects of Epoiten?
nausea, diarrhea, headache, fever, edema
Mechanism of action of Epoiten?
binds erythropoiten receptor of stem cells in the bone marrow, promoting growth and maturation of RBCs
what are colony stimulating factors?
they increase the production of leukocytes
what are the indications of colony stimulating factors?
chemo or radiation therapy, certain malignancies, and patients receiving transplants
what are the indications of oprelvekin?
to increase platelet counts following cancer chemotherapy
nuclear neonatal jaundice
newborn brain damage due to the cytotoxic effect of high concentrations of bilirubin
what happens with bilirubin in liver failure?
the liver cannot convert bilirubin from unconjugated to conjugated. Unconjugated bilirubin builds up.
what occurs in liver disease and bile duct disorder?
conjugated bilirubin is higher than unconjugated
intravascular hemolysis
occurs as a result of complement fixation in transfusion reactions, mechanical injury or toxic factors
bilirubin
a product of RBC breakdown and will be elevated if breakdown is accelerated
anemia
abnormally low number of circulating RBCs or level of Hb or both
what results due to increased bone marrow production?
bone pain
If anemia is caused by hemorrhage, what results?
bruising or petechiae
If anemia is hemolytic, what results?
increased bilirubin leading to jaundice
if anemia is aplastic, what results?
petechiae and pupura which are the results of decreased platelet function
causes of iron deficiency anemia?
low iron intake or bleeding
free iron is?
toxic
How is free iron transported?
Bound to ferritin, hemosiderin and transferrin
what is a good indicator of the amount of iron stored in the body?
serum ferritin
When is serum ferritin increased?
in inflammation or metabolic syndrome
Hemorrhagic anemia is due to?
severe blood loss
gestational anemia is caused by?
a disproportionate increase in plasma volume resulting in hemodilution
Extreme fatigue, weakness, pale skin, chest pain, tachycardia, SOB, headache, dizziness, lightheadedness, cold hands and feet, inflammation of the tongue, brittle nails, unusual cravings for non-nutritive substances, and poor appetite (especially in children)
Iron deficiency anemia
indication of ferrous sulphate
iron deficiency anemia
adverse effects of ferrous sulphate?
darkened stools, nausea, vomiting, constipation and brown stains on teeth if taken orally
Interventions for iron administration:
- administer on an empty stomach
- use a straw if patient taking liquid iron
pernicious anemia is caused by:
vitamin B12 deficiency
lack of B12 causes the formation of:
large, fragile, megaloblastic RBCs
what is a common initial sign of B12 deficiency anemia
red, sore tongue
dyspnea, palpations, dysrhythmias, fatigue, muscle weakness, sodium retention and hypokalemia are adverse effects of which drug?
Vitamin B12
why must pregnant women get enough folic acid?
folic acid is necessary for development of the fetus’s brain and spinal cord. Folate deficiency can lead to neural tube defects
Folic acid is required for?
DNA synthesis and RBC maturation
what are some of the main causes of folate deficiency?
- decreased dietary intake: old age, chronic diseases, alcoholism
- malabsorption: tropical sprue, gluten-sensitive enteropathy
- Increased requirements: pregnancy, infancy, malignancy
- Drugs: methotrexate, oral contraceptives
sickle cell disease
an inherited disorder in which an abnormal hemoglobin leads to chronic hemolytic anemia, pain and organ failure
thalassemias
group of inherited disorders of hemoglobin synthesis leading to a decreased synthesis of Hb
what can occur in thalassemia?
enlargement of the spleen or liver resulting from extramedullary hematopoises and increased red cell destruction
what are two risk factors for a G6PD deficiency?
aspirin and fava beans
causes of aplastic anemia
exposure of high doses of radiation, chemicals and toxins that suppress hematopoises directly or through immune mechanisms
polycythemia
a condition in which the RBC mass is increased
relative polycythemia
results from a loss of vascular fluid and is corrected by replacing the fluid
primary polycythemia
a proliferative disease of bone marrow with an absolute increase in total RBC mass accompanied by elevated white cell and platelet counts
Secondary polycythemia
results from increased erythropoiten levels caused by hypoxic conditions such as chronic heart and lung disease
