W1-14 Workshop Anemia and Antianemia Drugs
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Questions and Answers

What is the purpose of the fusion sessions?

  • To encourage practice-based learning (correct)
  • To provide live lectures on the workshop topics
  • To facilitate interaction with faculty
  • To test the attendees on their preparation

    • Why are the recordings of fusion sessions not posted?

  • To maintain exclusivity of the content
  • To encourage live interaction with faculty
  • Due to technical limitations
  • To encourage attendance and participation (correct)

    • What does RUSM aim to develop through these fusion sessions?

  • Critical thinking and analytical skills (correct)
  • Technical skills in handling online learning platforms
  • Research and publication skills
  • Practical clinical skills

    • What is the recommended action if attendees have questions about the content?

    <p>Contact faculty via email or office hours</p> Signup and view all the answers

    How many attempts are allowed for taking the quiz?

    <p>Three attempts</p> Signup and view all the answers

    What should attendees do after attending the live session?

    <p>Take the quiz again for a final attempt</p> Signup and view all the answers

    Which of the following is a characteristic of anemia of diminished erythropoiesis?

    <p>Reduced production of red blood cells in the bone marrow</p> Signup and view all the answers

    What is the main underlying cause of megaloblastic anemias?

    <p>Deficiency of vitamin B12 or folate</p> Signup and view all the answers

    What is the primary characteristic of acute posthemorrhagic anemia?

    <p>Increased production of new red blood cells to compensate for blood loss</p> Signup and view all the answers

    What does diagnosing anemia of diminished erythropoiesis involve?

    <p>CBC, PBS, and bone marrow aspirate/trephine</p> Signup and view all the answers

    What are the common symptoms of hemolytic anemias?

    <p>Fatigue, pallor, jaundice, and splenomegaly</p> Signup and view all the answers

    What is the main treatment for megaloblastic anemias?

    <p>Addressing nutritional deficiency through dietary changes and vitamin supplementation</p> Signup and view all the answers

    What type of anemia is characterized by a gradual and ongoing loss of blood over an extended period?

    <p>Chronic blood loss anemia</p> Signup and view all the answers

    What type of anemia is primarily associated with chronic gastrointestinal bleeding or chronic menstrual bleeding in women?

    <p>Chronic blood loss anemia</p> Signup and view all the answers

    Which type of hemolytic anemia is primarily caused by immune reactions or trauma to red blood cells?

    <p>Anemias with intravascular hemolysis</p> Signup and view all the answers

    What are the indices used in the 'iron panel' for diagnosing microcytic hypochromic anemias based on iron panel data?

    <p>'Ferritin, total iron binding capacity (TIBC), and transferrin saturation'</p> Signup and view all the answers

    What does acute blood loss lead to if the rate exceeds the body's ability to produce new red blood cells?

    <p>'Acute posthemorrhagic anemia'</p> Signup and view all the answers

    What does a deficiency of vitamin B12 or folate lead to in megaloblastic anemias?

    <p>'Disruption in DNA synthesis, inefficient cell division, and delayed maturation of erythroid cells'</p> Signup and view all the answers

    Which of the following anemias is characterized by increased RBC destruction and extravascular hemolysis?

    <p>Hereditary spherocytosis</p> Signup and view all the answers

    Which drug class is used for the treatment of anemia associated with vitamin B12 deficiency?

    <p>Vitamin B12 preparations</p> Signup and view all the answers

    Which of the following anemias is caused by a lack of intrinsic factor for vitamin B12 absorption?

    <p>Anemia due to acute blood loss</p> Signup and view all the answers

    Which anemia is associated with a deficiency in the enzyme glucose-6-phosphate dehydrogenase (G6PD)?

    <p>G6PD-deficiency anemia</p> Signup and view all the answers

    Which drug class is used for the treatment of anemia associated with folate deficiency?

    <p>Folic acid preparations</p> Signup and view all the answers

    Which type of antibody is involved in the warm antibody type of immune hemolytic anemia?

    <p>IgG</p> Signup and view all the answers

    Which clinical condition may lead to paroxysmal nocturnal hemoglobinuria (PNH)?

    <p>Bone marrow failure</p> Signup and view all the answers

    Which of the following is a feature of hereditary spherocytosis?

    <p>Splenomegaly</p> Signup and view all the answers

    Which enzyme deficiency leads to increased susceptibility to drug-induced hemolysis in G6PD-deficiency anemia?

    <p>$eta$-glucose-6-phosphate dehydrogenase</p> Signup and view all the answers

    What is the mechanism of anemia induced by P. falciparum?

    <p>Extravascular hemolysis and diminished erythropoiesis</p> Signup and view all the answers

    What is the characteristic feature of RBCs in severe cases of P. falciparum-induced anemia?

    <p>Nucleated RBCs and small size</p> Signup and view all the answers

    Which type of anemia is characterized by small RBCs without central pallor and increased MCHC?

    <p>Hereditary spherocytosis</p> Signup and view all the answers

    What is the primary effect of P. vivax on RBCs in contrast to P. falciparum?

    <p>Affects only young RBCs leading to less severe anemia</p> Signup and view all the answers

    What are the consequences of the release of IFN-γ and TNF-⍺ in P. falciparum-induced anemia?

    <p>Inhibition of erythropoietin response and spleen enlargement</p> Signup and view all the answers

    What is the distinguishing feature in the peripheral blood smear (PBS) of patients with hereditary spherocytosis?

    <p>Small RBCs without central pallor (spherocytes)</p> Signup and view all the answers

    Which enzyme deficiency leads to increased susceptibility to drug-induced hemolysis in G6PD-deficiency anemia?

    <p>Glutathione reductase deficiency</p> Signup and view all the answers

    What type of anemia is primarily associated with chronic gastrointestinal bleeding or chronic menstrual bleeding in women?

    <p>Iron-deficiency anemia</p> Signup and view all the answers

    What does diagnosing anemia of diminished erythropoiesis involve?

    <p>Assessing the number of reticulocytes in the blood</p> Signup and view all the answers

    Which drug class is used for the treatment of anemia associated with vitamin B12 deficiency?

    <p>Vitamin B12 Preparations</p> Signup and view all the answers

    What is the primary characteristic of acute posthemorrhagic anemia?

    <p>Increased reticulocyte count</p> Signup and view all the answers

    What are the indices used in the 'iron panel' for diagnosing microcytic hypochromic anemias based on iron panel data?

    <p>Ferritin and total iron binding capacity (TIBC)</p> Signup and view all the answers

    Which clinical condition may lead to paroxysmal nocturnal hemoglobinuria (PNH)?

    <p>$Aplastic anemia</p> Signup and view all the answers

    What is the main underlying cause of megaloblastic anemias?

    <p>$Deficiency of vitamin B12 or folic acid</p> Signup and view all the answers

    What does acute blood loss lead to if the rate exceeds the body's ability to produce new red blood cells?

    <p>$Acute posthemorrhagic anemia</p> Signup and view all the answers

    Which type of antibody is involved in the warm antibody type of immune hemolytic anemia?

    <p>$IgG antibodies</p> Signup and view all the answers

    What type of hemolytic anemia is primarily caused by immune reactions or trauma to red blood cells?

    <p>$Autoimmune hemolytic anemia</p> Signup and view all the answers

    What type of anemia is characterized by a gradual and ongoing loss of blood over an extended period?

    <p>$Posthemorrhagic anemia</p> Signup and view all the answers

    Which drug is the preferred treatment for chronic iron overload in the absence of anemia?

    <p>Deferasirox</p> Signup and view all the answers

    What is the mechanism of action of Deferoxamine?

    <p>Binds to Fe3+ (ferric) ions to form a complex, which is then excreted in urine</p> Signup and view all the answers

    What is the most common adverse effect of Deferasirox?

    <p>Acute renal failure, hepatic failure and gastrointestinal hemorrhage</p> Signup and view all the answers

    What is the primary clinical use of folic acid?

    <p>Supplementation to prevent neural tube defects</p> Signup and view all the answers

    Which route of administration is NOT recommended for synthetic forms of vitamin B12 due to poor absorption?

    <p>Oral</p> Signup and view all the answers

    What is the adverse effect associated with oral iron preparations in most cases?

    <p>Constipation, dark stools, nausea</p> Signup and view all the answers

    Which medication can reduce iron absorption when taken with iron supplements?

    <p>Medications which reduce gastric acid</p> Signup and view all the answers

    What is the route of administration for Deferasirox?

    <p>Oral</p> Signup and view all the answers

    Which condition may lead to paroxysmal nocturnal hemoglobinuria (PNH)?

    <p>Excess iron deposited in the heart, liver, pancreas</p> Signup and view all the answers

    What is the primary clinical use of Deferoxamine?

    <p>Treatment of acute iron toxicity</p> Signup and view all the answers

    What is the adverse effect associated with Deferoxamine?

    <p>Brown discoloration of skin by IM injection</p> Signup and view all the answers

    Which medication is used for the treatment of acute iron overload and chronic iron overload?

    <p>Deferoxamine</p> Signup and view all the answers

    Which of the following is a characteristic feature of paroxysmal nocturnal hemoglobinuria (PNH)?

    <p>Deficiency in CD55 and CD59 on RBCs</p> Signup and view all the answers

    What is the gold standard test for diagnosing paroxysmal nocturnal hemoglobinuria (PNH)?

    <p>Acidified serum (Ham) test</p> Signup and view all the answers

    What percentage of GPI-AP-deficient (PNH) cells is considered indicative of paroxysmal nocturnal hemoglobinuria?

    <p>50%</p> Signup and view all the answers

    What is a common clinical manifestation of paroxysmal nocturnal hemoglobinuria (PNH) during sleep?

    <p>Respiratory acidosis</p> Signup and view all the answers

    Which test is carried out on both RBCs and granulocytes for diagnosing paroxysmal nocturnal hemoglobinuria (PNH)?

    <p>Flow cytometry</p> Signup and view all the answers

    What is the characteristic feature of red blood cells (RBCs) from a patient with paroxysmal nocturnal hemoglobinuria (PNH) as seen in flow cytometry?

    <p>Deficiency in both CD55 and CD59</p> Signup and view all the answers

    What are the serum tests commonly used to detect intravascular hemolysis in paroxysmal nocturnal hemoglobinuria (PNH)?

    <p>Unconjugated hyperbilirubinemia, low haptoglobin, and elevated LDH</p> Signup and view all the answers

    What are the complications associated with paroxysmal nocturnal hemoglobinuria (PNH)?

    <p>Iron overload and venous thrombosis</p> Signup and view all the answers

    What kind of anemia is characterized by fragmented RBCs (schistocytes) in the peripheral blood smear?

    <p>Paroxysmal nocturnal hemoglobinuria (PNH)</p> Signup and view all the answers

    What is the primary cause of episodic (paroxysmal) hemolysis in paroxysmal nocturnal hemoglobinuria (PNH)?

    <p>Complement activation due to respiratory alkalosis during sleep</p> Signup and view all the answers

    Which type of antibody is involved in the warm antibody type of immune hemolytic anemia?

    <p>IgG antibodies</p> Signup and view all the answers

    What is the classification based on the mechanism of intravascular hemolysis characterized by turbulent blood flow and pressure gradient across damaged valves?

    <p>Macroangiopathic hemolysis</p> Signup and view all the answers

    What is the mechanism of action of Epoetin alfa and Darbepoetin alfa?

    <p>Stimulation of erythropoiesis by interacting with erythropoietin receptors</p> Signup and view all the answers

    Which iron preparation can be administered both intramuscularly (IM) and intravenously (IV)?

    <p>Iron Dextran</p> Signup and view all the answers

    What is Deferasirox used for in managing persons who present with acute iron overload?

    <p>Chelating excess iron</p> Signup and view all the answers

    Which drug may be used to manage persons who have vitamin B12 deficiency?

    <p>Cyanocobalamin</p> Signup and view all the answers

    What condition may occur if someone has folic acid deficiency?

    <p>Megaloblastic anemia</p> Signup and view all the answers

    Which type of anemia may best be treated with ferrous sulphate compounds in persons with anemia due to chemotherapy or due to zidovudine used for management of HIV?

    <p>Microcytic anemia</p> Signup and view all the answers

    What are the characteristics of megaloblastic anemias?

    <p>Increased red blood cell size and decreased hemoglobin content</p> Signup and view all the answers

    Which enzyme is deficient in glucose-6-phosphate dehydrogenase (G6PD)-deficiency anemia?

    <p>Glucose-6-phosphate dehydrogenase</p> Signup and view all the answers

    What type of antibody is involved in the warm antibody type of immune hemolytic anemia?

    <p>IgG</p> Signup and view all the answers

    What is the main underlying cause of megaloblastic anemias?

    <p>Deficiency of intrinsic factor for vitamin B12 absorption</p> Signup and view all the answers

    What is the classification for RBCs with MCV > 100 fL?

    <p>Macrocytic anemia</p> Signup and view all the answers

    Which deficiency leads to atrophic glossitis and subacute combined degeneration of the spinal cord?

    <p>Vitamin B12 deficiency</p> Signup and view all the answers

    What is the cause for vitamin B12 deficiency?

    <p>All of the above</p> Signup and view all the answers

    Which clinical findings are unique to pernicious anemia (PA)?

    <p>All of the above</p> Signup and view all the answers

    What are the labs findings in folate deficiency?

    <p>Reduced folate level in folate assay</p> Signup and view all the answers

    What is the underlying condition for vitamin B12 deficiency in adults over 40 years?

    <p>Chronic autoimmune atrophic gastritis with impaired production of intrinsic factor (IF)</p> Signup and view all the answers

    Which type of anemia is characterized by pancytopenia due to apoptosis of hematopoietic cells in the BM?

    <p>Megaloblastic anemia</p> Signup and view all the answers

    What is the biochemical function of cobalamin and folate?

    <p>Coenzymes in thymidine synthesis</p> Signup and view all the answers

    '5-methyl-THF' donates its methyl group to homocysteine to form what molecule?

    <p>Methionine</p> Signup and view all the answers

    Study Notes

    • Fusion sessions are online learning activities followed by a live session for translating content into practice.
    • To participate in a fusion session, complete learning content on Canvas before attending the live session.
    • Recordings of fusion sessions will not be posted; prepare accordingly to fully participate.
    • Anemia of diminished erythropoiesis:
      • Characterized by reduced production of red blood cells in bone marrow.
      • May manifest in different forms, such as iron-deficiency anemia, anemia of inflammation, megaloblastic anemia, etc.
      • Diagnosis involves comprehensive medical evaluation, including CBC, PBS, and bone marrow aspirate/trephine.
      • Treatment strategy depends on identifying underlying cause.
    • Hemolytic anemias:
      • Accelerated destruction of red blood cells leads to decreased number of circulating red blood cells, hemoglobin, and hematocrit.
      • Can be categorized into anemias with extravascular hemolysis (genetic mutations) and anemias with intravascular hemolysis (immune reactions or trauma).
      • Common symptoms include fatigue, pallor, jaundice, and splenomegaly.
    • Megaloblastic anemias:
      • Characterized by abnormally large red blood cells and erythroid precursors in bone marrow.
      • Main underlying cause is deficiency in vitamin B12 (cobalamin) or folate (folic acid), leading to disruption in DNA synthesis.
      • Diagnosis involves blood tests revealing presence of macrocytes, megaloblasts, and specific deficiencies.
      • Treatment typically involves addressing nutritional deficiency through dietary changes and vitamin supplementation.
    • Acute blood loss:
      • Occurs due to trauma, surgery, gastrointestinal bleeding, pathologic delivery, etc.
      • Body attempts to compensate by increasing production of new red blood cells.
      • If rate of blood loss exceeds body's ability to produce new red blood cells, acute posthemorrhagic anemia develops.
      • Treatment may involve immediate measures to stop bleeding and blood transfusions.
    • Chronic blood loss anemia:
      • Characterized by gradual and ongoing loss of blood, primarily associated with chronic gastrointestinal bleeding or chronic menstrual bleeding in women.
      • Diagnosis requires iron studies.
      • Management involves identifying and treating source of blood loss and supplementing with iron to replenish iron stores.
    • Learning objectives:
      • Compare and contrast aplastic anemia and pure red cell aplasia.
      • Explain etiology, pathogenesis, laboratory diagnosis, and clinical features of various anemias, including myelophthisic anemia and anemia of chronic kidney disease.
      • Explain etiology, pathogenesis, laboratory diagnosis, and clinical features of iron-deficiency anemia and anemia due to inflammation.
      • Explain etiology, pathogenesis, laboratory diagnosis, and clinical features of various hemolytic anemias, including Hereditary spherocytosis, G6PD-deficiency anemia, immune hemolytic anemias, anemia in malaria, Paroxysmal nocturnal hemoglobinuria, and hemolytic anemia resulting from trauma to RBCs.
      • Compare and contrast B12- and folate-deficiency megaloblastic anemias.
    • Antianemia drug classes:
      • Iron preparations: Ferrous sulfate, ferrous gluconate, ferrous fumarate, etc.
      • Iron antidotes: Desferoxamine mesylate, deferasirox, etc.
      • Vitamin B12 preparations: Hydroxocobalamin, cyanocobalamin, etc.
      • Folic acid preparations: Leucovorin, folic acid, etc.
      • Erythropoiesis-stimulating agents: Epoetin alfa, darbepoetin alfa, etc.
    • Molecular mechanism of action, pharmacological effects, important pharmacokinetic properties, adverse effects, contraindications, and therapeutic uses for each antianemia drug class.

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    Description

    This workshop is part of the Fusion Session for January 2024. It focuses on learning about anemia and antianemia drugs, with a practical live session to follow. Attendance and preparation are crucial as recordings of the session will not be available.

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