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40 Cards in this Set
- Front
- Back
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What are 3 causes of anemia?
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• impaired red cell production (chronic renal failure, AZT-related, B-12 & Folic Acid deficiency)
• impaired hemoglobin synthesis • decreased RBC survival (hemolytic anemia) |
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Where is iron absorbed?
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jejunum
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What are different types of WBCs?
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• neutrophils
• eosinophils • basophils • mast cells • monocytes |
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What are signs and symptoms of anemia?
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• fatigue
• tachycardia • vertigo • weakness |
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What is RDW?
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• red cell distribution width
• measures the variability in size of the red blood cell |
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How do you calculate transferrin saturation (TSAT)?
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TSAT % = (iron x 100) / TIBC
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What TSAT or Ferritin level indicates a need for iron therapy?
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• TSAT < 20%
• Ferritin < 100 |
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When are bone marrow biopsies usually done?
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in a normcytic anemia with a low reticulocyte count and unknown cause to rule out myelodysplasia
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What are lab findings of microcytic anemia?
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• decreased serum iron
• decreased transferrin • increased TIBC |
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What are causes of normocytic anemia?
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• acute blood loss
• hemolytic anemia • chronic disease |
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What are causes of macrocytic anemia?
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• B12 deficiency
• Folic Acid deficiency • AZT |
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What are causes of folic acid deficiency?
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• alcohol
• Bactrim • methotrexate |
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What is the MOA of growth factors like erythropoietin (Epogen) or Darbopoetin (Aranesp)?
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• binds to receptor on surface of erythroid precursor cells in bone marrow
• leads to erythropoiesis |
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What are conditions that can decrease endogenous production of erythropoietin?
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• bone marrow disease
• hypoxia • iron deficiency • renal disease |
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What should be given in conjunction with erythropoietin?
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• iron
• helps erythropoietin to stimulate bone marrow |
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What are indications for using growth factors (erythropoietin/darbopoetin)?
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• anemia
• AZT-related anemia • chemotherapy-induced anemia • chronic renal failure |
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What are adverse effects for erythropoietin?
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• severe HTN
• tachycardia |
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How are growth factors like erythropoietin or darbopoietin adminstered?
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subcutaneous injection
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What is the dosage for erythropoietin?
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• 10,000 units M,W,F
OR • 40,000 units/wk |
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What is the dosing for Darbopoietin (Aranesp)?
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• 40-200 mcg (either once a week OR once every two weeks)
* 40, 60, 80, or 100 mcg are once a week * 200 mcg is every 2 weeks |
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What are myeloid growth factors?
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glcyoproteins that stimulate the prolferation and differentiateion of one or more myeloid cell lines
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Give an example of a GM-CSF
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Sargramostim (Leukine)
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What are indications for GM-CSF?
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• bone marrow transplant
• chemotherapy • AIDS-associated neutropenia |
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What are adverse effects of GM-CSF?
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• bone pain
• flu-like symptoms • malaise |
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Give an example of a G-CSF used to stimulate neutrophil production
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Filgrastim (Neupogen, Neulasta)
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How do you calculate absolute neutrophil count (ANC)?
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[(Bands + Segs) x WBC] x 100
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Based on the ANC, when do you stop G-CSF therapy?
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ANC > 1500 for 2 consecutive days
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What is the dosing for neupogen?
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5 mcg/kg/day sub-q
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What are effects of iron therapy?
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• increases sensitivity of erythropoetin receptors
• increases catecholamine production • increases mitochondrial enzyme production |
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What form must iron be to be absorbed?
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ferrous form (positively-charged)
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Iron is absorbed better in which type of environment?
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acidic environment
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What are the different forms of iron their corresponding percentage of elemental iron?
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• ferrous fumarate (35%)
• ferrous sulfate (feosol) (30%) • ferrous gluconate (20%) |
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Ferrous Fumarate is not given often because of its high incidence of adverse effects. What are adverse effects of iron?
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• abdominal cramping
• constipation |
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What are indications for iron IV?
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• patients on dialysis
• NPO patients (not FDA approved) * only good for the acute state; will not keep iron levels elevated chronically |
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What are the 2 IV forms of iron available?
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• Ferrous sucrose (Venofer)
• Ferric Gluconate (Ferlicit) |
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How should you administer Ferric Gluconate (Ferlicit) to avoid anaphlaxis?
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• Dose: 125 mg IV TIW (3x a week)
• give a test dose 25 mg IV over 1 hr • give the remainding 100 mg IV over 1 hr |
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What is the sub-q or IM form of iron?
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iron dextran (has the highest incidence of anaphylactic reactions)
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How do you treat iron toxicity?
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• acute: deferoxamine (which chelates iron)
• chronic: phlebotomy |
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What is the treatment and dosage for folic acid deficiency anemia?
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Tx: Folic Acid 1mg/day
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What is the treatment of Vit B12 deficiency anemia?
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• Tx: Vit B12 100 mcg
• treatment is given daily for the first week, then weekly for the first month, and then montly for life * Esty said milligram in class, but current says microgram |
