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Oncology
Anemias
| Question | Answer |
|---|---|
| The process by which pluripotent stem cells give rise to all formed elements of blood through regulated growth factor signaling | Hematopoiesis |
| Abnormally low number of neutrophils | Neutropenia |
| Qualitative or quantitative deficiency of hemoglobin | Anemia |
| Relatively few platelets | Thrombocytopenia |
| Act early in hematopoiesis and influence multiple blood cell lineages at once. | Pluripotent |
| Act on hematopoietic stem cells (HSCs) or early progenitors | Pluripotent |
| Promote survival, self‑renewal, and initial proliferation | Pluripotent |
| Support the development of several downstream lineages | Pluripotent |
| Act on committed progenitor cells | Lineage‑Specific |
| Act later in hematopoiesis and push cells toward a single, specific mature lineage. | Lineage‑Specific |
| Act on committed progenitor cells | Lineage‑Specific |
| Cause proliferation, maturation, and functional activation | Lineage‑Specific |
| Full human‑like glycosylation needed for stability, half‑life, receptor binding | Mammalian Cells (CHO) |
| EPO | Mammalian Cells (CHO) |
| darbepoetin | Mammalian Cells (CHO) |
| romiplostim | Mammalian Cells (CHO) |
| monoclonal antibodies | Mammalian Cells (CHO) |
| Can add limited glycosylation | Yeast |
| IL‑11 | Yeast |
| Sargramostim (GM‑CSF) | Yeast |
| Fast, cheap; BUT cannot glycosylate proteins | Bacteria (E. coli) |
| Filgrastim (G‑CSF) | Bacteria (E. coli) |
| some IL‑11 forms | Bacteria (E. coli) |
| Female: Hgb < 12 g/dL or Hct < 36 % | Anemia |
| Male: Hgb < 13.5 g/dL or Hct < 41 % | Anemia |
| Benefits of PRBC transfusion | Rapid ↑ in hemoglobin and hematocrit levels |
| Benefits of PRBC transfusion | Possible survival benefit |
| Risks of PRBC transfusion | Transfusion-related reactions |
| Risks of PRBC transfusion | Congestive heart failure |
| Risks of PRBC transfusion | Bacterial contamination |
| Risks of PRBC transfusion | Viral infections |
| Risks of PRBC transfusion | Iron Overload |
| 1 unit of PRBCs usually raises the Hgb by ___ | 1 g/dL |
| 1 unit of PRBCs usually raises the hematocrit by ___ | 3% |
| An acute phase reactant | Serum ferritin |
| High serum ferritin + chronic inflammation then can diagnose based off only ___ | Transferrin sat (Tsat) |
| Blood loss within gastrointestinal tract | Increased iron requirements |
| Blood loss within genitourinary tract | Increased iron requirements |
| Blood donation | Increased iron requirements |
| Pregnancy and lactation | Increased iron requirements |
| Insufficient dietary iron | Inadequate iron supply |
| Impaired iron absorption | Inadequate iron supply |
| Gastric surgery | Inadequate iron supply |
| Intestinal malabsorption | Inadequate iron supply |
| Celiac disease | Inadequate iron supply |
| Ferrous Sulfate 325 mg tabs (Various) | 20% |
| Ferrous Sulfate 160 mg (Slow-Fe®) | 30% |
| Ferrous Gluconate 325 mg (Various) | 12% |
| Ferrous Fumarate 300 mg (Various) | 33% |
| Polysaccharide Iron Complex 50 mg tab (Niferex®) | 100% |
| Polysaccharide Iron Complex 150 mg tab (Hytinic®) | 100% |
| Ferric citrate (Auryxia) | 21% |
| Ferric maltol (Accufer) | 100% |
| Heme Iron Polypeptide | 100% |
| Ferrous Sulfate 325 mg tabs (Various) | 65 mg |
| Ferrous Sulfate 160 mg (Slow-Fe®) | 50 mg |
| Ferrous Gluconate 325 mg (Various) | 39 mg |
| Ferrous Fumarate 300 mg (Various) | 99 mg |
| Polysaccharide Iron Complex 50 mg tab (Niferex®) | 50 mg |
| Polysaccharide Iron Complex 150 mg tab (Hytinic®) | 150 mg |
| Ferric citrate (Auryxia) | 210 mg |
| Ferric maltol (Accufer) | 30 mg |
| Heme Iron Polypeptide | 11 mg |
| Ferrous Sulfate 325 mg tabs (Various) | acidic environment required |
| Ferrous Sulfate 160 mg (Slow-Fe®) | acidic environment required |
| Ferrous Gluconate 325 mg (Various) | acidic environment required |
| Ferrous Fumarate 300 mg (Various) | acidic environment required |
| Polysaccharide Iron Complex 50 mg tab (Niferex®) | acidic environment not required |
| Polysaccharide Iron Complex 150 mg tab (Hytinic®) | acidic environment not required |
| Ferric citrate (Auryxia) | acidic environment not required |
| Ferric maltol (Accufer) | acidic environment required |
| Heme Iron Polypeptide | acidic environment not required |
| Convenient dosage form | oral iron therapy advantage |
| Avoid anaphylaxis risk with IV iron | oral iron therapy advantage |
| Avoid risk of iron overload | oral iron therapy advantage |
| GI adverse effects > 50% patients at 200 mg/day | oral iron therapy disadvantage |
| Bioavailability related to GI acidity | oral iron therapy disadvantage |
| Adherence may be difficult with multiple doses | oral iron therapy disadvantage |
| Efficacy significantly reduced as GFR declines | oral iron therapy disadvantage |
| Drug-drug interactions are common | oral iron therapy disadvantage |
| Iron decreases absorption of | levothyroxine |
| Iron decreases absorption of | tetracycline antibiotics |
| Iron decreases absorption of | fluoroquinolone antibiotics |
| Iron absorption is reduced by | calcium |
| Iron absorption is reduced by | coffee and tea |
| Iron absorption is increased by | Vitamin C |
| Iron absorption is reduced by | H2 blockers |
| Iron absorption is reduced by | proton pump inhibitors |
| Iron absorption is reduced by | antacids |
| Used to determine cause of anemia | MCV |
| Significantly more effective than oral iron | parenteral iron therapy advantage |
| Avoid GI side effects with oral iron | parenteral iron therapy advantage |
| Avoid drug-drug interactions with oral iron | parenteral iron therapy advantage |
| Adherence can be documented | parenteral iron therapy advantage |
| Inconvenient dosage form | parenteral iron therapy disadvantage |
| Increased risk of infusion reactions | parenteral iron therapy disadvantage |
| Increased risk of iron overload | parenteral iron therapy disadvantage |
| Preferred IDA therapy for patient that had gastric bypass surgery | parenteral iron therapy |
| Preferred IDA therapy for patient that had tnflammatory bowel disease | parenteral iron therapy |
| IV iron formulations that can replace deficits in ___ infusions are preferred to those requiring more | 2-Jan |
| Small molecules that bind very tightly to metal ions and render the metal ion chemically inert | iron chelation therapy |
| Clinical sequelae includes hepatic cirrhosis | iron overload |
| carbohydrate shell and iron core | parenteral iron product |
| Low Molecular Wt Iron Dextran (Infed®) | highest anaphylaxis risk |
| Ferric Na Gluconate (Ferrlecit®) | moderate anaphylaxis risk |
| Iron Sucrose (Venofer®) | lowest anaphylaxis risk |
| Cause of aplastic anemia | NSAIDS (phenylbutazone) |
| Cause of aplastic anemia | Sulfonamides |
| Cause of aplastic anemia | Acyclovir |
| Cause of aplastic anemia | Gancyclovir |
| Cause of aplastic anemia | Chloramphenicol |
| Cause of aplastic anemia | Anti-epileptics (phenytoin, carbamazepine, valproic acid) |
| Cause of aplastic anemia | Nifedipine |
| usually a diagnosis of exclusion | anemia of chronic disease |
| Can coexist with IDA and anemia of CKD | anemia of chronic disease |
| includes anemia of cancer | anemia of chronic disease |
| limits the utilization of iron for erythropoiesis | inflammation |
| decreased levels of erythropoietin lead to ___ that affects formation and biological activity of erythropoietin | inflammation |
| Chronic infection that causes ACD | Endocarditis |
| Chronic infection that causes ACD | Tuberculosis |
| Chronic infection that causes ACD | Human Immunodeficiency Virus |
| Chronic inflammation that causes ACD | Rheumatoid arthritis |
| Chronic inflammation that causes ACD | Gout |
| Chronic inflammation that causes ACD | Systemic Lupus Erythematosus |
| Disease causing ACD | Malignancies |
| Assess to determine reduced EPO production for anemia of cancer differential diagnosis | IL-1, TNF |
| Assess to determine suppression of BFU-e and CFU-e for anemia of cancer differential diagnosis | IFN-gamma, IL-1, TNF, alpha-1 antitrypsin |
| Assess to determine impaired iron utilization despite activated immune system for anemia of cancer differential diagnosis | IFN-gamma, IL-1, TNF |
| Prevent transfusions | Benefit of ESA |
| Gradual improvement in fatigue | Benefit of ESA |
| Increased mortality and tumor progression | Risk of ESA |
| Risk of thromboembolism | Risk of ESA |
| Risk of hypertension | Risk of ESA |
| Risk of pure cell aplasia (rare) | Risk of ESA |
| The Hbg/Hct level to start chemotherapy | any |
| Common etiology of vitamin B12 deficiency | inadequate intake/utilization |
| Common etiology of vitamin B12 deficiency | malabsorption syndromes (lack of intrinsic factor-pernicious anemia) |
| Common etiology of vitamin B12 deficiency | metformin |
| B12 deficiency anemia symptom | Beefy tongue (enlarged) |
| B12 deficiency anemia symptom | Fatigue |
| B12 deficiency anemia symptom | Neurologic manifestations |
| B12 deficiency anemia symptom | Paresthesia: numbness/tingling in extremities |
| B12 deficiency anemia symptom | Numbness |
| B12 deficiency anemia symptom | Memory loss |
| B12 deficiency anemia symptom | Psychosis |
| side effect of cyanocobalamin | Hyperuricemia |
| side effect of cyanocobalamin | Hypokalemia |
| side effect of cyanocobalamin | Sodium retention |
| side effect of cyanocobalamin | Rebound thrombocytosis → possible thromboembolic events |
| Medication that interferes with folate utilization | sulfasalazine |
| Medication that interferes with folate utilization | TMP-SMX |
| Medication that interferes with folate utilization | methotrexate |
| Common etiology of folate deficiency | increased need for folate is not matched by an increased intake |
| Common etiology of folate deficiency | dietary folate intake does not meet recommended needs |
| Common etiology of folate deficiency | folate excretion increases |
| Consequences of neural tube defects (preconceptual folate deficiency) | malformations of the spine (spina bifida) |
| Consequences of neural tube defects (preconceptual folate deficiency) | skull malformations |
| Consequences of neural tube defects (preconceptual folate deficiency) | brain (anencephaly) |
| Recommended dose of daily folic acid for women who are pregnant or planning to become pregnant | 400 mcg |
| Folic acid deficiency anemia symptom | Breathlessness |
| Folic acid deficiency anemia symptom | Tiredness |
| Folic acid deficiency anemia symptom | Dizziness |
| Folic acid deficiency anemia symptom | Rapid, weak pulse rate |
| Folic acid deficiency anemia symptom | Palpitations |
| Folic acid deficiency anemia symptom | Headaches |
| Folic acid deficiency anemia symptom | Paleness (of skin and inside eyelids) |
| Folic acid deficiency anemia symptom | Children – slow growth |
| RBC transfusion criteria if undergoing orthopedic surgery | Hgb < 8 g/dL |
| RBC transfusion criteria for preexisting cardiovascular disease | Hgb < 8 g/dL |
| RBC transfusion criteria if undergoing cardiac surgery | Hgb < 7.5 g/dL |
| RBC transfusion criteria for acute hemorrhage with evidence of hemodynamic instability | any Hgb level |
| RBC transfusion criteria in general | Hgb < 7 g/dL |
| MCV < 80 | Microcytic |
| MCV 80 -100 | Normocytic |
| MCV 80 -101 | Normocytic |
| MCV > 100 | Macrocytic |
| MCV > 101 | Macrocytic |
| Iron Deficiency Anemia | Microcytic |
| Anemia of Chronic Disease | Normocytic |
| Anemia of Chronic Kidney Disease | Normocytic |
| B12 deficiency Anemia | Macrocytic |
| Folic Acid deficiency | Macrocytic |
| MCV < 80 | Iron Deficiency Anemia |
| MCV 80 -100 | Anemia of Chronic Disease |
| MCV 80 -101 | Anemia of Chronic Kidney Disease |
| MCV > 100 | B12 deficiency Anemia |
| MCV > 101 | Folic Acid deficiency |
| Serum ferritin < 30 ng/ml AND Transferrin Sat (Tsat) < 20 % | Absolute Iron Deficiency |
| Serum ferritin > 1000 ng/ml | iron overload |
| Tsat exceeds 50% | iron overload |
| A clinical sequelae of iron overload | hepatic cirrhosis |
| 1st line therapy is reduction therapy for iron overload | therapeutic phlebotomy |
| If Hgb will not tolerate phlebotomy, ___ can be used for iron overload. | iron chelation therapy |
| Small molecules that bind very tightly to metal ions and render the metal ion chemically inert | iron chelation therapy |
| Deferoxamine (Desferal) IV | Iron Chelation Therapy |
| Deferasirox (Exjade and Jadenu) PO | Iron Chelation Therapy |
| Deferiprone (Ferriprox) PO | Iron Chelation Therapy |
| Not recommended if ferritin normal or high in ACD | Iron supplementation |
| ACD therapy | RBC transfusion |
| ACD therapy | Epoetin alfa (Procrit) |
| ACD therapy | Epoetin alfa-epbx |
| ACD therapy | darbepoietin alfa (Aranesp) |
| Treatment for anemia of cancer + chronic kidney disease | Consider ESA with kidney dosing |
| Must be present to meet criteria to use ESAs for treating anemia of cancer + myelosuppressive chemotherapy | incurable |
| Must be present to meet criteria to use ESAs for treating anemia of cancer + myelosuppressive chemotherapy | Hgb < 10 g/dL |
| Must be present to meet criteria to use ESAs for treating anemia of cancer + myelosuppressive chemotherapy | Iron, b12, folate levels normal |
| ACD patient receiving EPO wth Hgb > 10 g/dL | D/C, restart if < 10 |
| ACD patient receiving EPO has no response in 8 weeks | D/C |
| MCV > 100, low B12, normal folate, and normal IF | investigate GI pathology |
| MCV > 100, low B12, normal folate, and low IF | pernicious anemia |
| MCV > 100, normal B12, and low folate | folic acid deficiency |
| MCV > 100, normal B12, and normal folate | Consider hepatic disease; drug induced anemia; hypothyroidism; reticulocytosis |
| etiology of vitamin B12 deficiency anemia | metformin |
| treatment for pernicious anemia severe malabsorption symptom | cyanocobalamin |
| Pernicious anemia severe malabsorption symptom | neurologic symptoms |
| treatment for pernicious anemia mild malabsorption | cyanocobalamin |
| treatment for dietary vitamin B12 deficiency | supplements or foods fortified with B12 |
| ADRs of Cyanocobalamin (rare) | Hyperuricemia |
| ADRs of Cyanocobalamin (rare) | Hypokalemia |
| ADRs of Cyanocobalamin (rare) | Sodium retention |
| ADRs of Cyanocobalamin (rare) | Rebound thrombocytosis |
| Occurs in alcoholics and pregnant women | folic acid deficiency |
| amount of folic acid that is sufficient for replacement | 1 mg daily |
| Thiamine 100 mg + Folic acid 1 mg + MVI 1 amp to 1 Liter of Dextrose 5% and Normal Saline | banana bag |
| added to a banana bag if there is risk for withdrawals or seizures during folic acid deficiency treatment | magnesium sulfate |
Created by:
CaristW