Anemia

Question 1

Iron Deficiency Anemia (IDA)

Dx & Tx

Answer 1

All treatments of IDA should include high-potency vit. B complex and vit. C.

Oral iron forms: (MW < 1000 Da)
Ferrous sulfate is the most commonly used form. Adults: BID, Elderly: QD.
Ferric forms: requires reduction to ferrous form in the intestinal lumen.

How long should you treat: Correct to target Hb plus at least 2 months to replenish body stores
**Treat at least 1 month + 2 months to replenish iron storage

Factors that > iron absorption: Anything that > stomach acidity (vit C, orange juice). Avoid PPI, enteric coated.

Side effects of oral iron: stomach pain, nausea, constipation, black tarry stools
Side effects of injectable iron: allergy, anaphylaxis, and hypotension
Contraindications of iron therapy: Known drug allergy, hemochromatosis, hemolytic anemia. Caution with: IBD (UC, CD), peptic ulcer. Iron in the stomach can impair the absorption of other drugs

Question 2

B12 & Folate Deficiency Anemia

Answer 2

Both: Hypo-proliferative Anemia (bone-marrow is under producing RBC). Caution: hypokalemia during replacement. monitor K levels in case they need potassium replacement. Macrocytic Anemia.

B12: Give B12. Caused by diet (vegans/strict vegetarians) & metformin: PO B12
bariatric surgery & pernicous anemia: Parenteral B12.

Folate: Give Folate. Avoid sulfa abx (TMP-SMX)

Question 3

Drug-Induced Macrocytosis

Answer 3

(N. RDW) carbamazepine, valproic acid, phenytoin, and alcohol (>3 drinks in a woman, >5 drinks in a man)

Question 4

Anemia of Chronic Disease

Answer 4

Especially in CKD, Tx: EPO. Baseline H&H 7/21 (watery), Goal: HMG 10-12 to avoid slow flow ischemia (thrombosis).

SE of Erythropoetin = > BP

Question 5

Sickle Cell Anemia

Answer 5

Adult with sickle cell & fever, they are immunocompromised (no spleen). Tx: Abx