Anemia Flashcards
MCV < 80 fL
microcytic
-due to iron deficiency
MCV 80-100 fL
normocytic
-cause: acute blood loss, malignancy, CKD, bone marrow, hemolysis
MCV > 100 fL
macrocytic
-likely due to vitamin B12 or folate deficiency
dx of iron deficiency anemia
- decrease Hgb, low MCV, RBC production
-decrease serum iron, ferritin and TSAT - increase TIBC
iron deficiency anemia tx
-100-200 mg elemental iron/day
-take on empty stomach
-avoid H2RAs and PPI - separate from antacids
ferrous sulfate
20% elemental iron
-325 mg (65 mg of elemental iron) PO TID
ferrous sulfate dried
30% elemental iron
-160 mg (50 mg elemental iron)
safety of oral iron
-accidental overdose of iron-containing products in children that can cause fatal poisoning under 6
-constipation, dark and tarry stools
iron overdose antidote
deferoxamine (desferal)
antacids, H2RAs and PPIs
decrease iron absorption by increasing gastric PH
-take 2 hours before or 4 hours after taking antacids
quinolone and tetracycline abx & iron
take iron two hours before or 4-8 hrs after these agents due to chelation
bisphosphonates & iron
take iron 60 min after oral ibandronate or 30 minutes after alendronate/risedronate
levothyroxine and iron
separate from iron by 2-4 hours
vitamin C
increases the absorption of iron
when to use IV iron
CKD on HD
CKD on ESAs
unable to tolerate oral iron or failure of oral therapy
iron sucrose (venofer) and ferumoxytol (feraheme)
-serious and sometimes fatal anaphylactic reactions iron dextran or ferumoxytol; all patients receiving iron dextran should be given a test dose
-all parenteral iron products carry a risk for hypersensitivity reactions
causes of macrocytic anemia
vitamin B12, folate deficiency, alcoholism, poor nutrition, GI disorders, and pregnancy
dx of macrocytic anemia
-low hgb and high MCV
-low B12 or folate
tx of macrocytic anemia
-vitamin B12 injections (cyanocobalmin) are first line - IM or deep SC 100-1000 mcg daily/weekly/monthly
-Folic acid, folate
Anemia of chronic kidney disease
deficiency in EPO
tx of anemia of CKD
IV iron is first line for HD patients (non-HD can have oral iron
ESAs
Epoetin Alfa (Epogen, Procrit)
Darbepoetin (Aranesp)
*help maintain Hgb levels and reduce the need for blood transfusions but are ineffective if iron stores are low
Epogen, Procrit
CKD:
-3x/week
-initiate when Hgb < 10 g/dL
-decrease or interrupt dose when Hgb approaches or exceeds 11 g/dL
Cancer:
-initiate when Hgb < 10 g/dL
Aranesp
CKD:
-IV or SC weekly
-half-life is 3 fold longer than epogen
all ESAs
-increase risk of death, MI, stroke, VTE, thrombosis
-use lowest effective dose
-CKD: increase risk of death when hgb > 11 g/dL
-cancer: no indicated when the anticipated outcome is cure
-HTN, arhtralgias
-monitor: H/H TSAT, serum ferritin, BP
-do not shake
hemolytic anemia
drug induced, sickle cell, or G6PD deficiency
drugs that cause hemolytic anemia
cephalosporins, dapsone, isoniazid, levodopa, methyldopa, methylene blue, nitrofurantoin, pegloticase, penicillins, primaquine, quinidine, quinine, rasburicase, rifampin, sulfonamides
immunizations in sickle cell disease: routine childhood series
Hib and PCV13
immunizations in sickle cell disease: additional vaccines for functional asplenia
meningococcal conjugate series + booster
meningococcal serogroup B
pneumococcal vaccines: PCV20 x1 or PCV15 x1 followed by PPSV23 > 8 weeks later
Infections: sepsis and meningitis
S.pneumoniae, H. influenza, N. menigitidis
-utilize prophylactic penicillin
disease-modifying drug in sickle cell disease
hydroxyurea
Hydroxyurea (Draxia, Hydrea, Siklos)
-myelosuppression, fetal toxicity, avoid live vaccinations
-CBC w/diff every 2-4 weeks during initiation and titration
-contraception required
-folic acid supplementation
-hazardous (wear gloves and wash hands)
L-glutamine (Endari)
reduce complications of SCD
Voxelotor (Oxbryta)
inhibiting HgbS polymerization
Crizanlizumab (Adakveo)
reduce frequency VOC in SCD
