Professional Documents
Culture Documents
Thrombocytopenia
Neutropenia
Agents Used in Anemias
Iron
growing children
pregnant women
menstruating women
Heme iron in food Transport, storage, elimination
meat
Nonheme iron in food
chelators
complexing agent
apotransferrin
ferritin: liver
spleen
bone
plasma
transferrin receptor
Clinical Pharmacology
Clinical Toxicity
I. Acute iron toxicity: young children
necrotizing gastroenterities
shock, lethargy, dyspnea, metabolic acidosis, coma, death
Chemistry
prophyrin-like ring + Co
Active form:
Deoxyadenosylcobalamin
Methylcobalamin
Food: cyanocobalamin
hydroxycobalamin
microbial synthesis
animals or plants: not
meat, eggs, dairy products
extrinsic factor
Pharmacokinetics
Parenteral injection:
Cyanocobalamin
Hydroxocobalamin: protein-bound
Oral
bone marrow: 48 hr
reticulocytosis: second or third day
hemoglobin: begins to increase in the first week and
return to normal by 1-2 months
Folic Acid
Chemistry
polyglutamates
Pharmacokinetics
the richest sources: liver, kidney, green vegetables
1. no neurologic syndrome
2. Inadequate dietary intake: elderly patients,
poor patients,
food faddist
3. Liver disease
4. Pregnant women
patient with hemolytic anemia
5. Fetal neural tube defect: spina bifida
6. Phenytoin, oral contraceptives, isoniazide
7. Methotrexate, trimethoprim, pyrimethamine
dihydrofolate reductase
High-risk patient: pregnant women, alcoholics, patient
with hemolytic anemia, liver disease
renal dialysis, certain skin disease
Hematopoietic Growth Factors
Erythropoietin
Pharmacodynamics
Clinical Pharmacology
1. Chronic renal failure
iron deficiency
folate supplementation
2. Primary bone marrow disorders and secondary anemias
aplastic anemia
chronic inflammation
3. HIV infection: Zidovudin
Phlebotomies
4. Athletes
Toxicity
hematocrit and hemoglobin
hypertension and thrombotic complication
G-CSF:granulocyte colony-
Myeloid Growth Factors stimulating factor
GM-CSF: granulocyte-
macrophage colony-
stimulating factor
Chemistry and Pharmacokinetics
Filgrastim: G-CSF
Sargramostim:GM-CSF
Pharmacodynamics
1. receptor on various myeloid progenitor cells:
tyrosine kinase in the JAK/STAT pathway
2. G-CSF: stimulate the production and function of neutrophil
mobilize hematopoietic stem cells
3. GM-CSF: neutrophil
early and late granulocytic progenitor cells
erythroid and megakaryocyte progenitor
T cell proliferation (+ IL-2)
peripheral blood stem cell
Clinical Pharmacology
1.Neutropenia : myelosuppressiove chemtherapy
G-CSF: prior episode of febrile neutropenia
GM-CSF: itself can induce fever
2. Acute myeloid leukemia : postchemotherapy supportive care
G-CSF; GM-CSF
3.Secondary and primary neutropenia
aplastic anemia, congenital neutropenia
cyclic neutropenia, myelodysplasia
4. Autologus stem cell transplantation
5. Mobilize peripheral blood stem cell
autologus and allogeneic transplantation
G-CSF
Toxicity
GM-CSF: more sever side effect
G-CSF:bone pain
Megakaryocyte Growth factor
Pharmacodynamics
IL-11: primitive megakaryocytic progenitors
increases the number of peripheral platelets
and neutrophil
Thrombopoietin: primitive megakaryocytic progenitors
mature megakaryocytes
Clinical Pharmacology
1. IL-11
thrombocytopenia
no effect on leukopenia and neutropenia
2. Thrombopoietin: investigational agent
Toxicity
Cardiovascular effect: anemia, dyspenia,
transient atrial arrhythmia
fluid retention
Objectives