Iron Administration in Chronic Renal Failure

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Questions and Answers

Which administration of iron is typically utilized for patients with chronic renal failure?

Iron-sucrose intravenously (correct)

Iron chelators intragastrically

Ferrous fumarate orally

Ferrous sulfate orally

What is a potential effect of acute iron toxicity?

Nausea leading to appetite enhancement

Increased production of erythropoietin

Severe necrotising gastritis (correct)

Reduced absorption in the gastrointestinal tract

Which best describes the primary function of desferrioxamine?

Promote iron absorption in the gut

Increase folate levels in the bloodstream

Stimulate the production of red blood cells

Bind to iron to prevent its absorption (correct)

In which condition is it unlikely for patients to produce adequate erythropoietin?

Chronic renal disease Signup and view all the answers

What is one possible adverse reaction to parenteral iron administration?

Anaphylactic reactions Signup and view all the answers

Which condition is most associated with chronic iron toxicity?

Thalassaemias Signup and view all the answers

Which dietary source is considered rich in folate?

Liver and green vegetables Signup and view all the answers

What is a common symptom associated with oral iron administration?

Abdominal cramps Signup and view all the answers

What is the primary definition of anaemia?

A clinical condition with a decrease in red blood cells. Signup and view all the answers

Which of the following is NOT a type of anaemia mentioned?

Isolated thrombocytopenic anaemia Signup and view all the answers

Which symptom is associated with severe cases of anaemia?

Tachycardia Signup and view all the answers

What is the primary action of haematinic agents?

Promote the formation of red blood cells. Signup and view all the answers

Which nutrient is essential for the treatment of macrocytic anaemia?

Vitamin B12 Signup and view all the answers

What is the threshold hemoglobin level for diagnosing anaemia in women?

12 g/dL Signup and view all the answers

Which neurological symptom may indicate severe B12 deficiency-related anaemia?

Ataxia Signup and view all the answers

Which of the following is a commonly used haematinic agent?

Folic acid Signup and view all the answers

What is a indicated use of erythropoietin in clinical settings?

Anemia during chemotherapy for cancer Signup and view all the answers

Which condition must NOT be present before starting treatment with erythropoietin?

Iron deficiency Signup and view all the answers

What is a common adverse reaction associated with erythropoietin treatment?

Hypertension Signup and view all the answers

Granulocyte colony-stimulating factors are primarily used to manage which of the following conditions?

Neutropenia caused by cytotoxic drugs Signup and view all the answers

Which of these is NOT a genetic cause of hemolytic anemia?

Aplastic anemia Signup and view all the answers

What role do thromboietin and its agonists play in treatment?

Enhance platelet production Signup and view all the answers

Which of the following drugs is an oral agonist of thrombopoietin?

Eltrombopag Signup and view all the answers

Which statement regarding hydroxycarbamide is true?

It functions as a cytotoxic drug. Signup and view all the answers

What is the primary role of tetrahydrofolate (FH4) in the body?

DNA synthesis and amino acid metabolism Signup and view all the answers

Which condition is a common reason for the treatment of megaloblastic anemia with folic acid?

Poor dietary intake Signup and view all the answers

Why is vitamin B12 typically administered via injection?

It is poorly absorbed orally due to intrinsic factor requirements Signup and view all the answers

In what scenario is prophylactic administration of folic acid particularly important?

For pregnant women and those planning conception Signup and view all the answers

Which of the following statements regarding erythropoietin is NOT true?

It is always administered orally. Signup and view all the answers

What is a common adverse effect associated with erythropoietin therapy?

Influenza-like symptoms Signup and view all the answers

Which component is critical for the absorption of vitamin B12 in the body?

Intrinsic factor Signup and view all the answers

What distinguishes Darbepoetin from Epoetin in clinical use?

Longer half-life allowing for less frequent administration Signup and view all the answers

Study Notes

Anemia Treatment

Anemia is a clinical condition defined by a decrease in red blood cell (RBC) count, hemoglobin concentration, or hematocrit, which hinders oxygen transport to tissues.
Diagnosed when hemoglobin levels fall below 13 g/dL in men and 12 g/dL in women; these values vary based on population and lab standards.
Anemia symptoms are often nonspecific and stem from decreased oxygen delivery. Common symptoms include fatigue, weakness, dizziness, pallor, shortness of breath, tachycardia, palpitations, angina, headache, and difficulty concentrating. Neurological issues like paresthesias and ataxia can occur, particularly in B12 deficiency.

Pathophysiology of Anemia

Anemia's causes are multifaceted, with some genetic factors playing a role, and excessive bleeding, or menstrual bleeding, among other causes.
Types include hypochromic, microcytic; macrocytic; and normochromic, normocytic anemia.

Treatment of Anemia

Treatment strategy hinges on the underlying cause and severity of the condition.
Haematinic agents are substances promoting blood formation, typically by boosting red blood cell or hemoglobin production, iron, folic acid, and Vitamin B12 are examples.
Haematopoietic growth factors stimulate blood cell production, like erythropoietin to address anemia caused by deficiency, particularly in chronic kidney disease, AIDS, or cancer.
Treatment of hemolytic anemia targets the increased destruction of red blood cells. Strategies vary depending on the cause of hemolysis (e.g., genetic mutations, infections).

Haematinic agents (Iron)

Iron is usually administered orally, sometimes with Vitamin C to improve absorption.
Oral forms: ferrous sulfate, ferrous succinate, ferrous gluconate, ferrous fumarate
Parenteral forms: Iron-dextran, Iron-sucrose
Adverse reactions (ADR) to oral iron include nausea, abdominal cramps, and diarrhea. Parenteral iron can cause anaphylactic reactions and infections. Acute iron toxicity can lead to severe gastritis, hemorrhage, and circulatory collapse.
Iron metabolism: Iron absorption from the diet occurs in the gastrointestinal tract (GIT). Iron is stored as ferritin or haemosiderin in the liver.

Haematinic agents (Folic acid)

Important for DNA synthesis, amino acid metabolism, and nucleotide production.
Sources include liver and green vegetables.
Daily requirement is approximately 0.2 mg in healthy non-pregnant adults, increasing during pregnancy.
Administered orally and absorbed in the ileum.
Clinical uses include malabsorption syndromes, treatment/prevention of methotrexate toxicity, prophylaxis for pregnant women, before conception, and in premature infants.

Haematinic agents (Vitamin B12)

The therapeutic preparation is called Hydroxocobalamin.
Sources include meat, eggs, and dairy products.
Daily requirement is 2-3 µg.
Absorption depends on intrinsic factors secreted by gastric parietal cells.
Stored in the liver.
Functions include DNA synthesis, conversion of methyl-FH4 to FH4, and isomerization of methylmalonyl-CoA to succinyl-CoA.
Administered via injection, typically lifelong in patients with pernicious anemia, and weekly/biweekly in some cases.
Often given prophylactically, after abdominal surgery that impacts its production and/or absorption.

Haemopoietic growth factors

Erythropoietin is a glycoprotein stimulating erythroid progenitor cell proliferation for red blood cell generation. Uses include treating anemia due to deficiency (e.g., chronic kidney disease, AIDS).
Recombinant human erythropoietins (like epoetin and darbepoetin) are used. Darbepoetin has a longer half-life and can be administered less frequently.
Adverse reactions include influenza-like symptoms and hypertension.
Clinical uses for erythropoietin include anemia of chronic renal failure, anemia during cancer chemotherapy, and prevention of anemia in premature infants. Additionally, it can be used to increase the yield of autologous blood before donation and treating anemia in HIV patients exacerbated by zidovudin use.

Treatment of Haemolytic Anemia

Anemia linked with increased red blood cell destruction.
Genetic causes include sickle cell disease (mutations in the HBB gene affecting hemoglobin S production) and thalassemia.
Non-genetic causes encompass autoimmune disorders, infections, and adverse drug reactions.
Treatment is typically symptomatic. Analgesics for painful crises, supportive care like fluid balance and oxygen therapy, and blood transfusions are commonly employed. Antibiotics may be needed depending on the cause.
Drugs such as hydroxycarbamide (a cytotoxic drug) are used to lower red blood cell and platelet counts in conditions like polycythemia, chronic myeloid leukemia, or sickle cell disease.
Eculizumab, a monoclonal antibody, treats paroxysmal nocturnal hemoglobinuria (PNH).

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Description

This quiz assesses your knowledge of iron administration, particularly in patients with chronic renal failure. It covers topics such as iron toxicity, erythropoietin production, and dietary sources of folate. Test your understanding of these critical components of patient care and nutrition!