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40 Cards in this Set

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What are 3 causes of anemia?
• impaired red cell production (chronic renal failure, AZT-related, B-12 & Folic Acid deficiency)
• impaired hemoglobin synthesis
• decreased RBC survival (hemolytic anemia)
Where is iron absorbed?
jejunum
What are different types of WBCs?
• neutrophils
• eosinophils
• basophils
• mast cells
• monocytes
What are signs and symptoms of anemia?
• fatigue
• tachycardia
• vertigo
• weakness
What is RDW?
• red cell distribution width
• measures the variability in size of the red blood cell
How do you calculate transferrin saturation (TSAT)?
TSAT % = (iron x 100) / TIBC
What TSAT or Ferritin level indicates a need for iron therapy?
• TSAT < 20%
• Ferritin < 100
When are bone marrow biopsies usually done?
in a normcytic anemia with a low reticulocyte count and unknown cause to rule out myelodysplasia
What are lab findings of microcytic anemia?
• decreased serum iron
• decreased transferrin
• increased TIBC
What are causes of normocytic anemia?
• acute blood loss
• hemolytic anemia
• chronic disease
What are causes of macrocytic anemia?
• B12 deficiency
• Folic Acid deficiency
• AZT
What are causes of folic acid deficiency?
• alcohol
• Bactrim
• methotrexate
What is the MOA of growth factors like erythropoietin (Epogen) or Darbopoetin (Aranesp)?
• binds to receptor on surface of erythroid precursor cells in bone marrow
• leads to erythropoiesis
What are conditions that can decrease endogenous production of erythropoietin?
• bone marrow disease
• hypoxia
• iron deficiency
• renal disease
What should be given in conjunction with erythropoietin?
• iron
• helps erythropoietin to stimulate bone marrow
What are indications for using growth factors (erythropoietin/darbopoetin)?
• anemia
• AZT-related anemia
• chemotherapy-induced anemia
• chronic renal failure
What are adverse effects for erythropoietin?
• severe HTN
• tachycardia
How are growth factors like erythropoietin or darbopoietin adminstered?
subcutaneous injection
What is the dosage for erythropoietin?
• 10,000 units M,W,F
OR
• 40,000 units/wk
What is the dosing for Darbopoietin (Aranesp)?
• 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
What are myeloid growth factors?
glcyoproteins that stimulate the prolferation and differentiateion of one or more myeloid cell lines
Give an example of a GM-CSF
Sargramostim (Leukine)
What are indications for GM-CSF?
• bone marrow transplant
• chemotherapy
• AIDS-associated neutropenia
What are adverse effects of GM-CSF?
• bone pain
• flu-like symptoms
• malaise
Give an example of a G-CSF used to stimulate neutrophil production
Filgrastim (Neupogen, Neulasta)
How do you calculate absolute neutrophil count (ANC)?
[(Bands + Segs) x WBC] x 100
Based on the ANC, when do you stop G-CSF therapy?
ANC > 1500 for 2 consecutive days
What is the dosing for neupogen?
5 mcg/kg/day sub-q
What are effects of iron therapy?
• increases sensitivity of erythropoetin receptors
• increases catecholamine production
• increases mitochondrial enzyme production
What form must iron be to be absorbed?
ferrous form (positively-charged)
Iron is absorbed better in which type of environment?
acidic environment
What are the different forms of iron their corresponding percentage of elemental iron?
• ferrous fumarate (35%)
• ferrous sulfate (feosol) (30%)
• ferrous gluconate (20%)
Ferrous Fumarate is not given often because of its high incidence of adverse effects. What are adverse effects of iron?
• abdominal cramping
• constipation
What are indications for iron IV?
• patients on dialysis
• NPO patients (not FDA approved)

* only good for the acute state; will not keep iron levels elevated chronically
What are the 2 IV forms of iron available?
• Ferrous sucrose (Venofer)
• Ferric Gluconate (Ferlicit)
How should you administer Ferric Gluconate (Ferlicit) to avoid anaphlaxis?
• 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
What is the sub-q or IM form of iron?
iron dextran (has the highest incidence of anaphylactic reactions)
How do you treat iron toxicity?
• acute: deferoxamine (which chelates iron)
• chronic: phlebotomy
What is the treatment and dosage for folic acid deficiency anemia?
Tx: Folic Acid 1mg/day
What is the treatment of Vit B12 deficiency anemia?
• 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