Anemia Flashcards
What are specific symptoms seen in iron deficiency anemia?
Glossitis (inflamed tongue)
Koilonychias (spoonshaped nails)
Pica (craving to eat non-foods)
What are causes of iron-deficiency anemia?
Pregnancy
Iron poor diet (vegetarian)
Blood loss
High gastric pH (low iron absorption (PPI)
Celiac disease, IBD, gastric bypass
Ferrous sulfate dosing
325 mg (65 mg of elemental iron)
20%
Ferrous sulfate DRIED dosing
160 mg (50 mg of elemental calcium)
30%
What is the recommended iron dose for iron deficiency anemia?
100-200 mg of elemental calcium per day
Ferrous Sulfate, dried 160 mg PO TID
Ferrous Sulfate 325 mg PO BID
Counseling points for iron supplementation
-take iron on an empty stomach (if possible)
- separate from PPI or antacids (iron 2 hours before or 4 hours after)
- may cause constipation or dark/tarry stools
- separate from Quinolones, Tetracyclines, Bisphosphonates, Levothyroxine, and Sinemet due to binding with iron
What is the antidote to iron overdose (common in children)?
Deferoxamine (Desferal)
***look for “fe”
What can you prescribe to help patients with iron-induced constipation?
Prescribe Docusate with iron to help loosen the hard stools up
Due to iron’s ability to bind and decrease the absorption of some medications, what medications must you separate from iron?
Levothyroxine
Quinolones
Tetracyclines
Sinemet
Bisphosphonates
What vitamin increases the absoprtion of iron?
Acorbic acid (vitamin C)
Venofer
Iron sucrose an IV formulation of iron
SE: hypersensitivity rxns, muscle aches, flushing
Ferumoxytol (Feraheme)
IV iron
SE: hypersensitivity rxns, muscle aches, flushing
When is IV iron indicated?
CKD on hemodialysis
CKD receiving ESA (need to correct iron 1st)
Inability to tolerate oral iron
What is 1st line treatment for macrocytic deficiency anemia?
Vitamin B12 injection (Cyanocobalamin)
What is the most common cause of normocyctic anemia?
Anemia of Chronic Kidney Disease
What anemia medication stimulates the bone marrow to produce Red Blood Cells (RBCs)
Erthropoietin Stimulating Agents
-Epoetin alfa (Epogen, Procrit)
-Darbepoetin (Aranesp)
Counseling points for ESAs
-do not shake vials
-given IV or SC (IV better for HD patients)
-strore in the fridge
-use the lowest necessary dose to prevent blood transfusions
Which drugs cause hemolytic anemia?
Cephalosporins
Dapsone
Isoniazid
Levodopa/Methyldopa
Methylene blue
Nitrofurantoin
Pegloticase
Penicillins
Primaquine
Quinidine
Quinine
Rasburcase
Rifampin
Sulfonamides
**check if AB are stock to RBCs with Coombs test
What deficiency should you look for in the risk of hemolytic anemia?
GP6D deficiency
***try to avoid hish-risk drugs
(Sinemet, Cephalosporins, Penicillins, Sulfonamides, Nitrofurantoin)
