anemia Flashcards by Kelly Ann

Anemia

3 most common causes of microcytic anemia?

thalessemia
ACD
IDA

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Anemia

How is microcytic anemia defined?

MCV < 80

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Anemia

How is macrocytic anemia defined?

MCV > 100

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Anemia

What is another word for macrocytic

megaloblastic

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Anemia

what are some common causes of macrocytic anemia?

ETOH
antiretroviral therapy
B12 deficiency

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Anemia

What are some common causes of B12 deficiency?

PPI 
vegan 
age > 75
IBD 
autoimmune or congenital lack of intrinsic factor

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Anemia

Why is B12 deficiency not normally dx until later in life?

develops over 20-30 years ** C&G? rx script

BC Guidelines: takes 3-5 years to become deficient (exhaust all stores)

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Anemia

Signs and symptoms anemia

General: Bleeding problems
Neuro: Headaches. Fatigue
CVS: Pallor, Tachycardia, Postural hypotension
RESP: SOB, Dyspnea on exertion 
Skin: Spoon nails, glossitis, cheilitis 
MSK: Restless legs
GI: Pica

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Anemia

B 12 deficiency S & S?

peripheral neuropathy
gait instability
memory issues
cognitive or personality changes
ataxia (symmetrical)
paresthesias
proprioception issues
age-related cognitive impairment
weakness
fatigue
pallor

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Anemia

who to screen for B12 deficiency?

anyone > 75 yrs
IBD
gastric or small intestine surgery
vegan
longterm use PPI (12 mo), metformin (4 mo)

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Anemia

Symptomatic B12 deficiency - serum cobalamin cut-offs

< 75 - High
75-150 - Moderate
150-220 - Low
> 220 - Rare

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Anemia

What is the dosing for oral cyanocobalamin, for food-bound cobalamin malabsorption (FBCM) or pernicious anemia?

1000 mcg/day

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Anemia

What is the dosing for oral cyanocobalamin, for causes other than pernicious anemia or FBCM?

250 mcg/day (ie. vegans)

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Anemia

When is parenteral administration of Vit B12 indicated?

neurologic symptoms
- 1 to 5 IM or Subcut of 1000mcg daily, followed by oral doses 1000 to 2000 mcg/day. Retets after 4-6 months. Then annually. Pts with pernicious anemia will require supplementation for life.

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Anemia

Who is prophylactic cobalamin supplementation recommended for?

vegans, FBCM, pernicious anemia

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Anemia

what other test might you consider for FBCM?

H pylori

Anemia

what is FBCM caused by?

H pylori or lack of gastric acid (hence PPI)

Anemia

what is pernicious anemia? how prevalent is it?

autoimmune destruction of parietal cells (that produce intrinsic factor required for B12 absorption)

~ 2% north americans > 60 yoa have pernicious anemia

Anemia

How common is FBCM in people > 60 years?

20-40%

Anemia

How long do you continue iron supplementation after correction?

4-6 months

Anemia

When do you recheck ferritin?

What is the ferritin target?

3-6 months after normalization of hgb OR in non-anemic patients, 3-6 months after initiation of supplements. Target ferritin > 100

Anemia

what are common causes for IDA in ped’s?

nutritional (consider SDOH) 
Medications (PPI) 
bleeding
IBD/celiac 
cow's milk protein colitis 
vegetarian

infants < 6 mo

maternal
low birth weight
BF/formula substitutes

Infants 6 to 36mo

cow’s milk before 9 mo
over 750 ml/day cow’s milk
bottle use beyond 12-15mo/insufficient solid food intake

Teens
- menorrhagia 
- disordered eating 
- extreme physical activity/athletes
- low body weight 
-

Anemia

ferritin values for ped’s

< 12 = deficiency
12-20 = possible
> 20 = normal in prepubescent children

Anemia

ferritin values for adults

< 15 = deficiency
15-30 = probable
30-100 = low/asymp
> 100 = normal 
> 600 = overload --> investigate

Anemia Common causes IDA in adults?

-pregnancy - lactation - nutritional (SDOH) - AUD - age > 65 - IBD/celiac - gastric lymphoma - PPIs - bariatric surgery - CKD - menstruation - GI bleeding: PUD, GI CA, IBD, esophagitis, hemorrhoids - Blood donation - post op - hematuria - endurance athletes -

Anemia IDA can occur in CKD or HF, but the ferritin may appear normal as ferritin can be increased in inflammation. What are the TSAT cut off's for CKD and HF respectively to confirm IDA?

HF < 20% | CKD < 24%

Anemia Pt counselling for iron supplementation

Oral iron preparations may cause nausea, vomiting, dyspepsia, constipation, diarrhea or dark stools. Iron absorption from iron salts can be enhanced by taking them on an empty stomach (at least 1 hour before or 2 hours after eating), or with 600–1200 mg vitamin C. Avoid taking iron supplements with tea, coffee or milk. Iron absorption can be decreased by various medications and supplements such as multivitamins, calcium, or antacid tablets. Space administration by at least 2 hours apart

Anemia What are some strategies to improve iron supplement adherence/tolerability?

o start at a lower dose and increase gradually after 4 to 5 days (to reach target dose in a few weeks) o give divided doses o give the lowest effective dose o take supplements with meals (note: iron absorption is enhanced when supplements are taken on an empty stomach; however, tolerance and adherence may be improved when iron is taken with meals) o try a different iron preparation o try alternative dosing schedules such as every other day dosing

Anemia How soon will Hgb improve w/ iron supplementation?

Hemoglobin should increase by 10-20 g/L by 4 weeks.

Anemia Indications for specialist referral for IDA

- Failure of oral supplementation trial - Suspected or overt GI/GU bleeding - Moderate to severe anemia with unknown cause