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Pharmacy312 > Anaemia > Flashcards

Anaemia Flashcards

1
Q

What is macrocytic anaemia?

A

Red blood cells with a MCV that is greater than normal.

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2
Q

What are the two classification of macrocytic anaemia? What are the differences?

A

Megaloblastic: caused by VB12 and folate deficiency

Non-megaloblastic: caused by alcoholism, liver damage, myelodysplastic syndrome

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3
Q

How does VB12 deficiency affect folic acid?

A

VB12 binds to intrinsic factor secreted by gastric parietal cells and is absorbed in the terminal ileum.
VB12 also acts as a coenzyme for the production of folic acid.
Both are required for DNA synthesis, which becomes impaired.

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4
Q

How does VB12 and folate deficiency cause macrocytic anaemia?

A

Both are required for DNA synthesis, which becomes impaired. As RNA synthesis carries on as normal, there is an increase in cytoplasmic contents in the RBC –> macrocytic anaemia.

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5
Q

What is pernicious anaemia?

A

Pernicious anaemia is an autoimmune condition where antibodies attack intrinsic factor, impairing VB12 uptake thus causing VB12 deficiency.

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6
Q

What drugs can cause VB12 deficiency?

A

Metformin
Proton pump inhibitors
Nitrous oxide

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7
Q

How does metformin cause VB12 deficiency?

A

Metformin affects calcium-dependent membrane surface receptors. Calcium is required for VB12 uptake.

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8
Q

How do PPIs cause VB12 deficiency?

A

Gastric acid is involved in dissociating VB12 from food proteins. Drugs that lower gastric acid may lower VB12 deficiency.

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9
Q

How does nitrous oxide cause VB12 deficiency?

A

Inactivates VB12 synthesis and impairs its ability to act as a cofactor for methionine. Cobalamin (VB12) is a methionine synthase.

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10
Q

What drugs cause folic acid deficiency?

A

Methotrexate
Trimethoprim
Phenobarbitone
Phenytoin

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11
Q

How do methotrexate and trimethoprim cause folic acid deficiency?

A

Inhibits dihydrofolate reductase, which interferes with folic acid synthesis, and in turn interfering with DNA, RNA and protein synthesis

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12
Q

How do phenobarbitone and phenytoin cause folic acid deficiency?

A

Decrease mucosal uptake of folic acid

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13
Q

What tests should be done to confirm diagnosis of macrocytic anaemia?

A 
Serum VB12 (<200pg/mL)
Bilirubin: rules out haemolytic anaemia
Reticulocyte: rules out acute blood loss
TSH
Liver function tests
Copper levels
Intrinsic factor
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14
Q

What is the treatment for VB12 deficiency?

A

PO: VB12 supplement

IM injection: Hydroxycobalamin (Neo-B12)

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15
Q

When is IM VB12 best?

A

Pernicious anaemia/altered GI anatomy: patients cannot absorb VB12 orally due to lack of intrinsic factor thus parenteral route is preferred.

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16
Q

What is the treatment of folate deficiency?

A

Oral folic acid

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17
Q

Why should VB12 be administered before folic acid?

A

Folic acid may reverse haematological abnormalities associated with VB12 deficiency, but does not treat the neurological symptoms of VB12 deficiency. Thus, may mask symptoms of VB12 deficiency and cause neurological damage.

18
Q

What should be monitored in a patient with macrocytic anaemia?

A 
Markers of haemolysis (lactate dehydrogenase, bilirubin) to exclude haemolytic origin of MA.
Reticulocyte count
Haemoglobin, haematocrit
Serum folate and VB12
Neurological assessment
19
Q

Lifestyle advice for patients with macrocytic anaemia?

A

Increase VB12 in the diet:

  • meats, fish, eggs
  • fortified cereals
  • leafy green veg
20
Q

What is the pathophysiology of anaemia of chronic disease?

A

Low iron: body limits available iron for invading microbes.

Hepcidin is produced in response to exposure to bacterial antigens. It causes iron to be retained within cells causing anaemia.

21
Q

What is the pathophysiology of anaemia in CKD?

A

CKD causes damage to the kidneys and thus impairs EPO production, which causes anaemia. Additionally, CKD is inflammatory, and may bring about anaemia via ACD.

22
Q

What lab tests are performed to confirm A-CKD?

A

Iron status

  • Serum iron
  • Total Iron Binding Capacity
  • Serum Ferritin
  • Transferrin saturation
23
Q

What are the treatment options for A-CKD?

A

Iron supplementation
(oral, IV)
Erythropoiesis stimulating agents (oral, IV)

24
Q

Erythropoiesis Stimulating Agents MOA?

A

Stimulates division and differentiation of erythroid progenitor cells to increase erythrocyte concentration.

25
Q

Discuss short acting ESAs.

A

Example: epoietin alfa

Shorter duration of action therefore increased dosing frequency. Better for dialysis patients.

26
Q

Discuss long acting ESAs

A

Example: darbapoietin alfa

Longer duration of action therefore less dosing frequency. Better for patients not on dialysis.

27
Q

Discuss the approaches to IV iron

A

Low Dose High Frequency (100-200mg), 2 or more infusion.

High dose, low frequency (500mg), no more than 2 infusions. May be more suitable for patients not on dialysis.

28
Q

What should be monitored in a patient with A-CKD?

A

Ferritin and Transferrin saturation
Renal function
Hypersensitivity during infusion
Hb levels

29
Q

What is packed cell volume?

A

Identifies presence of anaemia, also known as haematocrit.

The proportion of blood that is made up of cells. It can increase when total blood volume is decreased.

30
Q

What is mean cell volume?

A

Distinguishes between macro or microcytic anaemia.

The measure of the average volume of a red blood cell.

31
Q

What is mean cell haemoglobin?

A

Identifies hypochromic anaemia

The average amount of haemoglobin in a sample of blood.

32
Q

What is mean cell haemoglobin concentration?

A

Identifies decreasing haemoglobin production.

Measure of the concentration of haemoglobin in a given volume of packed red cells.

33
Q

What is total iron binding capacity?

A

High in IDA, low in ACD

Measures the ability of blood to bind iron with transferrin

34
Q

What is ferritin?

A

Identifies iron concentration,

Measure of iron in the body.

35
Q

What is transferrin saturation?

A

Measures how much serum iron is bound to transferrin.

36
Q

What is serum soluble transferrin receptor?

A

Measure of functional iron status. It is insensitive to inflammation and thus can be used to identify ACD; Ferritin levels may be altered during inflammation thus not accurate.

37
Q

How does cigarette smoking, antacids and aspirin cause IDA?

A

Cigarette smoking: causes menorrhagia
Antacids: decreases iron absorption
Aspirin: causes GI ulceration

38
Q

What are the oral iron supplements available?

A

Ferrous fumarate
Ferrous gluconate
Ferrous sulfate
Iron polymaltose

39
Q

What are IV iron supplements available?

A

Ferric carboxymaltose
Iron dextran
Iron sucrose
Iron polymaltose

40
Q

What monitoring is required for IDA?

A

Re-evaluate after 2 weeks and subsequent blood testing at 4-6 week intervals until values normalise.

  • Haematocrit
  • MCV
  • Ferritin
  • Total iron binding capacity
  • CBC

Pharmacy312 (5 decks)

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