anemia Flashcards
Anemia
3 most common causes of microcytic anemia?
thalessemia
ACD
IDA
Anemia
How is microcytic anemia defined?
MCV < 80
Anemia
How is macrocytic anemia defined?
MCV > 100
Anemia
What is another word for macrocytic
megaloblastic
Anemia
what are some common causes of macrocytic anemia?
ETOH
antiretroviral therapy
B12 deficiency
Anemia
What are some common causes of B12 deficiency?
PPI vegan age > 75 IBD autoimmune or congenital lack of intrinsic factor
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)
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
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
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)
Anemia
Symptomatic B12 deficiency - serum cobalamin cut-offs
< 75 - High
75-150 - Moderate
150-220 - Low
> 220 - Rare
Anemia
What is the dosing for oral cyanocobalamin, for food-bound cobalamin malabsorption (FBCM) or pernicious anemia?
1000 mcg/day
Anemia
What is the dosing for oral cyanocobalamin, for causes other than pernicious anemia or FBCM?
250 mcg/day (ie. vegans)
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.
Anemia
Who is prophylactic cobalamin supplementation recommended for?
vegans, FBCM, pernicious anemia
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
