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Flashcards in Hematologic Deck (55):
1

the bone marrow of a healthy fetus produces _________ of cells every day

Billions

2

What is the challenge of the bone marrow in a fetus vs. an adult?

The marrow must produce enough cells to maintain a stable cell number per body mass as the infant grows

3

Preterm birth is a/w additional hematologic stressors which can result in _______ or __________

Anemia
Neutropenia

4

What is Erythropoetin?

Glycoprotein that regulates erythrocyte production (RBC's).

5

What is the pathway of erythropoetin synthesis in the fetus/NB?

Yolk sac-->Liver-->Kidneys

6

Where is Epo production much of fetal life?

Liver

7

When does Epo production change to the kidneys?

Around time of birth

8

Epo maintains RBC production by inhibiting ______ of erythroid progenitors and stimulating their _________ & ________ into normoblasts

Apoptosis
Proliferation & Differentiation

9

Does EPO cross the placenta?

No, Fetus produces their own

10

To maintain the increase in RBC volume a/w fetal growth, it is estimated ______ erythrocytes/day must be produced

50 x 10 to the 9th power

11

Erythropoetin production is stimulated by ________ induceable Factor __ & __, and regulated by ______ requirements for oxygenation

Hypoxia
Factor 1 & 2
Tissue requirements

12

In healthy, term infants, serum erythropoetin concentrations reach Nadir between ___-___wks.

By ___-___ wks, they reach adult concentrations.

4-6 wks


10-12 wks

13

In preterm infants, the fallen erythropoetin is more _______ and lasts ______--->what?

profound
longer
Anemia of prematurity

14

What does rEPO stand for?

Recombinant EPO (the med)

15

What medication is widely used to treat or prevent Anemia due to a variety of causes including Renal failure and prematurity?

rEPO

16

Name the 4 clinical trials w/EPO currently under way

1. Anemia of prematurity
2. Anemia from Rh-hemolytic Dz
3. Anemia of BPD
4. CHD

17

Name the other medication that is an erytrhopoesis stimulating protein.
Advantages?
Disadvantages?

-Aranesp
-Single 1x/wk injection
-Well-studied (in adults)
-Very few studies in preterm or term babies re: Pharmacokinetics, efficacy, risks/benefits of use

18

What other med must be given w/EPO?

Iron

19

Neonates require ______ dosing of rEPO/kg and more _______ dosing to achieve an equivalent hematopoetic repsonse r/t...?

Higher
Frequent
Increased plasma clearance, high vol. of distribution, short fractional elimination time

20

Garcia et. al showed that for doses at _____ u/kg/wk rEPO, the average # tranfusions per pt decreased by 3/4 of a transfusion.

500 u/kg/wk

21

What lab level may be helpful in assessing Fe stores?

Ferritin

22

What are the adverse effects of rEPO in adults?

Hypertension, thrombus formation, polycythemia, red cell aplasia

23

Early, high-dose rEPO may have a _______ effect on the retina by ameliorating the first stage of ROP .

Protective effect

--but one study suggested an increased risk of ROP in pts started on early high-dose rEPO and Iron.

24

In 2008, the FDA put out a warning for pts getting rEPO at higher than recommended doses w/what Dz?
What were the effects?

Chronic Kidney Failure
Increased risk blood clots, stroke, death

25

In preterm infants, rEPO for treatment of Anemia has been very ____ with ____ adverse side effects of adults.

Safe
none

26

What is a potential side effect of EPO?

an effect on Iron balance

27

Preterm babies are at risk for Iron deficiency r/t ...?

Bulk of Iron transfer is during 3rd trimester

28

Iron is required for normal ______ & _______

growth and development

29

Iron deficiency can lead to?

Adverse Neurodevelopmental consequences: Deficits in executive function & memory

30

T/F: Administration of Iron in the 1st 2 weeks of life is NOT advised d/t potential oxidative effects in the face of deficient anti-oxidant mechanisms.

True

31

The actual side-effects of rEPO are what we are __________ to see-including:

Hoping
Increasing Erythropoesis
Possible Megakaryocytopoesis

32

What is a nutritional source of highly bio-available Iron?

Breastmilk

33

Iron is a required mineral in transfer of _____from the lungs to the tissues for storage for use during muscle contraction.

Oxygen

34

Iron contained in cow's milk is less well ___________.

Absorbed-a reason it is not recommended until 1 yr/life

35

Iron is found as _____ iron in animal-based foods (meats). This is the most ____-______ form vs. plant-based (grains, fruits, vegetables)

Heme iron

Bio-available

36

Preterm formulas only provide ___ mg/kg/day iron. Supplemental iron is required

1.8 mg/kg/kday

37

____ overdose is the most common cause of poisoning death in children

Iron
6 y/o

38

Endogenous Iron stores are used up by ___ months of age.

6 months

39

Preterm, LBW, & breastfeeding: Iron supplement via gtts at ____ mg/kg/day. Start __-__ wks/age until 12 months.

2 mg/kg/day

2-4 wks/age

40

Healthy, term breastfeeding babys: supplement w/___ mg/kg/day iron.
Starting at __-__ months add iron from complimentary foods.

1 mg/kg/day

4-6 months

41

Infants < 12 months should be given only ___ fortified formulas.

Iron-fortified

42

What other possible effects might EPO have?

Neuroprotection
Protection of other organs: Heart, Kidneys

43

Fer-in-sol supplement provides more/less iron per dose than multi-vitamin product?

More~25 mg/mL vs. 10 mg/mL

44

Studies show children Anemic in early childhood continue to have _____ ________ & motor development and depressed school achievement into middle childhood.

Poor Cognitive

45

What does G-CSF stand for?

Granulocyte Colony Stimulating Factor

46

G-CSF is a physiologic _______ of ______production and function.

Regulator of Neutrophil

47

G-CSF has multiple effects on what type of cell's maturation and function?

WBC

48

How does G-CSF enhance Neutrophil functions?

Chemotaxis
Phagocytosis
Superoxide Production
Bacteriocidal activity

49

Administration of G-CSF has long been used to prevent _______ in pts w/non-myeloid malignancies receiving Anti-CA drugs and suffering Febrile Neutropenia.
It is also used to supplement _________after bone marrow transplant.

Infection



Recovery

50

Name the 5 G-CSF clinical trials in process

1. Infants w/bacterial sepsis
2. Infants whose mothers had PIH
3. Alloimmune Neutropenia
4. Autoimmune Neutropenia
5. Chronic Idiopathic Neutropenia

51

What are the 3 adverse effects (rare) of G-CSF?

1. Thrombocytopenia
2. Osteoporosis
3. Contrandicated w/known hpersensitivity to e-coli derived proteins or any components of the product.

52

What is rGM-CSF?

Recombinant Granulocyte Macrophage Colony Stimulating Factor

53

What does rGM-CSF do?

Increases Neutrophil counts and may decrease mortality due to sepsis when used prophylactically.
--Significant increase in ANC w/in 48 hrs of administration.

54

Name the 2 clinical trials w/rGM-CSF?

1. Neonatal sepsis
2.Prophylaxis against Nosocomial Infections

55

What adverse effects are there w/rGM-CSF?
What is needed?

No serious adverse effects reported

Long-term studies needed.