Anemia Flashcards
What is anemia defined as
a decrease in hemoglobin and hematocrit
What is the purpose of Hgb
to carry oxygen
What are immature RBCs called
reticulocytes
What are three things that cau cause anemia?
1) nutritional deficiencies - iron, folate, b12
2) complication of another medical disorder like CKD
3) due to a malignancy
What are symptoms of anemia
fatigue, headache, exercise intolerance, diziness, anorexia, pallor
glossitis
inflamed sore tongue
kolionycias
thin, conave spoon shaped nails
pica
craving non foods such as chalk or clay
cobalmin
b12
b12 deficiency presentation
peripheral neuropathies
What does MCV tell you?
size of RBC
MCV <80
microcytic
likely due to iron deficiency
MCV 80-100
Normocytic
likely cause: acute blood loss, malignancy, CKD, bone marrow failure (aplastic anemia, hemolysis
MCV >100
macrocytic
likely cause either B12 or folate deficiency
Causes of iron deficiency anemia
1) iron poor diets (vegetarian)
2) Blood loss
3) Decreased iron absorption
4) Increased iron requirements - pregnancy, lactation
Reticulatocyte cell is low in untreated anemia and with bone marrow supression because
in order to form they take up hgb and iron in the bone marrow
Ferrous sulfate dosing and percent elemental iron
325 mg PO daily to TID, 65mg elemental iron which is 20%
what form of iron is used in dialysis
parenteral
desferal
deferoxamine which is the antidode for iron overdose
side effects of oral iron
constipation, dark tarry stoools - may give docusate
Administration of oral iron
food decreases absorption so take on empty stomach **, acidic environment increases absorption so avoid any meds that supress acid, sustained release causes less gi irritation
What classes of meds should iron be separated from by 2 hours before and 4 hours after
antacids/h2ras/ppi
levothyroxine (seperate by 2-4 hours after)
quinalone/tetracycline antibiotics
What should you give iron with to increase absorption
vitamin c
How to administer iron with bisphosphonates (alendronate/risedronate, oral ibandronate)
alendronate/risendronate - 30 minutes
ibandronate - 60 min
What is the concern with IV iron?
serious and fatal anaphylactic reactions,
what are the indications for getting IV iron?
CKD on hemodialysis or receiving ESA, unable to tolerate oral iron
triferic indication
only for people in hemodialysis
which iron requires test dose due to risk of anaphylaxis
iron dextran
what is the most common cause of b12 deficiency
pernicious anemia aka lack of intrinsic factor for b12 absorption
what can diagnose pernicious anemia
shilling test
how to treat pernicious anemia
lifelong b12
folic acid deficiency can cause
ulcerations of the tongue
b12 name
cyanocobalmin
b9
folic acid
b1
thiamine
b6
pyroxidine
b3
niacin
nasocobal
nasal b12 sprayed once weekly
1st line tx for b12 deficiency
injections either IM or deep SC
what is the purpose of giving an ESA
to maintain HGB levels and reduce need for blood transfusions
ESA is ineffective if what is depleated
iron stores
epo is what
a hormone produced by the kidney that stimulates the bone marrow to produce RBCS
at what hgb level should epogen be initiated
<10, decrease when it exceeds 11 (CKD on HD)
what is the boxed warning for esas
increased risk of death, MI, stroke, VTE, thombosis
what are the side effects of EPOS
arthralgia, hypertension
how to store EPO
in refrigerator, do not shake
half life of epoetin vs darbepoetin
darbepoetin half life 3x longer than epoetin
epogen
epoetin alfa (1/2)
Procrit
epoetin alfa (1/2)
aranesp
darbepoetin
use of esas in cancer
not indicated when outcome is cure since can shorten survival
types of hemolytic anemia
drug induced (usually by drugs that bind to RBC surface) or inherited (sickle cell, g6pD)
Antibiotics that can cause hemolytic anemia (both drug induced/coombs test and inherited)
bactrim (coombs test, g6pd/inherited), nutrofurantoin (g6pd/inherited), isoniozid, rifampin, penicillnsm cephalosporins
