Anemia

Question 1

MCV < 80 fL

Answer 1

microcytic
-due to iron deficiency

Question 2

MCV 80-100 fL

Answer 2

normocytic
-cause: acute blood loss, malignancy, CKD, bone marrow, hemolysis

Question 3

MCV > 100 fL

Answer 3

macrocytic
-likely due to vitamin B12 or folate deficiency

Question 4

dx of iron deficiency anemia

Answer 4

• decrease Hgb, low MCV, RBC production
  -decrease serum iron, ferritin and TSAT
• increase TIBC

Question 5

iron deficiency anemia tx

Answer 5

-100-200 mg elemental iron/day
-take on empty stomach
-avoid H2RAs and PPI - separate from antacids

Question 6

ferrous sulfate

Answer 6

20% elemental iron
-325 mg (65 mg of elemental iron) PO TID

Question 7

ferrous sulfate dried

Answer 7

30% elemental iron
-160 mg (50 mg elemental iron)

Question 8

safety of oral iron

Answer 8

-accidental overdose of iron-containing products in children that can cause fatal poisoning under 6
-constipation, dark and tarry stools

Question 9

iron overdose antidote

Answer 9

deferoxamine (desferal)

Question 10

antacids, H2RAs and PPIs

Answer 10

decrease iron absorption by increasing gastric PH
-take 2 hours before or 4 hours after taking antacids

Question 11

quinolone and tetracycline abx & iron

Answer 11

take iron two hours before or 4-8 hrs after these agents due to chelation

Question 12

bisphosphonates & iron

Answer 12

take iron 60 min after oral ibandronate or 30 minutes after alendronate/risedronate

Question 13

levothyroxine and iron

Answer 13

separate from iron by 2-4 hours

Question 14

vitamin C

Answer 14

increases the absorption of iron

Question 15

when to use IV iron

Answer 15

CKD on HD
CKD on ESAs
unable to tolerate oral iron or failure of oral therapy

Question 16

iron sucrose (venofer) and ferumoxytol (feraheme)

Answer 16

-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

Question 17

causes of macrocytic anemia

Answer 17

vitamin B12, folate deficiency, alcoholism, poor nutrition, GI disorders, and pregnancy

Question 18

dx of macrocytic anemia

Answer 18

-low hgb and high MCV
-low B12 or folate

Question 19

tx of macrocytic anemia

Answer 19

-vitamin B12 injections (cyanocobalmin) are first line - IM or deep SC 100-1000 mcg daily/weekly/monthly
-Folic acid, folate

Question 20

Anemia of chronic kidney disease

Answer 20

deficiency in EPO

Question 21

tx of anemia of CKD

Answer 21

IV iron is first line for HD patients (non-HD can have oral iron

Question 22

ESAs

Answer 22

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

Question 23

Epogen, Procrit

Answer 23

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

Question 24

Aranesp

Answer 24

CKD:
-IV or SC weekly
-half-life is 3 fold longer than epogen

Question 25

all ESAs

Answer 25

-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

Question 26

hemolytic anemia

Answer 26

drug induced, sickle cell, or G6PD deficiency

Question 27

drugs that cause hemolytic anemia

Answer 27

cephalosporins, dapsone, isoniazid, levodopa, methyldopa, methylene blue, nitrofurantoin, pegloticase, penicillins, primaquine, quinidine, quinine, rasburicase, rifampin, sulfonamides

Question 28

immunizations in sickle cell disease: routine childhood series

Answer 28

Hib and PCV13

Question 29

immunizations in sickle cell disease: additional vaccines for functional asplenia

Answer 29

meningococcal conjugate series + booster
meningococcal serogroup B
pneumococcal vaccines: PCV20 x1 or PCV15 x1 followed by PPSV23 > 8 weeks later

Question 30

Infections: sepsis and meningitis

Answer 30

S.pneumoniae, H. influenza, N. menigitidis
-utilize prophylactic penicillin

Question 31

disease-modifying drug in sickle cell disease

Answer 31

hydroxyurea

Question 32

Hydroxyurea (Draxia, Hydrea, Siklos)

Answer 32

-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)

Question 33

L-glutamine (Endari)

Answer 33

reduce complications of SCD

Question 34

Voxelotor (Oxbryta)

Answer 34

inhibiting HgbS polymerization

Question 35

Crizanlizumab (Adakveo)

Answer 35

reduce frequency VOC in SCD