Hematopoiesis And Colony Stimulating Factors

Front 1

Define Neutropenia

Back 1

An abnormally low number of neutrophils

The drop in neutrophils makes patients susceptible to bacterial infections.

Front 2

Define Anemia

Back 2

A qualitative or quantitative deficiency of hemoglobin

Leads to hypoxia of organs

Front 3

Define thrombocytopenia

Back 3

A reduction in the number of platelets.

Can result in bleeding problems

Front 4

Define pluripotent

Back 4

One cell tat can differentiate into other types of cells.

Pluripotent stem cells differentiate into the myeloid and lymphoid stem cells. Eventually leading to the productionof granulocytes, platelets, erythrocytes, and lymphocytes.

Front 5

Describe the flow from stem cell to granulocytes, platelets, erythrocytes, and lymphocytes in hematopoeisis.

Back 5

Stem cell --> Myeloid and lymphoid stem cells

myeloid stem cells --> granuloctyes/eosinohils/basophils, platelets, erythrocytes

lymphoid stem cells --> lymphocytes (B-cells, T-cells, NK cells)

Front 6

Describe a CFU and BFU. What is the difference?

Back 6

CFU: Colony Forming Unit
BFU: Burst Forming Unit

Population of cells that are waiting to be stimulated by growth factors to continue through differentiation.

When BFU is stimulated by GFs it causes a surge of mature erythrocyte production (like a burst)

Front 7

Compare when GMCSF acts in the development of red blood cells compared to GSF.

Back 7

GMCSF acts very early on in the development of blood cells. GSF acts later on in the process.

GMCSF acts upon the tri-lineage myeloid stem cell to stimulate the development of the 3 different branches.

Front 8

What is the primary role of GSF?

Back 8

Maturation of Neutrophils

GSF stimulates the production of neutrophils specifically

Front 9

Is erythropoieitin a single lineage or multi lineage GF?

Back 9

single lineage

Front 10

Where does erythropoietin act in the development of red blood cells?

Back 10

EPO stimlutes the BFU to produce RBCs

Front 11

What role does thrombopoietin play in hematopoeisis?

Back 11

Thrombopoeitin is the final component involved in the maturation of platelets

Front 12

How does the glycosylation of Epoetin alfa distinguish it from native erythropoietin?

Back 12

The glycosylation pattern differs

Glycosylation changes do not change kinetics, potency, or immunoreactivity

Glycosylation differences can be detected

Front 13

What is unique about the manufacturing process of Epoetin alfa?

Back 13

It produces cross-reactive antibodies.

Front 14

True or False: Darbepoetin has a longer half life and lasts longer than epoetin alfa in the body.

Back 14

True

Front 15

What is the purpose of Darbepoetin and Epoeitin alfa in cancer patients?

Back 15

Cancer patients can become anemic. We use these drugs to stimulate the production of erythrocytes in the treatment of anemia.

Front 16

Which growth factor acts higher in hematopoeisis? GCSF or GMCSF?

Back 16

GMCSF

Front 17

The primary effect of GMCSF (Sargramostim) is to....

Back 17

Stimulate myelopoiesis

It acts synergistically with the other GFs to stimulate proliferation and differentiation along the myeloid cell line

Front 18

List the growth factors that Sargramostim stimulates.

Back 18

CFU-GEMM
CFU-GM
CFU-M
CFU-E
CFU-Meg

Front 19

What are the effects of GMCSF (Sargramostim) other than differentiation of the myeloid cell line?

Back 19

Enhances migration, phagocytosis, superoxide production, and antibody-dependent cell-mediated toxicity of neutrophils, monocytes, and eosinophils

Front 20

True or False: Sargramosim can be delivered via SQ and IV route.

Back 20

True

Front 21

Which CSF is selective for increasing neutrophil production?

Back 21

Pegfilgrastim

Front 22

Which of the following growth factors participate in networking?

GM-CSF
G-CSF
Thrombopoietin
Erythropoietin
IL-11

Back 22

GM-CSF
G-CSF
Thrombopoietin
IL-11

NOT erythropoietin

Front 23

What is the primary effect of GM-CSF (sargramostim)?

Back 23

To stimulate myelopoiesis

Front 24

GM-CSF triggers which of the following:

Macrophages
Eosinophils
Neutrophils

Back 24

All of them

Front 25

GM-CSF will primarily trigger ______ at low doses.

Macrophages
Eosinophils
Neutrophils

Back 25

Neutrophils

Front 26

List the AE of GM-CSF

Back 26

Bone pain, malaise, flu-like sx, fevere, diarrhea, dyspnea, rash

acute reaction to first dose

capillary leak syndrome (peripheral edema and pleural/cardiac effusions)

transient supraventricular arrhythmias

dyspnea

elevation of SCr, Bilirubin, and hepatic enzymes

Front 27

What is the principle action of G-CSF (filgrastim)

Back 27

stimulation of CFU-G to increase neutrophil production

This is NOT pluripotent

Front 28

G-CSF has minimal effects on which of the following:

Monocytes
Macrophages
Neutrophils
Eosinophils

Back 28

Monocytes
Macrophages
Eosinophils

Front 29

What about G-CSF (pegfilgrastim) distinguishes it from filgrastim?

Back 29

Pegfilgrastim is pegylated. It has a longer half life due to decreased clearance by glomerular filtration.

Front 30

What role does IL-11 play in hematopoiesis?

Back 30

IL-11 stimulates the production of platelets. It is non-pluripotent.

Front 31

Name the non-pluripotent growth factors

Back 31

IL-11
Thrombopoietin
Erythropoietin

Front 32

What are the AE associated with IL-11

Back 32

Reversible fluid retention (CV symptoms)

Blurred vision

Inj site reaction

Paresthesias

Front 33

What should you do to prevent donor antibodies from forming (thrombocytopenia) to Thrombopoietin and native TPO?

Back 33

Give TPO to platelet donor to stimulate platelet production and when you harvest platelets get the antibodies too to prevent recipient developed thrombocytopenia.

Front 34

When is Eltrombopag indicated?

Back 34

With chronic immune (idiopathic) thrombocytopenic purpura after failure with corticosteroids, immunoglobulins, or splenectomy

Front 35

What black box warnin does Eltrombopag have?

Back 35

hepatotoxicity

Front 36

What are the AE of Eltrombopag?

Back 36

hepatotoxicity
worsened thrombocytopenia
hemorrhage following d/c
cataracts

Front 37

What are the potential risks of using Eltrombopag?

Back 37

bone marrow reticulum formation, bone marrow fibrosis, and thromboses

Front 38

Which Thrombopoietin Receptor Agonists requires prescribers to be enrolled in the PROMACTA CARES Program?

Back 38

Eltrombopag

Front 39

What is the MOA of Romiplostim and Eltrombopag?

Back 39

Thrombo receptor agonists

Induces proliferation and differentiation of megakaryocytes

Front 40

What are the indications for Romiplostim?

Back 40

Chronic Immune Thrombocytopenic Purpura (ITP) after failure with ccs, immunoglobulins, or splenectomy

Front 41

What pregnancy category is Romiplostim?

Back 41

Pregnancy category C

Front 42

What drug requires prescribers to be enrolled in the Nplate NEXUS Program?

Back 42

Romiplostim

b/c of side effects

Front 43

Sargramostim = ?
Filgrastim = ?Pegfilgrastim = ?

Back 43

Sargramostim = GM-CSF

Filgrastim = G-CSF

Pegfilgrastim = G-CSF