93 IDA Flashcards
Most common type of anemia
Hypoproliferative anemia
Most common hypoproliferative anemia
Iron deficiency anemia
Character of anemias related to renal disease, inflammation, cancer and hypometabolic states
Suboptimal Erythropoietin
Iron transport protein. It’s two forms. It’s half clearance time
Transferrin
Two forms: monoferric, diferric
Clearance time: 60-90 mins
Half clearance time of iron in IDA
10-15 minutes
Has the highest affinity for transferrin
Diferric transferrin
Cell having the highest number of transferrin receptors
Erythroblast
Iron needs of an adult male. Iron needs of a female in childbearing years.
Adult male: 1 mg/day
Adult female: 1.4 mg/day
Site of iron absorption
Duodenum and proximal small intestines
Transport of iron between membrane is accomplished by what protein
Divalent metal transporter type 1 (DMT 1)
Principal iron regulator hormone
Hepcidin
What are the stages of iron deficiency
Negative iron balance
Iron deficiency erythropoiesis
Iron deficiency anemia
First stage of IDA in which demands for iron exceed body’s ability to absorb iron from diet
Negative iron balance
Cardinal rule is that appearance iron deficiency in adult make or post menopausal Female is what until proven otherwise
GI blood loss
Signs of advanced anemia. Fissures at corner of mouth. Spooning of fingers
Cheilosis: fissures at corner of mouth
Koilonychia: spooning of fingernails
Represent the iron bound to transferrin. What is its normal value?
Serum iron represents iron bound to transferrin
Normal value: 50-150 mcg/dl
Indirect measure of transferrin. Normal value
TIBC
Normal: 300-360 mcg/dl
How is transferrin saturation computed? What is the normal value? What is the value in iron deficiency states?
Transferrin saturation: serum iron x 100 divided by TIBC
Normal: 20-50
Iron deficiency: less than 20
Intermediate in the pathway of heme synthesis and that when heme synthesis is impaired, it accumulates in the blood. That is it normal value and value in iron deficiency states?
Protoporphyrin
Normal: less than 30 mcg/dl
Iron deficiency: more than 100 mcg/dl
Most common cause of protoporphyrin levels
Absolute or relative iron deficiency
Lead poisoning
Three differential for hypochromic microcytic anemia
Thalassemia: RDW normal compared to IDA
Anemia of inflammation: ferritin is normal or increased, ferritin saturation and TIBC are low
Myelodysplastic syndrome: normal stores despite anemia
Most prominent complication of oral iron therapy
GI distress
Upon initiation of iron therapy, Reticulocyte count should begin to increase within and peaks when?
Reticulocyte count begins to increase in 4-7 days and peaks at 1 to 1 and half week
How is iron tolerance test done
Two iron tablets are give to patient and serum iron is measured 2-3 hours later. Serum iron increases of at least 100 mcg/dl then normal absorption occurred.
Iron content. Ferrous sulfate 325 mg. 195 mg
325 - - 65
196 - 39
Iron content. Ferrous fumarate. 325 mg. 195 mg
325 - -107
195- - 64
Iron content. Ferrous gluconate. 325 mg.
325 - - 39
Iron content. Iron polysaccharide. 150 mg. 50 mg
150 - - 150
50 - - 50
Which oral iron preparation has the most iron content? Which has the least iron content?
Most content: iron polysaccharide
Least content: ferrous gluconate
How much elemental iron are given per day for iron replacement therapy?
200 mg elemental iron
Iron content. Ferumoxytol? Ferruc gluconate? Ferric carnoxymaltose? LMW iron? Iron sucrose
Ferumoxytol: 510 mg Ferric gluconate complex: 125 Ferric carnoxymaltose:750 LMW iron dextran : 1500 Irom sucrose: 200
Two ways to administer IV iron
- Total dose +500 iron stores given in 1 infusion
2. Small repeated doses in protected time
Usual approach of IV iron in dialysis patients
100 mg iron weekly for 10 weeks
How is IV iron computed
Weight x 2.3 x (15- Hgb) +500 or 1000 for stores
Concern regarding IV iron
Anaphylaxis
Most distinguishing feature between IDA and AI
Serum ferritin increases 3x in the face of inflammation
Directly increases EPO production
Interluekin 1
What is the iron study profile to Anemia sec CKD
Normal serum iron, TIBC and ferritin levels
Hormones that augment erythropoiesis
Testosterone and anabolic steroids
When is blood transfusion needed?
Below 7 - 8 mg/dl
Usual dose of EPO in CKD patient. When is effect usually seen?
50 - 150 U/Kg 3x per week
Target hemoglobin of 10-12 mg/dl is achieved by 4-6 weeks
Dose of EPO in chemotherapy induced anemia
EPO 300 U/Kg 3x per week
Long acting preparation of EPO with additional carbohydrate and half life is M 3x - 4x longer then recombinant human EPO
Darbepoeitin
In CBC, how to differentiate IDA from thalassemia?
In thalassemia, RBC is normal or high as hemoglobin is normal
Blood loss leading to iron deficiency
10-20 ml/ day
Max elemental iron to be given per day
200 mg/day
True or false. EPO is not part of IDA regimen
True.
Which form of iron preparation is given?
Based on patients tolerance. At least 105 mg elemental iron
When is blood transfusion warranted in IDA? In cardiac patient with anemia what’s the target Hgb?
General population: Hgb less than 7 mg/dl
Stable cardiac patient: Hgb 8 mg/dl
Unstable cardiac patient: Hgb 10 mg/dl
What’s the hemoglobin level for pallor to manifest?
Hgb less than 8 mg/dl
What uncommon cause of IDA base on EGD finding?
Hiatal hernia, the rubbing of the herniated stomach causes intermittent blood loss leading to IDA
Cause of IDA in vegetarians? Where is this substance found also?
Phytates inferred with iron absorption.
Phytate is also found in tea and coffee
When is iron supplement given? What can enhance iron absorption?
Oral supplements are to be taken on empty stomach
Vitamin C can enhance iron absorption
Iron requirement in 2nd and 3rd trimester of pregnancy
5-6 mg iron
Causes of IDA due to increased demand for iron
Rapid growth in infancy and adolescence
Pregnancy
Erythropoietin therapy
Causes of IDA due to increased iron loss
Chronic blood loss Menses Acute blood loss Blood donation Phlebotomy as treatment for PV
Causes of IDA due to decreased iron intake or absorption
Inadequate diet
Malabsorption from disease
Malabsorption from surgery
Acute or chronic inflammation
