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PDAT3 > 15 - Anemia > Flashcards

15 - Anemia Flashcards

1
Q

Anemia
Hemoglobin Levels

A

Males:
< 13 g/dL
Hematocrit < 41%

Females:
< 12 g/dL
Hematocrit < 36%

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2
Q

Nutritional Anemia

A
  • Inadequate* Intake or Malabsorption of:
  • *Iron - Vitamin C**
  • *Vitamin B12** and Folic Acid

High Risk:
Children / Elderly
Pregnancy
Alcoholics
Obesity surgery = gastric bybass

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3
Q

Signs & Symptoms of
Nutritional Anemia

A

ACUTE

  • *Tachycardia** / Lightheadedness
  • *Dyspnea / Palpitations / Angina**

CHRONIC:
Fatigue / Weakness
HA / Vertigo / Pallor

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4
Q

Iron Deficiency Anemia
MICROcytic

A

Most Common form of anemia & nutritional deficiency

Deficiency occurs FIRST –> takes time before anemia

Iron Intake =/= Iron Absorbed
As physiologic ironlevelsDECREASE
VVV
GI absorption INCREASES

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5
Q

Signs & Symptoms
of WHICH type of ANEMIA?

Asymptomatic
Glossal Pain
Smooth Tongue // reduced Salivary Flow​

PICA
compulsive eating of non-food items

PAGOPHAGIA
wanting ICE

A

Iron Deficiency Anemia
MICROcytic​

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6
Q
  • *Iron Deficiency Anemia**
  • *LABS**
A

SERUM FERRITIN
low serum ferritin
best determinant for iron-deficiency, most sensitive & seen EARLIEST

Low Serum Iron** **/ Transferrin Saturation

High TIBC
Total Iron Binding Capacity >400 mcg/dL

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7
Q

Iron Deficiency Anemia
INTAKE GOALS

A

ELEMENTAL IRON / DAY

8
Adult males / postmenopause females

18
menstrating females

7-10
children = HIGH RISK

27mg - Preggos

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8
Q
  • *Iron Deficiency Anemia**
  • *DIET**
A

VITAMIN C
ENHANCES absorption of non-heme IRON

  • *HEME IRON**
  • *Meat / Fish / Poultry**
  • Non-Heme Iron = Less Absorbed*
  • Vegies / Fruites / Beans / Nuts / Grains*
  • TANNIN (TEA) / COFFEE*
  • REDUCES absorption of Iron*
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9
Q

Iron Deficiency Anemia
Oral Supplementation for ADULTS / PREGGOS

Allow 3-6 months
after anemia is resolved to replete iron stores

A
  • *Treatment for ADULTS**
  • *200 mg** elemental iron divided into several doses
  • *Recommended in PREGNANCY**
  • *30 mg/day** of iron

1 HOUR B4 MEALS

2 HOURS w/ CALCIUM products

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10
Q

Iron Deficiency Anemia
Oral Supplementation for CHILDREN

Allow 3-6 months
after anemia is resolved to replete iron stores

A
  • *Treatment for Children**
  • *3-6 mg/kg/day** elemental iron in 3 div-doses

Recommended in Children @ risk
Infants > ​4 months breastfeeding
Ferrous sulfate 1mg/kg/day elemental iron

1 HOUR B4 MEALS

2 HOURS w/ CALCIUM products

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11
Q

Iron Deficiency Anemia
Oral Supplementation​ - ADR / DI

A
  • ADRs*
  • *Dark coloration of Feces**
  • *Constipation** / diarrhea / NV
  • DECREASED ABSORPTION*
  • *H2 Blockers / PPI / Antacids** (calium)
  • *Tetracyclines** (also can bind to iron)
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12
Q

Iron Deficiency Anemia
IV Supplementation

A

IV is reserved for:
Intolerance to PO // Malabsorption
Long-term Non-adherence

  • *IRON DEXTRAN - 50mg/mL ele iron**
  • *Test Dose needed** - concern for Anaphylactic Reactiion
  • *IV PUSH / PB** or IM (z–tract)
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13
Q

Vitamin B12 Deficiency Anemia

A

Most Common in - Elderly 15%

  • *Malabsorption**
  • *H.Pylori** // Gasttric Surgery / Autoimmune mech
  • *Gastric-acid suppressing Agents**
  • *GOOD GASTRIC ACID –> BETTER ABSORPTION**

TAKES YEARS TO DEVELOP

Intrinsic Factor Specific Pathway - Absorption
Cobalamin released frrom protein by gastric acid
Release of free cobalamin –> binds INTRINSIC FACTORS
intrinsic factor discarded –> cobalmamin bound to ttrans

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14
Q

Which form of ANEMIA?
SIGNS AND SYMPTOMS:

  • *Neurologic**
  • *NOT reversed by supplementation** –> can be irreversible
  • *Numbness / Ataxia / Spasticity /** Vision Changes
  • Diminished / decreased:*
  • *Vibratory sense / Proprioception / Imbalance**

Psychiatric
Irritability / Depression / Psychosis
Personality Changes / Memory Impairment

A

VITAMIN B12 DEFICIENCY

MacroCytic

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15
Q

Vitamin B12 Deficiency Anemia
LABS

A
  • *METHYLMALONIC ACID**
  • *ELEVATED** - MOST SPECIFIC & shown EARLY

Homocysteine
also increased and shown early

Mean Cell Volume
INCREASED, but may be normal

Vitamin B12 = low <150-250 pg/mL

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16
Q

Vitamin B12 Deficiency Anemia
SUPPLEMENTATION

A

ORAL
low Vit B12 + HIGH MMA +/- homocysteine
1000-2000 mcg x1-2 weeks
maintanence is 100mcg daily, EQUAL EFFICACY AS IM

IM
for those with neurological effects
100 mcg QD x6-7 days –> if improvement QOD x7 doses
–> then q3-4 days for 2-3 weeks –> 100mcg monthly maintanence

INTRANASAL
Maintanence only, 500mcg in 1nostril qweekly

17
Q

Folic Acid Deficiency Anemia

A

Prevelant in:
Alcoholics // Pregnancy // Women of child bearing age 4-22%

Inadquate Intake in:
Elderly / teenagers / alcoholics
FAD diets / socioeconomic / demented / chronically ill

Malabsorption

Folic Acid = Water-Soluble Vitamin

18
Q

Which type of ANEMIA?
Signs & Symptoms

GRAY HAIR + MOUTH SORES

Fatigue / Tongue swelling

Growth Problems / SOB

Pallor / Lethargy / Irritability

A

FOLIC ACID DEFICIENCY

19
Q

Folic Acid Deficiency Anemia
LABS

A

LOW FOLATE

  • *Vitamin B12 + Methylalonic Acid**
  • *NORMAL**

Mean Cell Volume
Increased, may be normal

Homocysteine
Increased

20
Q

Folic Acid Deficiency Anemia
SUPPLEMENTATION

A

0.4 - 0.8mg PO QD
for maintanence in women of childbearing age
PREVENTS birth defets / spina bifida / anencephaly

0.4 - 1mg PQ QD
sufficient to replace stores

Malabsorption –> 1-5mg QD

21
Q

Diet for Folic Acid Deficiency

A

LIVER / CEREAL / LENTILS

Chickpeas / Asparagus / Spinach

White Rice / Pasta / beans

22
Q

Diet for VIT B12 Deficiency

A

CLAMS / BEEF LIVER / CEREAL

FISH / BEEF

Milk / Yogurt

oysters

23
Q

Diet for IRON DEFICIENCY Anemia

A

CEREAL / OATMEAL / DARK CHOCOLATE

Tofu / Lentils / Beef

Potato / Wheat / brocolli

PDAT3 (23 decks)

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