Anemia Flashcards
Anemia definition
low hemoglobin concentration in the blood (<13 g/dL in men OR <12 g/dL in women)
Normocytic Anemia
MCV 80-100
Aplastic anemia
Anemia of chronic disease
CKD
Hemolytic Anemia
Microcytic anemia
MCV < 80
- iron deficiency anemia
- thalassemia
Macrocytic anemia
MCV > 100
- folic acid deficiency
- Vitamin B12 deficiency
- liver disease
- alcohol
- hypothyroidism
- drugs (sulfonamides, antineoplastics)
Causes of Iron Deficiency Anemia
Blood loss
- menstruation
- GI bleed
- hemorrhoids
- medication use (NSAIDs, anticoagulants, corticosteroids)
- iron malobsorption
Serum iron def
Fe bound to transferrin
Total iron binding capacity (TIBC)
Indirect measurement of the iron binding capacity of serum transferrin
Percent transferrin saturation (TSAT)
Ratio of serum iron to TIBC
Serum ferritin
the amount of iron stored in the liver, spleen, and bone marrow cells
Iron Deficiency Anemia: iron panel
Serum iron: low
TIBC: high
TSAT: low
Serum ferritin: low (most sensitive indicator)
Recommended daily iron allowance
Adult males and post menopausal females: 8mg
Menstruating females: 18mg
Food effects on iron absorption
Orange juice / ascorbic acid: increases absorption
Milk and tea: decreases absorption
Preferred dosing frequency for oral iron supplementation
every other day
Oral iron ADE
dark, discolored feces
constipation
nausea
vomiting
Drugs that decrease oral iron absorption
Al / Mg / Ca containing antacids
tetracycline and doxycycline
H2RA
PPIs
Cholestyramine
Drugs decreased by iron
Levodopa
Methyldopa
Levothyroxine
Penicillamine
Fluoroquinolones
Tetracycline and doxycycline
Mycophenolate
take at least 4 hours apart
Indications for IV iron supplementation
Malabsorption
Poor adherence or tolerance to PO
Gastric bypass
CKD
Cancer while receiving active chemo
IV iron formulations
target: 1000 mg total
Iron sucrose
- 200mg IV x 5 days
- subtract 1 dose for each pRBC transfusion received
IV iron supplementation ADE
cramping
flushing
hypotension
N/V
GI irritation
rash
malaise
arthralgias
myalgias
hypophosphatemia
do not start during active infection
Megaloblastic anemia
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)
B12 deficiency labs
RBC low
Hgb low
Hct low
MCV high
Reticulocyte count low
Serum B12 low
Serum folate eh
Serum methylmalonic acid High
Serum homocysteine High
Macrocytic anemia treatment
B12 deficiency -> supplementation
Folate deficiency -> supplementation
Normocytic anemia
anemia of inflammation
- anemia of chronic disease
- anemia of critical illness
Diseases causing anemia of inflammation
Tuberculosis
HIV
COPD
Malignancies
Gout
How to tell Anemia of Inflammation from Iron Deficiency Anemia
TIBC
AI: TIBC is low
IDA: TIBC is high
Anemia of Inflammation treatment
Treat underlying condition
Consider iron supp if pt also has IDA
Erythropoiesis stimulating agents
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
Epoetin alpha
Short acting ESA
ADE
- fever
- N/V
- HTN
- cough
- pruritis
- rash
- HA
- Arthralgia
Darbepoetin alpha
Long acting ESA
ADE:
- infections
- blood pressure alterations
- HA
- N/V
- diarrhea
- peripheral edema
pRBC transfusions indication
consider in acute oxygenation complications of hgb < 7
