Hematinics

Question 1

What is the main regulator of erythropoiesis?

Answer 1

Tissue oxygenation

Question 2

Erythropoietin dependent immature RBC:

Answer 2

Burst-forming unit (BFU-E)
Colony-forming unit (CFU-E)
Erythroblast

Question 3

Iron dependent immature RBC:

Answer 3

Erythroblasts
Reticulocytes
Erythrocytes

Question 4

Factors that decrease oxygenation:

Answer 4

Anemia
Poor blood flow/blood volume
Low hemoglobin
Pulmonary disease

Question 5

Important nutrients/components of erythropoiesis:

Answer 5

Hematopoietic growth factors
Erythropoietin
Iron
Cobalamin
Folic acid

Question 6

Growth factors stimulating granulocyte and stem cell formation:

Answer 6

Granulocyte-Colony stimulating factor (G-CSF)

Granulocyte-Monocyte Colony stimulating factor (GM-CSF)

Question 7

Endogenous regulators of platelet production:

Answer 7

Thrombopoietin

IL-11

Question 8

Combine to form heme:

Answer 8

Protoporphyrin

Ferrous iron

Question 9

Most common hemoglobin form in humans:

Answer 9

Hemoglobin A

Question 10

Types of anemia:

Answer 10

Hypoproliferative anemia
Megoblastic anemia
Hemolytic anemia

Question 11

Types of hypoproliferative anemia:

Answer 11

Iron deficiency anemia
Chronic inflammation anemia
Metabolic defect
Renal disease
Infiltrative fibrosis/aplasia

Question 12

Morphology of IDA:

Answer 12

Microcytic hypochromic

Question 13

Causes of IDA:

Answer 13

Increased demand for iron/hematopoiesis
Increased iron loss
Decreased intake/absorption

Question 14

1 mL RBC requires __ mg elemental Fe:

Answer 14

1

Question 15

Amount of iron needed daily and percentage absorbed:

Answer 15

16-20 mg/day; 10-15% absorbed

Question 16

Iron absorption needed in males, females and children:

Answer 16

Male: 1mg
Female: 1.4mg (x2 pregnancy)
Children: 1.5 mg

Question 17

Stages of iron deficiency:

Answer 17

Negative iron balance
Iron deficient erythropoiesis
Iron deficiency anemia

Question 18

First iron marker to decrease during negative iron balance stage:

Answer 18

Serum ferritin (20)

Question 19

Iron marker profile during iron deficient erythropoiesis stage:

Answer 19

15 serum ferritin (no iron stores)
380 TIBC
50 SI
20% saturation
10 marrow sideroblasts
100 RBC protoporphyrin

Question 20

By definition, marrow iron stores are absent when ____ level is below ___ g/L:

Answer 20

serum ferritin; 15

Question 21

When serum iron falls below ___ mcg/dL, ___ begins to be affected:

Answer 21

50; hemoglobin synthesis

Question 22

Normal iron markers:

Answer 22

1-3 marrow stores
50-200 serum ferritin
300-360 TIBC
50-150 SI
30-50% saturation
40-60 marrow sideroblasts
30-50 RBC protoporphyrin

Question 23

Hemoglobin level where bone marrow remains hypoproliferative:

Answer 23

10-13 g/dL

Question 24

In inflammation anemia TIBC is ___, Ferritin is ___ and serum iron is ___:

Answer 24

decreased; increased; decreased

Question 25

Inflammation anemia is due to inhibition of ___ function in macrophages:

Answer 25

ferriportin

Question 26

Protein stimulated by inflammation that inhibits ferriportin:

Answer 26

hepcidin

Question 27

Iron is not affected in thalassemia, although ___ and ___ may be increased:

Answer 27

serum iron; serum ferritin

Question 28

Type of anemia where the dysfunction is inability to utilize iron:

Answer 28

Sideroblastic anemia (iron not affected)

Question 29

Iron is absorbed in which part of the small intestine:

Answer 29

Duodenum | Proximal jejunum

Question 30

Causes increased absorption of iron:

Answer 30

ascorbic acid

Question 31

Causes decreased absorption of iron:

Answer 31

tea, dairy, fish

Question 32

Oral iron therapy gives ___ mg elemental iron/day:

Answer 32

300

Question 33

When to use parenteral iron therapy:

Answer 33

Pt cannot tolerate oral iron Condition is chronic Pt has advanced chronic renal disease Pt needs continuous iron

Question 34

Administer iron with ___ to prevent neural tube defect:

Answer 34

folic acid

Question 35

Type of iron toxicity exclusively in young children:

Answer 35

Acute

Question 36

Drug and administration route used in acute iron toxicity:

Answer 36

Deferoxamine; parenteral

Question 37

Chronic iron toxicity occurs when:

Answer 37

Excess iron deposits in hear, liver, pancreas, etc. (hemochromatosis)

Question 38

Drug and administration route used in chronic iron toxicity:

Answer 38

Deferasirox; oral

Question 39

Erythropoietin is increased when:

Answer 39

Decreased red cell mass Impaired O2 loading High Hgb O2 affinity Impaired renal blood flow

Question 40

Drug extends half life of EPO to 24-36hr:

Answer 40

Darbepoietin alfa

Question 41

Normal EPO level:

Answer 41

10-25 U/L

Question 42

EPO is increased when Hgb falls below:

Answer 42

10-12 g/dL

Question 43

Indications for epoietin alpha:

Answer 43

Chronic renal failure AIDS Cancer

Question 44

Megaloblastic anemia is due to a deficiency of:

Answer 44

Cobalamin (Vit B12) | Folic acid

Question 45

Deficiency of Vit. B12 causes:

Answer 45

Anemia with neutropenia Thrombocytopenia GI symptoms Neurologic abnormalities

Question 46

Ultimate source of Vit B12:

Answer 46

Microbial synthesis

Question 47

Needed for absorption of Vit. B12:

Answer 47

Intrinsic factor

Question 48

Vit. B12 stores last for ___:

Answer 48

5 years

Question 49

Preferred drug in megaloblastic anemia:

Answer 49

Hydroxycobalamin (more protein bound)

Question 50

Main storage pool of Vit. B12 is located in:

Answer 50

Liver (3000-5000 ug)

Question 51

B12 deficiency is mainly related to dysfunction in:

Answer 51

Malabsorption (pernicious anemia)

Question 52

Megaloblastic anemia appears ___ after stopping folic acid:

Answer 52

1-6 months

Question 53

Daily requirement of folic acid:

Answer 53

100 ug

Question 54

GM-CSF is effective in treating neutropenia associated with:

Answer 54

Congenital neutropenia Cyclic neutropenia Myelodysplasia Aplastic anemia

Question 55

Better tolerated G-CSFs:

Answer 55

Filgrastim | Pegfilgrastim

Question 56

GM-CSFs associated with more side effects:

Answer 56

Molgramostim | Sargramostim

Question 57

Most severe adverse effect of G-CSF:

Answer 57

Splenic rupture

Question 58

GM-CSF is associated with maturation of:

Answer 58

Monocytes | Macrophages

Question 59

G-CSF is associated with maturation of:

Answer 59

Neutrophils

Question 60

Recombinant myeloid GFs:

Answer 60

Sargramostim (GM-CSF) | Filgrastim (G-CSF)

Question 61

Advantage of pegfilgrastim over filgrastim:

Answer 61

Longer acting (long serum half-life)

Question 62

Recombinant thrombopoeitins:

Answer 62

Romiplostim | Eltrombopag (better tolerated)

Question 63

Recombinant thrombopoetins are used in:

Answer 63

idiopathic thrombocytopenic purpura

Question 64

Clotting factors dependent on Vitamin K:

Answer 64

II, VII, IX, X

Question 65

vWF disease is treated by ____, a Factor ___ concentrate:

Answer 65

Humate P; VIII

Question 66

Classic hemophilia is a deficiency in Factor ___:

Answer 66

VIII

Question 67

Christmas or hemophilia B is a deficiency in Factor ___:

Answer 67

IX

Question 68

Inhibits plasminogen activation:

Answer 68

Aminocaproic acid (EACA)

Question 69

Orally administered analog of EACA:

Answer 69

Tranexamic acid