Iron Deficiency TIBC- Transferrin will be high because body is trying to get more iron in
7:06
Vit 12 - Vegans/ Pernicious anemia
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Renal failue- lacking erythropoetin. Not getting the signal you need to absorb iron. RBC's will look normal
but the number of them is low.
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PBS of Microcytic Hypochormic Fe anemia photo here.
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Good picture of Iron transfer process.
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Oral iron preparations either ferrous sulfate or ferous gluconate. Fe2+
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Adverse effects: constipation, dark stools, nausea, stomach cramps, and vomiting. Acute iron toxicity
(overdose): gastrointestional bleeding, vomiting, abd. pain and bloody diarrhea--- most common in
young children who accidentally ingest iron.
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Parenteral iron: Iron Dextran or Ferric (parenteral is anything not by mouth)
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IM or IV for people that can't take oral for some reason. Given as FERRIC iron Fe3+ because it's being
injected into the blood and Fe3+ binds transferrin.
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adverse reactions: injection site reaction, headache, light-headedness, muscle craps, nausea, and diarrhea.
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Iron Toxicity: Mostly in children ( as few as 10 tablets can be lethal. activated charcoal does NOT bind to
iron. Must use Deferoxamine as a chelator.
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Deferoxamine: admin route is IM, IV, or SubQ.... Excreted in urine. Infusion reaction (skin, Flushing,
urticaria, and shock)
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Deferasirox is used to treat hemochromatosis which is excess iron which is more common in men. (serial
phelbotomy is preffered treamtment. Given orally. excreted in feces and bile. Adverse Effects: Acute renal
failure, hepatic failue, gastrointestinal hemorrhage.
15:43
Both Binds Fe+3 because that is what is in the bllod and then it is excreted in urine or feces and bile.
16:41
Cyanocobalamin=Syn. Vitamin B12 given IM or SubQ (IV not recommended beacuse they are not
absorbing it normally)
18:02
Mechanism of action is very important.
19:13
Adverse effects: pts with leber disease may suffer from optic atrophy- onset is rapid.
19:40
Polycythemia is a blood cancer- where you make too many RBC's
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Vitamin b12 deficiency maks polycythemia vera. Resolution of B12 deficiency may show polycythemia
vera.
19:53
Folic Acid: prepared in two forms as Folic acid and Leucovorin.
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Leucovorin- is given with cancer treatment to "rescue" health cells that methotrexin is killing by blocking
the dihydrofolate reductase catalyzed reaction. Leucovorin bypasses this in only healthy cells.
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Folic Acid: straight supplementation of folic acid that is required for enzymatic reactions to occur.
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Erythopoietin given in two drugs. Epoetin alfa and Darbepoetin alpha.
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Epoetin alfa is recombinant human erthropoietin and Darbepoetin alpha is a modified form of
erythropoietin with great half-life so it will last longer.
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Can only be given IV and Sub Q only. This is a protein and if given PO it will be metabolised down to AA's
and would not be effective.
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used to stimulate RBC production.
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Given to pt's suffering from Chronic Kidney Disease because erythropoietin is made in the kidney!),
chemotherapy, HIV, or pt's sechuled to undergo elective noncardiac, non fascular surgery to reduce the
need for allogenic RBC transfusion.
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DRUG COMES WITH A BLACK BOX LABEL.
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can cause thickening of the blood that will increase the risk of stroke/MI/venous thromboembolism,
thrombosis. Can cause hypertension.
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Iron Anemia is present here in this Pt.
29:41
Treat with Ferrous iron Fe2+ orally so that they can absorb the iron normally through the gut. Ferric Fe3+
is not absorbed easilly orally and would have to be converted to Fe2+
31:17
Megaloblastic anemia in this pt
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We do not have enough information to treat because we don't know if it's a folate deficiency or a B12
deficiency
33:48
Still do not have enough information because homocysteine is high in both folate and B12 deficiencies.
35:09
Now you know that this is a B12 deficiency!!! if this was low it would be folate.
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To treat B12 you give Cyanocobalamin or synthetic B12
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If you increase folate you can overcome the b12 deficiency. However, you will still have neurological
systems in B12.
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Methylemalonyl CoA mutase is the enzyme that is important in the nerves and is B12 dependent.