Anemia Flashcards
Microcytic anemia definition
<80 fL
Causes of microcytic anemia
IDA
IDA causes
Blood loss, iron malabsorption
Significant finding for IDA in iron panel
Serum ferritin and MCV are decreased
IDA treatment
Diet: increase intake of foods high in iron (8mg/day for adult males and postmenopausal females, 18mg for menstruating females)
Iron supplementation
Iron supplementation products
Ferrous sulfate
Ferrous gluconate
Ferrous fumarate
Iron supplementation dosing frequency
QOD with ascorbic acid to increase PO absorption
PO iron/DDIs: drugs that decrease iron absorption
Al/Mg/Ca-containing antacids
TTCs, doxycycline
H2RAs
PPIs
Cholestyramine
PO iron DDIs: drugs decreased by iron
Levodopa
Methyldopa
Levothyroxine
Pencillamines
FQs
TTC, doxycycline
MMF
Indications for IV iron therapy
Malabsorption
Poor oral adherence or tolerance
Gastric Bypass
Chronic Kidney Disease
Cancer while receiving active chemotherapy
IV iron drugs available
Iron sucrose
sodium ferric gluconate
ferric carboxymaltose
iron dextran
ferumoxtyol
ADEs of IV iron
Cramping
Flushing
Hypotension
Nausea
Vomiting
GI irritation
Rash
Malaise
Arthralgias
Myalgias
Hypophosphatemia
Infection??
ADEs of PO iron
Dark, discolored feces
Constipation
Nausea
Vomiting
Typical IV iron dosing
Iron sucrose 200mg IV x5 days
Decrease dose by 1 day’s worth if previously received pRBC transfusions
Macrocytic anemia definition
> 100 fL
Causes of macrocytic anemia
Folic Acid Deficiency
Vitamin B12 Deficiency
Liver Disease
Alcohol
Hypothyroidism
Drugs (Sulfonamides, Antineoplastics)
Causes of Vitamin B12 deficiency
Inadequate intake from diet, malabsorption syndrome
Significant findings for Vitamin B12 deficiency on iron panel
Serum folate unchanged
MMA and homocysteine is increased
Vitamin B12 deficiency anemia treatment
Vitamin B12 supplementation PO or IM/SQ, dietary intake
PO vitamin B12 dosing
1000-2000mcg QD
IM/SQ vitamin B12 dosing
1000mcg QD x1 week, then 1000mcg qweek x4 weeks, then 1000mch qmonth
Vitamin B12 side effects
Hyperuricemia, hypokalemia
Suggested dietary intake of vitamin B12
0.4mcg/day
Folate deficiency anemia causes
Inadequate intake, decreased absorption, increased folate requirements (so you’re not getting enough)
Folate deficiency findings on iron panel
Decreased folate, UNCHANGED MMA, increased homocysteine
Folate deficiency anemia treatment
PO supplementation
Folic acid in most patients
1mg PO QD
Folic acid in pregnancy
4mg PO QD
Folic acid AEs
Well-tolerated, could have flushing, malaise, pruritus/rash
Normocytic anemia definition
80-100 fL
Causes of normocytic anemia
Aplastic Anemia
Anemia of Chronic Disease
Chronic Kidney Disease (CKD)
Hemolytic Anemia
Significant finding for AI on iron panel
Decreased TIBC (will separate it from IDA)
AI treatment
Treatment of underlying condition causing chronic inflammation
ESAs
pRBC transfusions
ESAs in AI
Epoetin alfa, darbepoetin alfa
Epoetin alfa AEs
fever, N/V, hypertension, cough, pruritus, rash, headache, arthralgias
Darbepoetin alfa AEs
infections, blood pressure alternations, headache, nausea/vomiting, diarrhea, peripheral edema
Half-life of epoetin alfa
9 hours
Half-life of darbepoetin alfa
25 hours
ESA treatment is only effective when what?
Bone marrow has adequate stores of iron, B12, and folate
ESAs: when to D/C
Hgb >12g/dl
ESAs: when to hold or decrease dose
Hgb >1g/dl in 2 weeks
AI treatment in patients with malignancy
Determine underlying cause and treat it
Iron supplementation
When to consider pRBCs in AI treatment
acute oxygenation complications or Hgb <7g/dl
