Anemia Flashcards

1
Q

Anemia definition

A

low hemoglobin concentration in the blood (<13 g/dL in men OR <12 g/dL in women)

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2
Q

Normocytic Anemia

A

MCV 80-100
Aplastic anemia
Anemia of chronic disease
CKD
Hemolytic Anemia

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3
Q

Microcytic anemia

A

MCV < 80
- iron deficiency anemia
- thalassemia

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4
Q

Macrocytic anemia

A

MCV > 100
- folic acid deficiency
- Vitamin B12 deficiency
- liver disease
- alcohol
- hypothyroidism
- drugs (sulfonamides, antineoplastics)

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5
Q

Causes of Iron Deficiency Anemia

A

Blood loss
- menstruation
- GI bleed
- hemorrhoids
- medication use (NSAIDs, anticoagulants, corticosteroids)
- iron malobsorption

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6
Q

Serum iron def

A

Fe bound to transferrin

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7
Q

Total iron binding capacity (TIBC)

A

Indirect measurement of the iron binding capacity of serum transferrin

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8
Q

Percent transferrin saturation (TSAT)

A

Ratio of serum iron to TIBC

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9
Q

Serum ferritin

A

the amount of iron stored in the liver, spleen, and bone marrow cells

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10
Q

Iron Deficiency Anemia: iron panel

A

Serum iron: low
TIBC: high
TSAT: low
Serum ferritin: low (most sensitive indicator)

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11
Q

Recommended daily iron allowance

A

Adult males and post menopausal females: 8mg

Menstruating females: 18mg

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12
Q

Food effects on iron absorption

A

Orange juice / ascorbic acid: increases absorption

Milk and tea: decreases absorption

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13
Q

Preferred dosing frequency for oral iron supplementation

A

every other day

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14
Q

Oral iron ADE

A

dark, discolored feces
constipation
nausea
vomiting

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15
Q

Drugs that decrease oral iron absorption

A

Al / Mg / Ca containing antacids
tetracycline and doxycycline
H2RA
PPIs
Cholestyramine

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16
Q

Drugs decreased by iron

A

Levodopa
Methyldopa
Levothyroxine
Penicillamine
Fluoroquinolones
Tetracycline and doxycycline
Mycophenolate

take at least 4 hours apart

17
Q

Indications for IV iron supplementation

A

Malabsorption
Poor adherence or tolerance to PO
Gastric bypass
CKD
Cancer while receiving active chemo

18
Q

IV iron formulations

A

target: 1000 mg total

Iron sucrose
- 200mg IV x 5 days
- subtract 1 dose for each pRBC transfusion received

19
Q

IV iron supplementation ADE

A

cramping
flushing
hypotension
N/V
GI irritation
rash
malaise
arthralgias
myalgias
hypophosphatemia
do not start during active infection

20
Q

Megaloblastic anemia

A

Abnormal DNA metabolism -> Vitamin B12/Folate deficiencies

Presentation
- traditional signs of anemia
- GI (loss of appetite, diarrhea, constipation)
- CNS (paresthesia, loss of coordination, tremors, somnolence, taste and smell abnormalities, irritability)

21
Q

B12 deficiency labs

A

RBC low
Hgb low
Hct low
MCV high
Reticulocyte count low
Serum B12 low
Serum folate eh
Serum methylmalonic acid High
Serum homocysteine High

22
Q

Macrocytic anemia treatment

A

B12 deficiency -> supplementation
Folate deficiency -> supplementation

23
Q

Normocytic anemia

A

anemia of inflammation
- anemia of chronic disease
- anemia of critical illness

24
Q

Diseases causing anemia of inflammation

A

Tuberculosis
HIV
COPD
Malignancies
Gout

25
How to tell Anemia of Inflammation from Iron Deficiency Anemia
TIBC AI: TIBC is low IDA: TIBC is high
26
Anemia of Inflammation treatment
Treat underlying condition Consider iron supp if pt also has IDA Erythropoiesis stimulating agents
27
Erythropoiesis stimulating agents
Approved for use in AI due to HIV, CKD, anemia of malignancy, and MDS Agents: - Epoetin alpha (Procrit, Epogen, Retacrit) - Darbepoetin alpha (Aransep) Only effective if iron, B12, and folic acid levels are adequate Monitor hemoglobin - DC if Hgb > 12 - hold or decrease dose if Hgb increases > 1 g/dL in 2 weeks
28
Epoetin alpha
Short acting ESA ADE - fever - N/V - HTN - cough - pruritis - rash - HA - Arthralgia
29
Darbepoetin alpha
Long acting ESA ADE: - infections - blood pressure alterations - HA - N/V - diarrhea - peripheral edema
30
pRBC transfusions indication
consider in acute oxygenation complications of hgb < 7