15 - Anemia Flashcards
Anemia
Hemoglobin Levels
Males:
< 13 g/dL
Hematocrit < 41%
Females:
< 12 g/dL
Hematocrit < 36%
Nutritional Anemia
- Inadequate* Intake or Malabsorption of:
- *Iron - Vitamin C**
- *Vitamin B12** and Folic Acid
High Risk:
Children / Elderly
Pregnancy
Alcoholics
Obesity surgery = gastric bybass
Signs & Symptoms of
Nutritional Anemia
ACUTE
- *Tachycardia** / Lightheadedness
- *Dyspnea / Palpitations / Angina**
CHRONIC:
Fatigue / Weakness
HA / Vertigo / Pallor
Iron Deficiency Anemia
MICROcytic
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
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
Iron Deficiency Anemia
MICROcytic
- *Iron Deficiency Anemia**
- *LABS**
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
Iron Deficiency Anemia
INTAKE GOALS
ELEMENTAL IRON / DAY
8
Adult males / postmenopause females
18
menstrating females
7-10
children = HIGH RISK
27mg - Preggos
- *Iron Deficiency Anemia**
- *DIET**
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*
Iron Deficiency Anemia
Oral Supplementation for ADULTS / PREGGOS
Allow 3-6 months
after anemia is resolved to replete iron stores
- *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
Iron Deficiency Anemia
Oral Supplementation for CHILDREN
Allow 3-6 months
after anemia is resolved to replete iron stores
- *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
Iron Deficiency Anemia
Oral Supplementation - ADR / DI
- ADRs*
- *Dark coloration of Feces**
- *Constipation** / diarrhea / NV
- DECREASED ABSORPTION*
- *H2 Blockers / PPI / Antacids** (calium)
- *Tetracyclines** (also can bind to iron)
Iron Deficiency Anemia
IV Supplementation
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)
Vitamin B12 Deficiency Anemia
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
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
VITAMIN B12 DEFICIENCY
MacroCytic
Vitamin B12 Deficiency Anemia
LABS
- *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
Vitamin B12 Deficiency Anemia
SUPPLEMENTATION
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
Folic Acid Deficiency Anemia
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
Which type of ANEMIA?
Signs & Symptoms
GRAY HAIR + MOUTH SORES
Fatigue / Tongue swelling
Growth Problems / SOB
Pallor / Lethargy / Irritability
FOLIC ACID DEFICIENCY
Folic Acid Deficiency Anemia
LABS
LOW FOLATE
- *Vitamin B12 + Methylalonic Acid**
- *NORMAL**
Mean Cell Volume
Increased, may be normal
Homocysteine
Increased
Folic Acid Deficiency Anemia
SUPPLEMENTATION
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
Diet for Folic Acid Deficiency
LIVER / CEREAL / LENTILS
Chickpeas / Asparagus / Spinach
White Rice / Pasta / beans
Diet for VIT B12 Deficiency
CLAMS / BEEF LIVER / CEREAL
FISH / BEEF
Milk / Yogurt
oysters
Diet for IRON DEFICIENCY Anemia
CEREAL / OATMEAL / DARK CHOCOLATE
Tofu / Lentils / Beef
Potato / Wheat / brocolli
