Anemia, growth factors

Anemia

Reduction in RBCs, Hgb, and Hct, leading to decreased oxygen delivery to tissues

General manifestations of anemia

• Fatigue/weakness

• SOB

• Pallor

• Dizziness/headache

• Tachycardia/palpitations

• Cold hands/feet

Microcytic cell characteristic

Small RBC size

Macrocytic cell characteristic

Large RBC size

Hypochromic cell characteristic

RBCs contain less Hgb and appear paler

What does MCV determine?

Mean corpuscular volume- the average size and volume of RBCs

Iron deficiency anemia

Anemia caused by inadequate iron, limiting Hgb production

Causes of iron deficiency anemia

• Inadequate dietary iron intake

• Heavy menstrual bleeding

• Chronic GI bleeding

• Peptic ulcers

• Cancer

Iron deficiency anemia cell characteristics

Microcytic and hypochromic

Laboratory findings suggesting iron deficiency anemia

• Reduced Hgb/Hct

• Low MCV

• Low ferritin

How is iron deficiency anemia treated?

Iron replacement- ferrous sulfate

Sickle cell disease

Genetic disorder involving abnormal hemoglobin that causes RBCs to become rigid, sickle-shaped, sticky, and fragile

Sickle cell triggers

• Dehydration

• Infection/fever

• Hypoxia

• Cold exposure

• Acidosis

• Stress

Sickle cell disease manifestations

• Chronic hemolytic anemia

• Severe pain crises

• Ischemia

• Possible organ damage

• Increased infection risk

Sickle cell disease management/treatment

• Hydration

• Pain management

• Stress management

• Avoid cold

• Avoid high altitudes

• Oxygen if hypoemia present

• Hydroxyurea

How does hydroxyurea help in sickle cell disease?

Produces fetal Hgb, keeps RBCs round, flexible, and less likely to sickle

Vitamin B12 deficiency anemia

Blood condition where your body lacks enough healthy RBCs because it does not have enough vitamin B12 to make them properly

causes of Vitamin B12 deficiency anemia

• Lack of intrinsic factor (pernicious anemia)

• Low dietary intake of B12

• Malabsorption

How are vitamin B12 deficiency anemia cells classified

Normochromic + macrocytic

Neurological manifestations of B12 deficiency

• Confusion

• Cognitive changes

• Neurological injury can occur if deficiency is prolonged

How is vitamin B12 deficiency treated?

• Oral B12 replacement used for dietary deficiency

• Injection B12 replacement used for lacking intrinsic factor

Pernicious anemia

Autoimmune condition that causes a decrease in RBCs when the stomach cannot properly absorb vitamin B12 due to lack of intrinsic factor

true or false; pernicious anemia is a specific type of b12 deficiency anemia

true

Is every vitamin B12 deficiency pernicious anemia?

No- Pernicious anemia is a specific cause / type of B12 deficiency

How is pernicious anemia treated

Lifelong vitamin B12 IM injections

How is pernicious anemia classified by RBC size

Macrocytic, normochromic

folic acid deficiency anemia

folate deficiency that impairs DNA synthesis / RBC maturation, resulting in lack of healthy normal size RBCs

Does folate deficiency typically cause neurological symptoms?

Yes- but less frequent/severe than those with Vitamin B12 deficiency/pernicious anemia

risk factors for folate deficiency

• Poor diet/absorption (elderly patients)

• Alcohol use

• Pregnancy

How is folate deficiency treated

Folic acid replacement, improved dietary intake

Folic acid deficiency cell classification

macrocytic, megaloblastic, normochromic

Causes of anemia due to acute blood loss

• Trauma

• Surgery

• Sudden GI bleed

Manifestations of anemia from acute blood loss

• Hypovolemia

• Hypotension

• Tachycardia

• Pallor

Causes of anemia due to chronic blood loss

• Heavy menstrual bleeding

• Slow GI bleed

• Peptic ulcers

Hemolytic anemia

Anemia caused by premature destruction of RBCs

What is intrinsic hemolytic anemia

RBCs are destroyed faster than normal because of an internal defect within the cells themselves

Examples of intrinsic hemolytic anemia

• Thalassemia

• Sickle cell disease

What is extrinsic hemolytic anemia

healthy RBCs are prematurely destroyed by factors outside the cells themselves

Examples of extrinsic hemolytic anemia

• Autoimmune destruction

• Infections (EBV, pneumonia)

• Mechanical heart valve

Patient teaching for ferrous sulfate

• Take on empty stomach for best absorption

• Taken with Vitamin C increases absorption

• May take with food if GI upset occurs- decreases absorption

• Dark stools/constipation may occur

What are hematopoietic growth factors?

Proteins or hormones that stimulate bone marrow production of specific blood cells

What is erythropoietin (EPO)?

glycoprotein produces in the kidneys that stimulates the bone marrow to make more RBCs

How does the body regulate/trigger erythropoietin?

• Low O2 triggers the kidneys to release EPO

• EPO stimulates RBC production

• As oxygen levels normalize, EPO production decreases

Examples of erythropoiesis-stimulating agents (ESAs)

• Epoetin alfa (Epogen)

• Darbepoetin alfa (Aranesp)

When are erythropoiesis-stimulating agents used?

Anemia- especially with kidney disease / chemotherapy

What are the adverse effects of erythropoiesis-stimulating agents

• Hypertension

• Body aches / headaches

• Thrombotic events

What is filgrastim (Neupogen)?

granulocyte colony-stimulating factor (type of leukopoietic growth factor) that stimulate bone marrow to increase production of neutrophils

Filgrastim (Neupogen) is used for…

chemotherapy induced neutropenia and bone marrow transplants

How is Filgrastim (Neupogen) administered

SQ or IV

Filgrastim (Neupogen) adverse effects

Bone pain

How does pegfilgrastim (Neulasta) differ from filgrastim?

pegfilgrastim is long-acting; filgrastim is short-acting

What is Neumega (oprelvekin)

thrombopoietic growth factor that stimulates bone marrow production of megakaryocytes, which mature into platelets

What is Neumega (oprelvekin) used for

Chemotherapy-related thrombocytopenia

types of macrocytic anemia

• Folate deficiency

• B12 deficiency / pernicious anemia

Thalassemia

Inherited disorder involving defective / insufficient production of globin chains (building blocks of hemoglobin)

Thalassemia major treatment

• Blood transfusions

• Iron chelation drugs to remove excess iron

• Folic acid supplements

• Splenectomy

• Luspatercept