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52 Cards in this Set

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What are the vitamins that are important in RBC synthesis (hematopeisis) and what happens if you have a deficiency in them?
Feric Sulfate (Fe SO4), Vitamin B12, and Folic Acid

a deficiency in these results in anemia
What are the hemopoietic growth factors?
What do they do?
Erythropoitin (EPO, Epogen)
Filgrastim
Sargramostim
Oprelvekin

HGFactors are cytokines that stimulate diferetiation of progenitor cells into different types of blood cells
What type of blood cell does Erythropoietin stimulate the growth of?
RBC
What role do plasma protiens play in osmotic blood pressure (onconic pressure)?
In blood plasma, the dissolved compounds have an osmotic pressure. A small portion of the total osmotic pressure is due to the presence of large protein molecules; this is known as the colloidal osmotic pressure, or oncotic pressure. Because large plasma proteins can't easily cross through the capillary walls, their effect on the osmotic pressure of the capillary interiors will, to some extent, balance out the tendency for fluid to leak out of the capillaries. In conditions where plasma proteins are reduced, e.g. from being lost in the urine (proteinuria) or from malnutrition, the result of the too low oncotic pressure can be edema – excess fluid buildup in the tissues
What type of blood cell does Filgrastim and Sargamostin stimulate the growth of?
WBC's Granulocyte, CSF

Sargamostin- Macrophage
What type of blood cell does Oprelvekin stimulate the growth of?
RBC's (IL-11) Neumega
What is microcytic anemia due to?
Iron deficiency and a decreased amount of small RBC's (agranular)
What does Gastric Intrinsic Factor do (GIF)?
it is required for B12 absorption in the GI tract
What is Pernicious Anemia?
a type of macrocytic (magaloblastic) anemia that results from a B12 deficiency
What is a Macrocytic (megaloblastic) anemia?
A type of anemia that results from a B12 or folate deficiency and results in a decreased amount of large RBC's with protein granules in the RBC
Where is iron absorbed the most?
in the duodenum and proximal jejunum
What increases iron absorption? decreases it?
increases- gastric acid, ascorbic acid

decreases- food, tetracyclines, antacid, gastrectomy
By what mechanism does tetracycline decrease iron absorption?
chemical antagonism, iron binds to tetracycline and therefore can't be absorbed
Who requires more iron than usual?
Pregos, menstrating females, and infants
What is the major cause of iron deficiency?
blood loss, hemmorage often caused by gastric ulcer, or bleeding from uterus
What do we perscribe for iron deficiency?
Oral iron preparation 3-4 times a day, for 4-6 months
what is the prefered preparation?

What is not recommended?
Ferrous sulfate, or Iron w/ vit C (acid keeps iron in absorbable form for longer)

not rec- enteric coated (bad absorption)geritol (more vitamins no more absorption, more money) higher content iron formulas cause GI problems
What would be an indicatior for paraenteral iron admin?
What is the danger?
indications- intolerant to oral iron, malabsorption syndrome, chronic blood loss, chronic dialysis

Danger- anaphylaxix
What are some possible side effects of Iron supplements?
oral- NVD, epigastric pain, black stool

parenteral- skin discoloration, local pain, (IM) sarcoma
What is a good way to avoid iron side effects?
start with a low dose and slowly increase
Who is the most suceptable to iron poisoning?
small children, 10-30 tablets of ferrous sulfate is lethal

ss- NVD, Gas enteritis, necrosis lethargy, pallor, shock
What is the treatment for Iron overdose?
GI lavage, chelating agent- deferoxamine,
poikilocytosis
Poikilocytosis is an increase in the number of abnormally shaped red blood cells as seen on a blood film. It is commonly seen as a sign of iron-deficiency anemia. Normal red blood cells are round, flattened disks that are thinner in the middle than at the edges, whereas a poikilocyte is pear-shaped and so also called a teardrop cell. However, poikilocytosis can refer to an increase in abnormal red blood cells of any shape where they make up
anisocytosis
when RBC's are of unequal size
What are our two sources of B12?
diet and the liver
What does B12 have to bind to in order to be delivered to the tissues and the liver?
transcobalamin II, a plasma-B-globulin
What does B12 have to be converted to when metabolized?
methylcobalamin and 5-deoxyadenosylcobalamin
What is B12 needed for?
cell growth, DNA replication, maintenance of normal myelin through out nervous system
What is the earliest sign of a V B12 deficiency?
Megaloblastic Anemia
How are V B12 and Folate related?
via the methylfolate trap which results during B12 deficiency
What symptoms could result from a B12 deficiency?
NS damage, neurologic deficit, muscle weakness, numbness, dementia, ataxia and painful tounge
What are cyanocobalamin (Crystamine, Cyanoject)(IM/SC) injections and hydroxocobalamin (Hydro Cobex) used for?
B12 deficiency
What are some advantages and disadvantages to using hydroxocobalamin?
IM injection only, longer duration of action, but could cause antibody formation (-)
How long do you have to take B12 supplements if you have a GIF deficiency?
For the duration
Would a folic acid or a V B12 deficiency happen more often?
and why?
Folic acid deficiency would happen faster becasue we have a smaller store of it in our body and we need more of it
What is folic acid necessary for?

what is it converted to first?
folic acid is reduced to tetrahydrofolic acid which is then a methyl donor for thymidylate (DNA synthesis) amino acid synthesis, and histidine metabolism
How could you tell B12 deficiency and Folic Acid deficiency apart?
same symptoms like leukoblastic anemia ect. but folic acid deficiency does not result in neurologic deficit, CNS symptoms- muscle weakness, tingliness, dymentia
Indications for Folic Acid?
prevents spina bifida in utero
folate deficiencies
reduce risk of coronary heart disease/
How might folic acid decrease the risk of coronary heart disease?
occlusive vascular disease; decreases homosystein levels
Major causes of folic acid deficiency?
inadequate diet, alcoholism
where is erythropoitin made and in response to what?
EPO is primarily made in the peritubular cells in proximal kidney in response to hypoxia
What is the mechanism of action for EPO?
binds to specific receptors and increases calcium and protaglandins which stimulates RBC production in the bone marrow
When would we use EPO clinically?
in the case of chronic renal failure, other anemias associated with cancer, aids, aplastic anemias, leukemias
Are there any side effects associated with EPO use?
may cause Hypertension and increased clotting in the dialyser (often given to patients on dialysis)

succeptible to abuse by atheletes
When would you use Filgrastim or Sargramostim?
if you had a White Blood cell anemia, or in the case of a bone marrow transplant
How do Filgrastim and Sargamostim work?
they stimulate the proliferation, differentiation, and functional activity of neutrophils
Which drug also stimulates macrophage production?
GM-CSF- Sargramostim
Which drug has a remarkable ability to mobilize hematopoietic stem cells?
G-CSF Filgrastim
What are possible side effects of Filgrastim and Sargomostim?
moderate bone pain (G-CSF- Filrastim)

fever, malaise, arthalgias, myalgias, pleural and pericardial effusions (GM-CSF- Sargomostim
What drug stimulates platelets and neurophils proliferation by the megakaryocyte? (megakaryocyte growth factor)
Oprelvekin
When would you use Oprevekin?
to prevent thrombocytopenia in patients recieving cytotoxic chemotherapy for non-myeloid cancers
What are some possible side effects of Oprevekin?
fatigue, headache, dizziness, Cardio Vascular side effects like anemia, dyspnea, transient atrial arythmias.