Anaemia

Question 1

Iron deficiency Anaemia treatment

Answer 1

Treatment is only justified in the presence of demonstrable iron-deficiency state.

Important to exclude any serious underlying cause of the anaemia (e.g. gastric erosion | gastro-intestinal cancer)

Question 2

Iron deficiency Anaemia prophylaxis

Answer 2

For those with malabsorption, menorrhagia, pregnancy, after subtotal or total gastrectomy, in haemodialysis patients, and in the management of low birth weight infants

Question 3

How should iron be given?

Answer 3

by mouth

Question 4

out of the following ferrous salts are better in terms of absorption of iron:

• Ferrous fumarate
• Ferrous gluconate
• Ferrous sulfate
• Dried ferrous sulfate

Answer 4

There is no significant difference in efficacy of absorption by the ferrous salts

Question 5

How is the choice of iron preparation determined, in iron deficiency anaemia?

Answer 5

the incidence of side-effects and cost

Question 6

What dose of elemental iron should be given for prophylaxis of iron-deficiency anaemia

Answer 6

100 - 200 mg daily

Question 7

Modified Release Iron

Answer 7

Are of no therapeutic advantage - should not be used.

The low incidence of side effects may reflect the small amounts of iron available for absorption

Question 8

Cause of Megaloblastic anaemias

Answer 8

Lack of either vitamin B12 or folate

Question 9

Vitamin B12 of choice

Answer 9

Hydroxocobalamin

Question 10

Long term folic acid therapy

Answer 10

Few indications as most folate deficiencies are self-limiting or will yield to a short course of treatment.

Question 11

Treatment duration for megaloblastic anaemia

Answer 11

daily folic acid supplementation for 4 months - brings about haematological remission and replenishes body stores.

Question 12

Prophylaxis in chronic haemolytic states, malabbsorption or renal dialysis

Answer 12

Folic acid daily/weekly depending on the diet and the rate of haemolysis

Question 13

Prevention of methotrexate-induced side effects

Answer 13

Folic Acid

Question 14

Why must the type of anaemia be determined before initiation of treatment?

Answer 14

Because iron salts may be harmful and result in iron overload if given alone in patients with anaemia other than those due to iron deficiency.

Question 15

Sickle-cell anaemia

Answer 15

a disease caused be a structural abnormality of haemoglobin resulting in deformed, less flexible red blood cells

Question 16

Drug of choice in Sickle Cell anaemia

Answer 16

Hydroxycarbamide - can reduce the frequency of crisis and the need for blood transfusions in sickle-cell disease.
(Benefits may not become evident for several months)

Question 17

G6PD deficiency

Answer 17

Glucose 6-phosphate dehydrogenase (G6PD) highly prevalent in most parts of Africa, Asia, Oceania and Southern Europe

Inherited condition in which the body doesnt have enough of the enzyme which helps red blood cells function normally - can cause haemolytic anaemia usually after exposure to certain medications, food or infections

More common in Men

Question 18

Prescribing in G6PD deficiency

Answer 18

• haemolytic risk from drugs varies within individuals
• Manufacturers do not routinely test drugs for their effects in G6PD-deficient individuals
• Risk and severity of haemolysis is almost always dose-related

Question 19

Drugs with definate risk of haemolysis in most G6PD deficient individuals

Answer 19

• Dapsone
• Methylthioninium
• Nitrofurantoin
• Primaquine
• Quinolones
• Rasburicase
• Sulfonamides

Question 20

Treatment for hypoplastic and haemolytic anaemias

Answer 20

Anabolic steriods
Pyridoxine 
Antilymphocyte
Rituximab [unlicensed indication]
Various corticosteriods

Question 21

Treatment of anaemia related to erythropoietin deficiency

Answer 21

Epoetins

Question 22

Pain in Sickle-cell treatment

Answer 22

Paracetamol
NSAID
Codeine phosphate
or 
dihydrocodeine

severe crisis may require the use of morphine or diamorphine and an NSAID

Question 23

Sickle-cell and pethdine

Answer 23

AVOID (if possible) because accumulation of a neurotoxic metabolite can precipitate seizures
(short half-lfe –> frequent injections)