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Flashcards in Pharm 12-Anemia Deck (46):
1

Anemia

Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues.

2

What's required to produce RBCs?

kidney, bone marrow, iron, protein

3

Process which produces red blood cells

erythropoiesis

4

Describe the process of erythropoiesis.

1. Kidney senses hypoxia (anemia) and increases endogenous erythropoietin production
2. Erythropoietin acts on E-progenitor cells in bone marrow to produce new RBCs
3. Kidney sense increased tissue oxygenation
4. Kidney decreases erythropoietin production

5

What's the life of a normal RBC?

100 days

6

What percent of your blood do you lose every day?

1%

7

Clinical Vampirism

HCT lowered; bone marrow hasn't responded

8

What are some reasons that our patients will be anemic?

Renal failure, clinical vampirism, trauma, cancer, pregnant, "little old ladies"

9

How do perfusionists cause anemia?

Dilutional anemia, hemolysis, stupid perfusion practices

10

What can you do to combat anemia?

Start mannitol drip, but not much you can do as a perfusionist

11

What patients only want their own blood in their vasculature?

Jehovah's Witness

12

What are the 4 anemia therapeutics?

1. Iron
2. B12
3. Folic Acid (B9)
4. Erythropoietin

13

What is required for the hemoglobin molecule to carry O2?

Iron

14

Where is iron stored?

Intestinal mucosal cells, liver, spleen, and bone marrow as ferritin

15

What causes iron deficiency?

Inadequate iron stores and/or intake

16

What's a disadvantage of iron injections?

Extremely painful

17

What's a disadvantage of oral iron supplements?

GI upset

18

What does iron deficiency anemia classically cause?

Hypochromic, microcytic anemia; improper red blood cell production

19

Microcytic

smaller cell than normal

20

Hypochromic

Hypochromic anemia is a generic term for any type of anemia in which the red blood cells (erythrocytes) are paler than normal.

21

What are some causes of folic acid deficiency?

Pregnancy, lactation, intestinal pathology (Crohn's Disease) preventing absorption, alcoholism, certain drugs

22

What is required for DNA synthesis?

Folate

23

What is the rate limiting step for the formation of RBCs?

Ability to engage in DNA synthesis (not erythropoietin kicking in the bone marrow)

24

What does folate deficiency classically cause?

Megaloblastic anemia

25

Megaloblastic anemia

RBCs larger than normal

26

What is the most common cause of B12 deficiency?

Poor B12 absorption

27

What is the anemia caused by B12 deficiency called?

Pernicious anemia
Megaloblastic anemia

28

Pernicious anemia

Pernicious anemia is a decrease in red blood cells that occurs when your intestines cannot properly absorb vitamin B12

29

How is anemia from B12 deficiency treated?

B12 injections
Folic acid (b/c of megaloblastic anemia)

30

What are some erythropoetin drugs?

Epogen, Procrit

31

Epogen and Procrit are both synthetic forms of what?

Erythropoetin-alfa; both have identical protein structure and vary in their glycosylation

32

What is the "albumin-free" erythropoetin?

Darbepoetin (Aranesp)

33

Why would an "albumin-free" erythropoietin drug be important?

Some people have rxns to albumin
Jehovah's witness won't take anything that has albumin in it; used as part of a comprehensive blood conservation/blood management program

34

How long does it take for Darbepoetin (Aranesp) to kick in?

Week (s); so it's not appropriate for acute blood loss

35

What is Darbepoetin (Aranesp) usually giving with?

Iron; required for the hemoglobin molecule to carry oxygen

36

Why does erythropoetin have a high potential for abuse?

Athletic ability

37

What are some side effects of erythropoietin?

Stroke
Increased tumor risk
Thromboembolic events (DVT, etc)
Severe HTN
Death

38

What are the sickle cell drugs?

Hydroxyurea (Hydrea, Droxia)
Pentoxifylline (Trental)

39

Hydroxyurea (Hydrea, Droxia)

Failure effective in preventing painful, acute criss associated with sickling claudication

Causes sickle cell hemoglobin (HbS) to get diluted by an increased production of fetal Hgb (HbF) particularly when used with epo-alfa

40

How soon before surgery would you start Hydroxyurea (Hydrea, Droxia)?

A couple months before surgery

41

How does Hydroxyurea (hydrea, droxia) work?

Works by changing Hgb that bone marrow produces

42

Claudication

a condition in which cramping pain in the leg is induced by exercise, typically caused by obstruction of the arteries.

43

Pentoxifylline (Trental)

Rheologic modifier
Increases the flexibility of RBCs so they are less likely to clog capillaries
Decreases blood viscosity

44

Future possibilities for use of Pentoxylline (trental)

TIA
Strokes
Raynaud's
Diabetic ulcers

45

Pica

a symptom of iron deficiency anemia; hunger or ice, dirt, paper, etc.

46

Koilonychias

a symptom of iron deficiency anemia; upward curvature of the finger and toe nails