Anemia

Question 1

Anaemia causes?

Answer 1

1. Defective RBC production (nutritional) OR ↑ RBC destruction (hemolysis)
2. Blood loss (parasites, ulcers, tumors, ↑ menstruation)
3. BM replacement, abnormal Hb/RBC, chronic systemic diseases

Question 2

Anaemia signs & symtoms?

Answer 2

1. Palor (skin, mucous membranes, conjunctivae)
2. Exertional dyspnoea, fatigue, tachycardia
3. Eyes red in sever anemia
4. CNS: fainting
5. Heart: Chest pain, angina & heart attack

Question 3

Classification of and their subtypes?

Answer 3

1. Microcytic <80 dL:
    -Iron deficiency anaemia
    Anaemia of chronic
   disease
    -Thalassaemia
    -Sideroblastic anaemia
2. Normocytic anemia 80-90 dL
   -Hemolytic anaemia
   -Aplastic anaemia (bone
   marrow disorders)
3. Macrocytic >90 dL:
   -Megaloblastic anaemia
   (Vit. B12, folate
   deficiency, drug induced)
   -Non-megaloblastic
   anaemia (alcohol abuse,
   hypothyroidism,
   pregnancy)

Question 4

Iron Deficiency Anaemia?

Answer 4

Iron deficiency the most common cause → hypochromic microcytic RBCs

Question 5

Iron Deficiency Anaemia Pathogenesis?

Answer 5

blood loss (menstruation, GIT, trauma); increased
requirements (pregnancy); decreased absorption (e.g. regional enteritis)
-Most common in children and women of child bearing age
-In pregnancy and nursing females: folate deficiency and/or combined iron/folate
deficiency commo

Question 6

Symptoms of iron deficiency

Answer 6

-pallor
-lethargy
-fatigue

Question 7

Iron Deficiency Anaemia treatment goals?

Answer 7

Normalise Hb and hematocrit (Htc) and replenish body iron stores

Question 8

Iron Deficiency Anaemia Non-pharmacological treatment:

Answer 8

1. Identify the cause; e.g. chronic blood loss, and remove it if possible
   
2. Patient counselling, lifestyle modifications/adjustments

Question 9

Iron Deficiency Anaemia drug tx?

Answer 9

Adm of Iron preparations (necessary for Hb production):

1. Oral (ferrous salts): ferrous sulphate, ferrous gluconate, ferrous fumarate, ferrous bisglycate (amino acid chelate)
2. Parenteral : Iron dextran, Iron sucrose

Question 10

Factors affecting iron absorption that Increasing iron absorption?

Answer 10

1. Vitamin C (ascorbic acid)
2. Citric acid
3. Gastric secretions
4. Hydrochloric acid
5. Acidic pH

Question 11

Factors affecting iron absorption that Decreasing iron absorption?

Answer 11

 1. Phytate
 2. Phosphate
 3. Tannate
 4. Tetracycline
 5. EDTA
 6. Milk
 7. Alkaline pH

Question 12

Oral Iron Preparations

1. Indications(2)
2. CI(4)
3. Cautions(2)
4. DI(7)
5. A/E(4(

Answer 12

1. Indications:
   Prophylaxis and Tx of iron deficiency anaemia
2. CI:
   iron overload, chronic alcoholism, liver disease, repeated blood
   transfusion
3. Cautions:
    -Geriatrics: may cause constipation, faecal impaction, reduced
   absorption may necessitate large doses
   - Paediatrics: accidental poisoning common (use correct doses)
4. DI:
   Compounds containing Ca, Mg, Al, Bicarbonates, Phosphates
   (decreased absorption); Tetracyclines (↓absorption of both), Vitamin E
   impaired response to iron therapy
5. A/E:
   nausea
   epigastric pain
   diarrhoea
   constipation

Question 13

Parenteral Iron Preparations Include?

Answer 13

1. Iron polymaltose (IM)
2. Iron Sucrose (IV)
3. Iron dextran ( IM/slow IV) iron
4. carboxymaltose (IV)
5. iron isomaltoside (IV)

Question 14

Why would oral iron therapy fail & what is the solution?

Answer 14

1. Due to non-adherence, inflammation, malabsorption, continuing blood loss

SOLUTION:

(Malabsorption can be evaluated by measuring iron levels every 30 mins
for 2 hrs after admin of 50mg of ferrous sulphate)

2.If plasma iron levels increase by >50%, absorption is adequate

3. Intolerance to oral therapy
4. Required antacids therapy
5. Significant blood loss in pts refusing transfusion

Question 15

Parenteral Iron Preparations?

Answer 15

1. Iron carboxymaltose
   (I.V
   Iron isomaltoside (I.V)
2. Iron dextran OR Iron
   sucrose (I.M/ I.V)
3. Iron isomaltoside (I.V)
4. Iron polymaltose (I.V)

Question 16

Iron carboxymaltose
(I.V

1. Indications
2. A/E(4)
3. CI(2)

Answer 16

1. Indications:
   iron deficiency
2. A/E:
   headache, N, rash,
   phlebitis on injection
   site
3. CI:
   severe liver damage,
   iron overload, 1st trim.
   of pregnancy

Question 17

Iron dextran OR Iron
sucrose (I.M/ I.V)

1. Indications
2. A/E(4)
3. CI(5)

Answer 17

1. Indications
   severe iron deficiency
   in adults
2. A/E(4);
   metallic taste,
   headache,
   hypotension, N&V
3. CI(2)
   Iron overload,
   concurrent blood
   transfusion, liver
   disease, infection,
   history of allergies

Question 18

Iron isomaltoside (I.V)

1. Indications
2. A/E(5)
3. CI(5)

Answer 18

1. Indications:
   iron deficiency
2. A/E(4)
   N, rash, abdominal
   disorders,
   constipation, fever,
   dyspnoea
3. CI(5)
   severe liver damage,
   iron overload,
   infection, acute renal
   failure, active RA, 1st
   trim. of pregnancy

Question 19

Iron polymaltose (I.V)

1. Indications
2. A/E(4)
3. CI(3)

Answer 19

1. Indications;
   iron deficiency
2. A/E(4)
   allergic reactions,
   fever, leukocytosis,
   tachycardia
3. CI(3)
   haemolytic anaemia,
   severe liver damage,
   bone marrow
   depression

Question 20

Parenteral Iron Preparations general S/E?(3)

Answer 20

 1.Anaphylactic reactions
 2.Urticaria
 3.Lymphadenopathy

Question 21

Parenteral Iron Preparations allergies?

Answer 21

Parenteral iron preparations must be used with caution in
patients with history of asthma or allergies

Question 22

Anaemia of Chronic Disease characteristics ?

Answer 22

↓↓↓ RBC count

Question 23

Anaemia of Chronic Disease states?

Answer 23

1. Infections
2. Malignancy
3. Diabetes
4. Autoimmune disorders

Question 24

Anaemia of Chronic Disease Cause?

Answer 24

Continuous inflammation by Chronic Disease

-Impairs iron metabolism → ↓RBC production

Question 25

Anaemia of Chronic Disease Tx(3)?

Answer 25

1. Resolve the underlying cause 2. Blood transfusions for symptomatic anaemia 3. Recombinant human erythropoietin (EPO); though expensive

Question 26

Erythropoietin (EPO)?

Answer 26

Glycosylated protein hormone, haematopoietic growth factor

Question 27

Erythropoietin (EPO) MOA?

Answer 27

stimulate erythropoiesis → increase RBC production

Question 28

Recombinant erythropoietins?

Answer 28

1. Epoetin alfa & beta 2. darbepoetin alfa

Question 30

Erythropoietin (EPO) A/E?

Answer 30

1.Hypertension 2. Headache 3. Seizures 4. Flu-like symptoms 5.Rash 6. pruritus 7. injection site reaction

Question 31

Erythropoietin (EPO) CI(3)?

Answer 31

Uncontrolled hypertension myeloid malignancy known hypersensitivity, children <6 years, untreated iron deficiency

Question 32

Thalassaemia

Question 33

Erythropoietin (EPO) costs?

Answer 33

Expensive

Question 34

Sideroblastic Anaemia plasma concentrations ?

Answer 34

↑ serum iron, ↓TIBC, ↑ ferritin level

Question 35

Consequences of Immature RBC in bone marrow

Answer 35

1. Can’t utilize iron for haem synthesis → iron accumulation in mitochondria 2. Unused iron builds up in blood → ↓TIBC

Question 36

Sideroblastic Anaemia Dx(2)?

Answer 36

1. Bone marrow biopsy 2. genetic testing

Question 37

Sideroblastic Anaemia Tx?

Answer 37

Alcohol/meds cessation if that’s the cause; vitamin/mineral supplementation; bone marrow transplant.

Question 38

Megaloblastic Anaemia

Answer 38

Caused by a deficiency of folic acid and/or vitamin B → large, oval (macrocytic), well haemoglobinised RBCs.

Question 39

Folic Acid Deficiency Anaemia?

Answer 39

Folic acid deficiency → insufficient DNA synthesi

Question 40

Folic Acid Deficiency Anaemia causes?

Answer 40

Insufficient intake in diet, alcoholism, pregnancy

Question 41

Folic Acid Deficiency Anaemia frequency?

Answer 41

Common in pregnancy and in the elderly

Question 42

Why must folate deficiency be differentiated from B deficiency?

Answer 42

Folate deficiency must be differentiated from B deficiency because folate can reverse the haematological but not the neurological damage caused by B deficiency

Question 43

Types of megaloblastic Anaemia?

Answer 43

1. Folic Acid Deficiency Anaemia 2. Vitamin B Deficiency/ Pernicious Anaemia

Question 44

Vitamin B12 importance?

Answer 44

Vitamin B is essential for haematopoiesis, maintenance of myelin and production of epithelial cells

Question 45

Vitamin B Deficiency/ Pernicious Anaemia causes?

Answer 45

Impaired absorption (lack of intrinsic factor bacterial overgrowth)

Question 46

Reason for admin for vitamin B12?

Answer 46

Oral absorption of Vit B is very poor, therefore it should be given parenterally

Question 47

Vit B12 target?

Answer 47

Vit B deficiency occurs specifically in adults

Question 48

Non-Pharmacological Treatment of Megaloblastic Anaemia?

Answer 48

Dietary modifications to ensure adequate intake of folate and vit B

Question 49

Megaloblastic Anaemia tx goals?

Answer 49

1. Normalise Hb 2. Identify and treat the underlying cause (e.g. malabsorption)

Question 50

Drug Treatment of megaloblastic anemia?

Answer 50

1.Folic acid; 5mg daily until normal Hb/ ↑demand stops (in pregnancy give with Iron) 2. Vitamin B 12 (Cyanocobalamin); IM, 1000μg, alternate days for 1 week, then monthly for life.

Question 51

Aplastic Anaemia?

Answer 51

Anaemia caused by destruction or inhibition of red bone marrow

Answer 52

Drugs (e.g. chloramphenicol), cancer chemotherapeutics, and insecticides (e.g. DDT)