DƯỢC LÍ Goodman & Gilman's The Pharmacological Basis of Therapeutics 12th, 2010

1096 seventh days; the reticulocyte index reflects the proliferative state
of the marrow. Finally, the hematocrit begins to rise during the second
week.
It is possible to use the pattern of recovery as the basis for a
therapeutic trial. For this purpose, the patient should receive a daily
parenteral injection of 50-100 μg of folic acid. Administration of
doses >100 μg/day entails the risk of inducing a hematopoietic
response in patients who are deficient in vitamin B 12
, and oral
administration of the vitamin may be unreliable because of intestinal
malabsorption. A number of other complications also may
interfere with the therapeutic trial. The patient with sprue and deficiencies
of other vitamins or iron may fail to respond because of
these inadequacies. In cases of alcoholism, the presence of hepatic
disease, inflammation, or iron deficiency can blunt the proliferative
response of the marrow and prevent the correction of the anemia.
For these reasons, the therapeutic trial for the evaluation of the
patient with a potential deficiency of folic acid has not gained great
popularity.
SECTION IV
INFLAMMATION. IMMUNOMODULATION, AND HEMATOPOIESIS
CLINICAL SUMMARY
Several hematopoietic growth factors are available for
clinical use. Recombinant erythropoietin routinely is
used for patients with the anemia of renal insufficiency,
inflammation, and associated with cancer or the therapy
of cancer. Longer-acting growth factors that permit
less frequent dosing schedules are coming into increased
use. One of the first of these is novel erythropoiesisstimulating
protein (NESP), produced by the insertion
of two extra N-linked sialic acid side chains into the
erythropoietin molecule. Myeloid growth factors (e.g.,
GM-CSF and G-CSF) are used to hasten the recovery
of granulocytes after myelosuppressive therapy, to help
mobilize hematopoietic stem cells into the peripheral
blood to allow their harvest for transplantation, and to
augment the number of mature leukocytes in the
peripheral blood so that they can be used in patients
with overwhelming infection. Finally, the development
of IL-11 for use in thrombocytopenia and the investigational
use of thrombopoietin or mimics of the molecule
may provide many of the same therapeutic advances.
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