Anemia Flashcards
MCV
mean corpuscular volume, low MCV means smaller than normal RBC, and high means larger than normal RBC
MCV <80 fl= microcytic likely iron deficiency
MCV 80-200 fl= likely cause acute blood loss, malignancy, CKD, bone marrow failure, hemolysis
MCV>100 fl= most likey vitamin b12 or floate deficiency
Iron studies
further evaluate microcytic anemia
serum iron, serum ferritin, TIBIC, TSAT
Vitamin B12 and folate levels
further evaluate macrocytic anemia
folate, B12, homocysteine, methylmalonic acid
reticulocyte count
measures the production of RBCs. a low count is low in untreated anemia is due to iron, folate, b12 deficiency and with bone marrow suppression.
Hemoglobin, hematocrit, RBC count reticulocyte count
lab finding that indicate anemia
- decreased Hgb, MCV< 80, decreased RBC production (low reticulocyte count)
- decreased serum iron, ferritin, and TSAT
- increased TIBC
anemia tx oral therapy
- 100-200mg elemental iron per day
- avoid H2RA and PPIs; separate from antacids
- sustained-release or enteric-coated formation cause less GI irritation but are not recommended due to poor absorption
anemia tx goal
increase serum Hgb by 1g/dl every 2-3 weeks, continue tx for 3-6 months after anemia has resolved until iron stores return to normal
% elemental iron in oral products
ferrous gluconate 12%
ferrous sulfate 20%
ferrous sulfate, dried 30%
ferrous fumarate 33%
carbonyl iron, polysaccharide iron complex, ferric maltol 100%
Ferrous sulfate
FeroSul, Fer-In-Sol, OTC
325mg (65mg elemental) TID
20% elemental
Ferrous sulfate, dried
Slow Fe, Slow Iron
160mg (50mg elemental) TID
30% elemental
Ferrous fumarate
Ferrets, ferrimin 150, hemocyte
324mg (106mg elemental) TID
33% elemental
Ferrous gluconate
Ferate
324mg (38mg elemental) TID
12% elemental
carbonyl iron
FerraPlus 90, Ferralet 90, Iron chews
90mg (90mg elemental) PO daily
100% elemental
Polysaccharide iron complex
Ferrex 150
150mg (150mg elemental) dail
100% elemental y
Feerric maltol
Accrufer
30mg (30mg elemental) PO BID
100% elemental
oral iron info
- accidental overdose can occur!!!…. go to ED or call the poison center- antidote: deferoxamine (Desferal)
- SE: constipation dose-related, docusate can be recommended often w/supplement
- need acidic gut, avoid antacids, PPI and H2RAs (they increase gastric pH)
- Iron is a polyvalent cation (decrease other drugs absorption by binding to them)
—-> quinolone and tetracycline- take iron 2 hrs before or 4-8 hrs after
—-> bisphosphonates: 60min after ibandronate or 30 min after alendronate/risedronate
—-> cefdinir, dolutegravir, levothyroxine, levodopa, methyldopa: separate by 2-4 hrs - Vitamin C increases absorption of iron…acidic gut
IV parental iron
generally restricted for:
CKD on hemodialysis
CKD receiving erythropoiesis-stimulating agent (ESAs)
unable to tolerate oral Iron… or failure of oral therapy (IBD, celiac disease, H. pylori, etc.)
IV parental iron products
Iron Sucrose
Ferumoxytol
Iron dextran complex
Iron Sucrose (Venofer)
Ferumoxytol (Feraheme)
iron dextran (INFeD)
all pt receiving dextran should be tested before. dextran or ferumoxytol warning for fetal anaphylactic reactions.
all carry a risk for hypersensitivity reaction
Ferric pyrophosphate citrate (Triferic)- is only indicated for iron replacement in hemodialysis-dependent CKD. should be added to bicarbonate concentration.
Macrocytic anemia
low Hgb and high MCV
cyanocobalamin vitamin b12- IM/Sc daily/weekly/monthly
oral/sublingual- 1,000-2,000mcg
nascobal: 500mcg nasal- weekly one nostril
folic acid, folate, vitamin B9 0.4-1mg daily
epoetin alfa
Epogen, Procrit
CKD
3x weekly, initiate when Hgb <10g/dL
stop or decrease therapy when HgB approaches or exceeds 11g/dL
Chemo
initiate when Hgb <10g/dL when at least 2 additional months of chemo
for all indications titrate dose up or down but do not increase dose more frequently than once every 4 weeks
- ESA
Darbepoetin
Aranesp
CKD
IV or Sc weekly
chemo
2.25 mcg weekly IV or 500mcg Sc every 3 weeks
t1/2 is 3 for longer than epoetin alfa… give weekly
for all indications titrate dose up or down but do not increase dose more frequently than once every 4 weeks
- ESA
ESA info
generally last last last line for all
do not use in curable cancer cause it does increase there is of tumor progression!
increased risk of death, MI, stroke, VTE, thrombosis!
CKD: increased risk of death when Hgb>11
cancer: shortened overall survival… not indicated when the anticipated outcome is cure
refrigerate, protect from light. Do not shake
G6PD
glucose-6-phosphate dehydrogenase deficiency, is X-linked inherited disorder commonly affects African, Asia, middle eastern
G6PD protects RBCs from harmful substances.
G6PD
select drugs that can cause hemolysis
hemolytic anemia select drugs to monitor in G6PD
- cephalosporins
- Dapsone (AVOID in G6PD)
- Isoniazid
- Methyldopa
- Methylene blue (AVOID in G6PD)
- Nitrofurantoin (AVOID in G6PD)
- Pegloticase (AVOID in G6PD)
- penicillins
- primaquine (AVOID in G6PD)
- quindine
- quinine
- Rasburicase (AVOID in G6PD)
- Rifampin
- Sulfonamide* (AVOID in G6PD)
