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PHRM 864: Therapeutics IV > Anemia > Flashcards

Anemia Flashcards

1
Q

What is Anemia?

A
  • Decreased RBC or Hbg
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2
Q

What are some of the signs and symptoms of Anemia?

A
  • SOB, Chest Pain,Tachycardia, Fatigue, Paleness, Asymptomatic
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3
Q

What are some of the important bloodwork values that we should know for Anemia?

A
  • RBD: 4.5-5.5 x10^6 u/L [M] & 4.1-4.9x10^6 cells/uL [F]
  • Hgb: 13.5-18 g/L [M] & 12-16 g/dL [F]
  • Hct: 38-50% [M] & 36-46% [F]
  • MCV: 80-100 mm^3
  • MCH: 26-34 pg/cell
  • MCHC: 31-37 g/dl
  • RDW: 11.5-14.5%
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4
Q

Is Iron Supplementation the first line treatment in Anemia?

A
  • NO - it depends on the case
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5
Q

What are some of the causes for Anemia?

A
  • Decreased RBC production [chronic diseases or nutritional deficiencies]
  • Increased RBD destructinon [Drugs or Sickle Cell]
  • Increased RBC Loss [blood loss or NSAIDS/ASA]
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6
Q

What are the classifications of Anemia?

A
  • MICRO: MCV < 80 [Iron deficiency, Sickle Cell]
  • NORMAL: MCV 80-100 [Chronic Disease, Blood Loss]
  • MACRO: MCV > 100 [Folic Acid, B12]
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7
Q

What is the classification of Iron Deficiency Anemia?

A
  • Decreased Hgb
  • Decreased MCV
  • Increased or Normal RDW
  • Decreased Ferritin
  • Increased TIBC
  • Normal or Decreased Iron
  • Decreased TSAT
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8
Q

What are some of the important values for Iron Studies in Iron Deficiency Anemia?

A
  • Ferritin: 15-200ng/mL [Really <45]
  • Iron: 40-160 mcg/dL
  • Transferrin: 200-260 mg/dL
  • TIBC: 250-400 mcg/dL
  • TSAT: 20-50%
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9
Q

What is important to know about Ferritin within the Iron Studies in Iron Deficiency Anemia?

A
  • Anything <45 really is a deficiency
  • Inflammation or Chronic Disease gives a false positive
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10
Q

What are some of the causes for Iron Deficieny Anemia?

A
  • Blood Loss [menstration, donating]
  • Decreased Absorption
  • Vegetarian Diet [Heme from meat or Non-Heme from dairy or plants]
  • Increased Consumption [Pregnancy]
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11
Q

Can drugs cause Iron Deficieny Anemia?

A
  • NO - Drugs dont really cause any iron anemia
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12
Q

What are some of the addintional Signs and Symptoms ONLY for Iron Deficiency Anemia?

A
  • Spoon-shaped Nails
  • Inflamed Tongue
  • Pica [craving things with NO nutritional value]
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13
Q

What is the treatment of Iron Deficiency Anemia?

A
  • ORAL Iron [elemental iron]
  • Either 65mg every other day OR 120-200mg per day
  • 3-6 months to replete stores
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14
Q

When wouldn’t Oral Iron be used in Iron Deficiency Anemia and what would you use?

A
  • If they cant tolerate, cant absorb, ESRD, HF
  • Would switch to IV
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15
Q

Why might every other day dosing be better in Iron Deficiency Anemia?

A
  • Hepcidin: iron-regulating peptide in the liver that helps with absorption and transfering
  • within 48 Hours Hepcidin normalizes
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16
Q

What are some of the Oral Irons that could be used in Iron Deficiency Anemia?

A
  • Ferrous Fumarte 300mg [100mg - elemental]
  • Ferrous Sulfate 325mg [65mg - elemental]
  • Ferrous Gluconate 300mg [30mg - elemental]
17
Q

What are some important counseling points for Oral Iron in Iron Deficiency Anemia?

A
  • Increased Absorption on empty stomach
  • Stomach Upset - add food?
  • Increased Absorption with Vit C
  • Constipation
  • Dark Stools
18
Q

What is the classifaction of Vitamin B12 Deficiceny Anemia?

A
  • Decreased Hgb
  • Increased MCV
  • Increased RDW
  • Normal Ferritin/TIBC
  • Normal Iron/TSAT
  • Decreased B12 [<200pg/mL]
  • Increased Homocysteine
19
Q

What are some of the causes of Vitmain B12 Deficiency Anemia?

A
  • Diet [Vegans/Vegetarain, Alcoholism]
  • Decreased Absorption
  • Medications [PPIs, Metformin]
  • Pernicious Anemia [Rare]
20
Q

What is important to know about Vitamin B12 Deficiency?

A
  • Our bodies CANNOT make it; have to get from out diet
  • Could cause Neurologic issues [Weakness, Numbness, Cognitive, Dysfunction]
21
Q

What are some of the treatment options for Vitamin B12 Deficiency Anemia?

A
  • Oral B12 Replacement [1000-2000mcg/day] - BEST OPTION
  • IM/SubQ Replacement 100-1000mcg
22
Q

What are some of the classifications for Folic Acid Deficiency Anemia?

A
  • Decreased Hgb
  • Increased MCV
  • Increased RDW
  • Normal Ferritin/TIBC
  • Normal Iron/TSAT
  • Decreased Folate
  • Increased homocysteine
23
Q

What are some of the causes of Folic Acid Deficiency Anemia?

A
  • Malabsorption
  • Malnutrition [Green Vegatablesm Orange Juice, Cereal, Flour, Milk]
  • Alcoholism
  • Medications
24
Q

What are some of the Medications that could cause Folic Acid Deficiency Anemia?

A
  • Methotrexate
  • Phenytoin
  • Sulfasalazine
  • SMZ/TMP
25
Q

What are some fo the treatment options for Folic Acid Deficiency Anemia?

A
  • Oral Folic Acid 1-5 mg daily
  • IV not really used
  • Water Soluble Vitamin
26
Q

What is important to know about Folic Acid Deficiency Anemia?

A
  • ALL flour was enriched with Folic Acid to help prevent neural tube defects in pregnancy
  • ALWAY CHECK B12 TOO
27
Q

What are some of the common Chronic Diseases that could cause Anemia?

A
  • CKD
  • CHF
  • Cancer
  • HIV/AIDS
28
Q

What is the way that CKD could cause Anemia?

A
  • Erythropoietin is made in the kidenys which stimulates the production of RBC
  • Anemia = Decreased Erythropoietin, Chronic Inflammation, Nutritional Issues
29
Q

What are some treatment options for CKD in Anemia?

A
  • AVOID blood transfusion
  • Correct Nutritional Deficiencies
  • ESAs
30
Q

What is important to know about Blood Transfusion in Anemia of CKD?

A
  • AVOID –> risk of making antibodies
31
Q

What is important to know about Correcting Nutritional Deficiences in Anemia of CKD?

A
  • Give Folate/B12
  • ORAL Iron in Stages 3-5 & IV in Hemodialysis
  • Target is TSAT of 30%
32
Q

What is important to know about ESA in Anemia of CKD?

A
  • Helps prevent blood transfusion
  • DO NOT target NORMAL Hbg
  • Hgb NEEDS to be >10
  • Can cause cardio issues
33
Q

What are some of the treatment options for Heart Failure in Anemia?

A
  • IV Iron if NYHA Class II/III HF AND Iron Deficiency [Ferritin <100 OR 100-300 if TSAT <20%]
  • ORAL & Erythropoitein have not benefit
34
Q

What is the way that we treat Blood Loss Anemia?

A
  • Stop the bleeding
  • Tranfuse RBC when Hgb < 7 [1 unit = 250 mg iron]
35
Q

What is Hemolytic Anemia?

A
  • RBC are destoryed before 120 days
36
Q

What are the two types of Hemolytic Anemia?

A
  • Inherted: Sickle Cell, G6PD Deficiency
  • Acquired: Drug Induced
37
Q

What is important to know about Sickle Cell Anemia?

A
  • RBC are Sickle shaped = faster destruction
38
Q

What is the way that are can treat Sickle Cell Anemia?

A
  • Folic Acid 1mg [increased erythropoiesis]
  • Blood Transfusions [might iron overload them]
  • Hydroxyurea 10-15mg/kg/day –> MAX: 35mg/kg/day
  • Immunizations
  • Pain Control Acetaminophen, NSAIDS, Opioids
39
Q

What are the Drug Induced Anemia Types?

A
  • Aplastic
  • Immune Hemolytic
  • Oxidatvie [affects 6GPD deficiency]
  • Megaloblastic

PHRM 864: Therapeutics IV (28 decks)

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