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Anemia Flashcards

1
Q

Describe: erythrocyte development

A

-non-nucleocyte, non-dividing
-90% of cell -> hemoglobin (Hgb)
-40-50% to total blood volume
-maturation process takes ~1 week
-lifespan ~120 days

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2
Q

Define: Anemia

A

reduction in red cell mass, decrease in Hgb concentration
-women: Hgb < 12g/dL
-men: Hgb <13 g/dL

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3
Q

What are the signs and symptoms of acute anemia?

A

tachycardia, dyspnea, palpitations, hypotension

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4
Q

What are the signs and symptoms of chronic anemia?

A

fatigue/weakness, dizziness, decreased exercise tolerance, cold sensitivity, pallor

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5
Q

What is MCV?

A

mean corpuscular volume (MCV) is the average volume of red blood cells (RBC)

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6
Q

What is MCH?

A

mean corpuscular hemoglobin (MCH) is the average volume of Hgb in RBC

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7
Q

What is decreased MCV indicative of?

A

microcytic anemia

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8
Q

What is increased MCV indicative of?

A

macrocytic anemia

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9
Q

What is decreased MCH indicative of?

A

microcytosis or hypochromia

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10
Q

What is MCHC?

A

mean corpuscular hemoglobin concentration (MCHC) is the weight of Hgb per volume of cells

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11
Q

What is decreased MCHC indicative of?

A

hypochromia

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12
Q

What is RDW?

A

red blood cell distribution width (RDW) is RBC size variability

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13
Q

What is increased RDW indicative of?

A

early iron deficiency anemia or mixed anemia

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14
Q

What is microcytic, hypochromic morphology indicative of?

A

iron deficiency anemia

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15
Q

What is normocytic, normochromic morphology indicative of?

A

blood loss, hemolysis, chronic disease

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16
Q

What is macrocytic morphology indicative of?

A

vitamin B12 deficiency anemia, folic acid deficiency anemia

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17
Q

What is hypo-proliferation indicative of?

A

iron deficiency anemia, bone marrow damage, renal failure, chronic inflammation

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18
Q

What is hemolysis or hemorrhage indicative of?

A

hemolytic anemia, sickle cell, autoimmune disease, blood loss

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19
Q

What is maturation disorders indicative of?

A

folic acid deficiency anemia, B12 deficiency anemia, thalassemia

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20
Q

What is the daily iron need for menstruating women?

A

18mg

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21
Q

What is the daily iron need for men and non-menstruating women?

A

8mg

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22
Q

What foods include iron?

A

-heme iron: meat, fish, eggs
-non-heme iron: plant sources, legumes, dairy

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23
Q

What are the risk factors for iron deficiency anemia?

A

-blood loss: menstruation, GI disorders, trauma
-decreased absorption: medications( antacids, H2 blockers, PPIs), diet, gastrectomy, gastric bypass surgery
-increased demand: pregnancy, lactation, infancy, adolescence

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24
Q

What are the signs and symptoms of iron deficiency anemia?

A

-spoon shaped nails
-glossitis
-stomatitis
-pica (craving and eating foods that are not considered food items)
-pagophagia
-reduced salivary flow

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25
What laboratory values are indicative of iron deficiency anemia?
-decreased Hgb, MCV, MCHC, serum ferritin, serum iron, reticulocytes, % transferrin sat -increased TIBC, RDW (early or new)
26
What is iron dosing for adults?
up to 150-200 mg/day divided every 8-24 h
27
What is the iron dosing for pediatrics?
-mild to moderate: 3 mg/kg/day divided every 12-24h -severe: 4 to 6 mg/kg/day divided every 8h
28
What percent of ferrous sulfate is elemental iron?
20%, 65mg elemental iron
29
What percent of polysaccharide-iron complex is elemental iron?
100%, 150mg
30
What are the side effects of oral iron?
-dark, discolored feces -constipation or diarrhea -nausea/vomiting -abdominal cramping -epigastric pain
31
What can decrease the absorption of oral iron?
-coffee, tea, milk, eggs, whole-grain breads -medications, such as: antacids, H2 blockers, PPIs, tetracycline and doxycycline, and sustained release products
32
What can increase the absorption of oral iron?
-ascorbic acid (vitamin C) -citric acid -empty stomach
33
What are important patient counseling points for oral iron?
-start on low dose and titrate up slowly -take on an empty stomach -avoid sustained release or delayed release products -if constipation occurs, try a stool softener, laxatives, and increase fluid intake -discoloration of stools v tarry stools -avoid food and drug interactions -keep out of reach of children
34
What iron preparation (oral v IV) leads to a quicker "response"?
neither, hemoglobin will return to reference range at same rate using either product
35
What are the indications for parenteral (IV) iron?
-severe iron malabsorption (gastric surgery or IBD) -noncompliance or severe intolerance with oral therapy -chronic or ongoing blood loss -diminished erythropoiesis (CKD) -second or third trimester pregnancy -significant blood loss and unable to be transfused
36
What IV iron requires a test dose and why?
Iron Dextran requires a 25mg test dose due to risk of anaphylaxis
37
What are the monitoring parameters for Iron Deficiency Anemia?
-reticulocytes in 1 week -CBC at month 1, 3, 6 -iron studies, if on oral month 1, 3, 6, but if on IV 1-2 weeks after dose complete
38
What are the prevention of iron deficiency anemia iron dosing?
-healthy non-menstruating adults: 10mg/day -menstruating patients: 18mg/day -vegetarians: 16mg/day -blood donors: 20mg/day
39
What foods contain Vitamin B12?
meat, dairy, fish, fortified cereals
40
What is the goal dietary intake of vitamin B12?
5-15 mcg/day
41
How is Vitamin B12 absorbed?
B12-intrinsic complex is absorbed in ileum
42
How can Vitamin B12 deficiency anemia occur?
-impaired absorption -inadequate intake (vegans, heavy/chronic alcohol use, elderly) -inadequate utilization (transcobalamin II deficiency)
43
What diseases can cause impaired absorption of Vitamin B12?
-pernicious anemia (inadequate or lack of intrinsic factor) -gastric bypass -chronic H. pylori infection -acid suppressive agents -crohn's disease -tapeworm infestation -ileum resection
44
What are the signs and symptoms of vitamin B12 deficiency anemia?
*neurological* -abnormal deep tendon reflexes -paraesthesia -ataxia -loss of vibration sense -loss of proprioception -developmental delays (pediatrics) *muscle weakness* *psychiatric* *glossitis* *anorexia*
45
What laboratory values are indicative of vitamin B12 deficiency anemia?
-decreased Hgb, Hct, reticulocytes, B12 -increased MCV, homocysteine, MMA
46
What is the treatment for vitamin B12 deficiency anemia?
cyanocobalamin
47
What are the indications for oral vs parenteral (IV) cyanocobalamin?
-oral= prefered in pt without neurologic symptoms -IV= prefered in pt with neurologic symptoms
48
What are the side effects of cyanocobalamin?
-headache -infection -asthenia -rebound thrombocytosis -fluid retention -anaphylaxis (rare) -arthralgia
49
What are the important patient counseling points for oral cyanocobalamin?
-take without regard to food -multiple dosage forms available -life-long therapy
50
What are the monitoring parameters for vitamin B12 deficiency anemia?
-reticulocytes in 1-2 weeks -CNS symptoms -CBC and vitamin B12 levels 1-2 months after initiation then every 3-6 months
51
What foods contain folic acid?
green vegetables, citrus fruits, yeast, dairy products, animal organs
52
What is the goal dietary intake of folic acid?
50-100 mcg/day
53
What conditions may cause folate deficiency through inadequate intake?
elderly or heavy alcohol use
54
What conditions may cause folate deficiency through hyperutilization?
pregnancy
55
What medications may cause folate deficiency?
-methotrexate -trimethoprim -phenytoin -pyrimethamine -oral contraception
56
What lab values indicate folate deficiency anemia?
increased MCV, decrease folate, increased homocystine, decreased reticulocyte, normal MMA
57
What are the signs and symptoms of folate deficiency anemia?
-psychiatric -muscle weakness -glossitis -anorexia
58
What is the treatment for folate deficiency anemia?
folic acid 1 mg daily for about 4 months because their our stores in our body
59
What are the monitoring parameters for folate deficiency anemia?
-reticulocytes in 1 week -CBC at 2 weeks then at 2-6 months -uncommon to recheck folate
60
What are the causes of anemia of inflammation?
-critical illness -infection -inflammation -autoimmune -malignancy -liver disease -renal disease
61
What is the treatment for anemia of inflammation?
treat the underlying cause!!! but erythropoiesis stimulating agent (ESAs) may be used, iron if needed or possibly transfusion
62
When would transfusion be indicated for anemia of inflammation?
Hgb < 8g/dL AND symptomatic
63
What are the risks associated with transfusions?
-blood-born infection -development of antibodies -transfusion reactions -iron overload
64
What medications can treat iron overload?
-*DEFEROXAMINE* -deferasirox -deferiprone
65
What is the goal of treatment of sickle cell anemia?
-reduce hospitalizations -reduce acute and long-term complications -reduce mortality -improve quality of life -facilitate access to care -avoid adverse drug reactions -provide education -provide psychosocial support
66
What are the complications of Sickle Cell Anemia?
-vaso-occulusive crisis -anemia -infection -acute chest syndrome -stroke
67

Therapeutics 1 (16 decks)

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