Anaemia Flashcards
Iron deficiency Anaemia treatment
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)
Iron deficiency Anaemia prophylaxis
For those with malabsorption, menorrhagia, pregnancy, after subtotal or total gastrectomy, in haemodialysis patients, and in the management of low birth weight infants
How should iron be given?
by mouth
out of the following ferrous salts are better in terms of absorption of iron:
- Ferrous fumarate
- Ferrous gluconate
- Ferrous sulfate
- Dried ferrous sulfate
There is no significant difference in efficacy of absorption by the ferrous salts
How is the choice of iron preparation determined, in iron deficiency anaemia?
the incidence of side-effects and cost
What dose of elemental iron should be given for prophylaxis of iron-deficiency anaemia
100 - 200 mg daily
Modified Release Iron
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
Cause of Megaloblastic anaemias
Lack of either vitamin B12 or folate
Vitamin B12 of choice
Hydroxocobalamin
Long term folic acid therapy
Few indications as most folate deficiencies are self-limiting or will yield to a short course of treatment.
Treatment duration for megaloblastic anaemia
daily folic acid supplementation for 4 months - brings about haematological remission and replenishes body stores.
Prophylaxis in chronic haemolytic states, malabbsorption or renal dialysis
Folic acid daily/weekly depending on the diet and the rate of haemolysis
Prevention of methotrexate-induced side effects
Folic Acid
Why must the type of anaemia be determined before initiation of treatment?
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.
Sickle-cell anaemia
a disease caused be a structural abnormality of haemoglobin resulting in deformed, less flexible red blood cells
Drug of choice in Sickle Cell anaemia
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)
G6PD deficiency
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
Prescribing in G6PD deficiency
- 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
Drugs with definate risk of haemolysis in most G6PD deficient individuals
- Dapsone
- Methylthioninium
- Nitrofurantoin
- Primaquine
- Quinolones
- Rasburicase
- Sulfonamides
Treatment for hypoplastic and haemolytic anaemias
Anabolic steriods Pyridoxine Antilymphocyte Rituximab [unlicensed indication] Various corticosteriods
Treatment of anaemia related to erythropoietin deficiency
Epoetins
Pain in Sickle-cell treatment
Paracetamol NSAID Codeine phosphate or dihydrocodeine
severe crisis may require the use of morphine or diamorphine and an NSAID
Sickle-cell and pethdine
AVOID (if possible) because accumulation of a neurotoxic metabolite can precipitate seizures
(short half-lfe –> frequent injections)
