Anemia Overview and Treatment

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Questions and Answers

What must accompany folic acid treatment for megaloblastic anemia?

Calcium

Vitamin C

Iron supplementation

Vitamin B12 (correct)

What is the primary role of erythropoietin (EPO) in the body?

Increase white blood cell counts

Stimulate red blood cell proliferation (correct)

Enhance iron absorption

Regulate blood pressure

What is the primary purpose of myeloid growth factors such as Filgrastim and Pegfilgrastim?

To treat anemia by increasing red blood cell production

To enhance platelet production during chemotherapy

To reduce blood viscosity in sickle cell disease

To stimulate granulocyte production and increase neutrophil counts (correct)

Which of the following is true regarding the dosing of myeloid growth factors?

Dosing frequency varies among different agents, with no evidence of superiority Signup and view all the answers

Which of the following is NOT a condition treated by recombinant human erythropoietin (epoetin alfa)?

Anemia associated with liver disease Signup and view all the answers

What is a common adverse effect associated with agents used to treat neutropenia?

Bone pain Signup and view all the answers

What is a known side effect of erythropoietin and darbepoetin therapy?

Elevation in blood pressure Signup and view all the answers

Why should hemoglobin levels not rise more than 1 g/dL over a 2-week period during treatment?

To prevent cardiovascular events Signup and view all the answers

Which agent is specifically classified as a granulocyte-macrophage colony-stimulating factor (GM-CSF)?

Sargramostim Signup and view all the answers

What effect do myeloid growth factors have on neutrophil counts?

They increase neutrophil counts and reduce the duration of severe neutropenia Signup and view all the answers

What is the main difference between epoetin alfa and darbepoetin?

Darbepoetin is long-acting with decreased clearance Signup and view all the answers

What is the role of myeloid growth factors after chemotherapy and bone marrow transplantation?

To reduce the risk of developing neutropenia Signup and view all the answers

Which of the following treatment recommendations is advised for patients receiving epoetin alfa or darbepoetin?

Reduce doses if hemoglobin exceeds 10 g/dL Signup and view all the answers

What is the effect of hypoxia on the production of erythropoietin?

It stimulates EPO production Signup and view all the answers

Which of the following statements about the efficacy of different myeloid growth factor agents is correct?

There is no evidence showing superiority of one agent over others Signup and view all the answers

During what scenario are agents used to treat neutropenia most commonly administered?

Prophylactically following chemotherapy and bone marrow transplantation Signup and view all the answers

What is the primary role of transferrin in the body?

Delivering iron to the bone marrow for hemoglobin production Signup and view all the answers

Which type of anemia is caused specifically by iron deficiency?

Hypochromic microcytic anemia Signup and view all the answers

What is a common sign or symptom of anemia?

Insomnia Signup and view all the answers

Which vitamin is specifically mentioned as a treatment for anemia?

Vitamin B12 (Cyanocobalamin) Signup and view all the answers

What daily dosage of elemental iron is recommended for treating iron deficiency anemia?

150 to 180 mg/day Signup and view all the answers

What condition can result from iron deficiency that involves unusual cravings?

Pica Signup and view all the answers

In which part of the body is iron primarily absorbed after oral administration?

Duodenum Signup and view all the answers

Which of the following can cause iron deficiency due to increased demand?

Insufficient intake during pregnancy Signup and view all the answers

Study Notes

Anemia Overview

Anemia is a reduction in hemoglobin or red blood cell count.
Physiologically, anemia is any disorder causing tissue hypoxia due to decreased blood oxygen-carrying capacity.
Common symptoms include fatigue, rapid heartbeat, shortness of breath, pale skin, dizziness, and insomnia.
Causes of anemia include chronic blood loss, bone marrow abnormalities, increased hemolysis, infections, malignancy, endocrine deficiencies, renal failure, drug toxicity, dietary deficiencies (iron, folic acid, vitamin B12), and genetic conditions (sickle cell disease).

Drugs for Anemia

Agents used to treat anemias: Iron, Vitamin B12 (cyanocobalamin), folic acid, and erythropoietin.

Iron

Iron is stored in mucosal cells, liver, spleen, and bone marrow as ferritin (iron-protein complex).
Iron is transported to the marrow for hemoglobin production by the transport protein transferrin.
Iron deficiency can result from acute or chronic blood loss, insufficient intake (especially during growth spurts in children and pregnancy), or heavy menstruation.
Iron deficiency causes hypochromic microcytic anemia (small, pale red blood cells).
Symptoms of iron deficiency anemia may include pica (craving for non-nutritive substances), koilonychias (spoon-shaped nails), and soreness/cracking at the corners of the mouth.
Treatment: 150-180 mg of oral elemental iron daily, divided into two to three doses.
Iron absorption: Absorption occurs in the stomach (acidic conditions keep iron in the reduced ferrous form, which is more soluble), then the duodenum. Absorption depends on body iron stores - if stores are adequate, less iron will be absorbed; if low, more iron will be absorbed.
Lower doses are usually recommended.
Oral iron preparations include ferrous sulfate, ferrous fumarate, ferrous gluconate, and polysaccharide-iron complex/carbonyl iron formulations.
Parenteral iron formulations (iron dextran, sodium ferric gluconate, iron sucrose) are also available, and they are absorbed more rapidly than oral preparations.
Adverse effects of iron supplementation include gastrointestinal disturbances (abdominal pain, constipation, diarrhea) and dark stools.
Caution to patients with hypersensitivity to iron, especially iron dextran. Test dose should be administered prior to iron dextran.

Folic Acid (Folate)

Folic acid is used to treat folate deficiency states.
Causes of folate deficiency include high demand (pregnancy, lactation), poor absorption (intestinal pathology), alcoholism, and certain medications (dihydrofolate reductase inhibitors like methotrexate).
Folic acid deficiency leads to megaloblastic anemia (large, immature red blood cells).
Absorption occurs in the jejunum.
Excessive folic acid intake is excreted in urine and feces; oral folic acid is non-toxic.

Vitamin B12 (Cyanocobalamin)

Vitamin B12 deficiency can result from low dietary intake, poor absorption (due to the failure of gastric parietal cells to produce intrinsic factor, leading to pernicious anemia), or loss of receptor activity for intestinal uptake.
Conditions like gastric resection can also result in Vitamin B12 deficiency
Symptoms of B12 deficiency anemia include tingling in hands and feet, difficulty walking, dementia, hallucinations, paranoia, and even schizophrenia.
The vitamin can be given orally, via sublingual tablets, intramuscularly, or deep subcutaneously (especially for pernicious anemia).
Important to note: Administering folic acid alone for megaloblastic anemia can mask Vitamin B12 deficiency and lead to neurological damage. Treatment must consider the cause for a specific treatment, and typically requires continued lifelong therapy for pernicious anemia.

Erythropoietin and Darbepoetin

Kidneys produce EPO, which stimulates red blood cell production.
EPO effectively treats anemia caused by end-stage renal disease, HIV infection, bone marrow disorders, prematurity, and some cancers.
Darbepoetin is a long-acting form of EPO, with a longer half-life.
Side effects include increased risk of cardiovascular events (thrombosis, hypertension, increased death risk) when high hemoglobin levels are targeted.
Dosages should be carefully monitored.

Agents to treat Neutropenia:

Myeloid growth factors or granulocyte colony-stimulating factors (G-CSF): Filgrastim, Tbo-filgrastim, and Pegfilgrastim
Granulocyte-macrophage colony-stimulating factors (GM-CSF): Sargramostim These primarily stimulate granulocyte production in bone marrow to increase neutrophil counts and improve the duration of severe neutropenia.

Hydroxyurea

Often used to treat sickle cell anemia.
Action: Increases fetal hemoglobin, which reduces the presence of abnormal hemoglobin S.
Side effects: Bone marrow suppression, and cutaneous vasculitis.

Pentoxifylline

Methylxanthine derivative
Increases red blood cell deformability (flexibility) and reduces viscosity.
This decreases total systemic vascular resistance, improves blood flow, and enhances tissue oxygenation, particularly useful for peripheral vascular disease.
Primarily indicated to treat intermittent claudication. It may be used in other disorders like diabetic angiopathies, transient ischemic attacks, sickle cell anemias, and Raynaud's phenomenon.

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Description

This quiz covers the essentials of anemia, including its causes, symptoms, and the physiological impact on the body. It also highlights the drugs used for treating anemia, particularly the role of iron and vitamins in hemoglobin production. Test your knowledge on this important health topic!