Anemia Flashcards
Describe: erythrocyte development
-non-nucleocyte, non-dividing
-90% of cell -> hemoglobin (Hgb)
-40-50% to total blood volume
-maturation process takes ~1 week
-lifespan ~120 days
Define: Anemia
reduction in red cell mass, decrease in Hgb concentration
-women: Hgb < 12g/dL
-men: Hgb <13 g/dL
What are the signs and symptoms of acute anemia?
tachycardia, dyspnea, palpitations, hypotension
What are the signs and symptoms of chronic anemia?
fatigue/weakness, dizziness, decreased exercise tolerance, cold sensitivity, pallor
What is MCV?
mean corpuscular volume (MCV) is the average volume of red blood cells (RBC)
What is MCH?
mean corpuscular hemoglobin (MCH) is the average volume of Hgb in RBC
What is decreased MCV indicative of?
microcytic anemia
What is increased MCV indicative of?
macrocytic anemia
What is decreased MCH indicative of?
microcytosis or hypochromia
What is MCHC?
mean corpuscular hemoglobin concentration (MCHC) is the weight of Hgb per volume of cells
What is decreased MCHC indicative of?
hypochromia
What is RDW?
red blood cell distribution width (RDW) is RBC size variability
What is increased RDW indicative of?
early iron deficiency anemia or mixed anemia
What is microcytic, hypochromic morphology indicative of?
iron deficiency anemia
What is normocytic, normochromic morphology indicative of?
blood loss, hemolysis, chronic disease
What is macrocytic morphology indicative of?
vitamin B12 deficiency anemia, folic acid deficiency anemia
What is hypo-proliferation indicative of?
iron deficiency anemia, bone marrow damage, renal failure, chronic inflammation
What is hemolysis or hemorrhage indicative of?
hemolytic anemia, sickle cell, autoimmune disease, blood loss
What is maturation disorders indicative of?
folic acid deficiency anemia, B12 deficiency anemia, thalassemia
What is the daily iron need for menstruating women?
18mg
What is the daily iron need for men and non-menstruating women?
8mg
What foods include iron?
-heme iron: meat, fish, eggs
-non-heme iron: plant sources, legumes, dairy
What are the risk factors for iron deficiency anemia?
-blood loss: menstruation, GI disorders, trauma
-decreased absorption: medications( antacids, H2 blockers, PPIs), diet, gastrectomy, gastric bypass surgery
-increased demand: pregnancy, lactation, infancy, adolescence
What are the signs and symptoms of iron deficiency anemia?
-spoon shaped nails
-glossitis
-stomatitis
-pica (craving and eating foods that are not considered food items)
-pagophagia
-reduced salivary flow
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)
What is iron dosing for adults?
up to 150-200 mg/day divided every 8-24 h
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
What percent of ferrous sulfate is elemental iron?
20%, 65mg elemental iron
What percent of polysaccharide-iron complex is elemental iron?
100%, 150mg
What are the side effects of oral iron?
-dark, discolored feces
-constipation or diarrhea
-nausea/vomiting
-abdominal cramping
-epigastric pain
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
What can increase the absorption of oral iron?
-ascorbic acid (vitamin C)
-citric acid
-empty stomach
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
What iron preparation (oral v IV) leads to a quicker “response”?
neither, hemoglobin will return to reference range at same rate using either product
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
What IV iron requires a test dose and why?
Iron Dextran requires a 25mg test dose due to risk of anaphylaxis
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
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
What foods contain Vitamin B12?
meat, dairy, fish, fortified cereals
What is the goal dietary intake of vitamin B12?
5-15 mcg/day
How is Vitamin B12 absorbed?
B12-intrinsic complex is absorbed in ileum
How can Vitamin B12 deficiency anemia occur?
-impaired absorption
-inadequate intake (vegans, heavy/chronic alcohol use, elderly)
-inadequate utilization (transcobalamin II deficiency)
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
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
What laboratory values are indicative of vitamin B12 deficiency anemia?
-decreased Hgb, Hct, reticulocytes, B12
-increased MCV, homocysteine, MMA
What is the treatment for vitamin B12 deficiency anemia?
cyanocobalamin
What are the indications for oral vs parenteral (IV) cyanocobalamin?
-oral= prefered in pt without neurologic symptoms
-IV= prefered in pt with neurologic symptoms
What are the side effects of cyanocobalamin?
-headache
-infection
-asthenia
-rebound thrombocytosis
-fluid retention
-anaphylaxis (rare)
-arthralgia
What are the important patient counseling points for oral cyanocobalamin?
-take without regard to food
-multiple dosage forms available
-life-long therapy
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
What foods contain folic acid?
green vegetables, citrus fruits, yeast, dairy products, animal organs
What is the goal dietary intake of folic acid?
50-100 mcg/day
What conditions may cause folate deficiency through inadequate intake?
elderly or heavy alcohol use
What conditions may cause folate deficiency through hyperutilization?
pregnancy
What medications may cause folate deficiency?
-methotrexate
-trimethoprim
-phenytoin
-pyrimethamine
-oral contraception
What lab values indicate folate deficiency anemia?
increased MCV, decrease folate, increased homocystine, decreased reticulocyte, normal MMA
What are the signs and symptoms of folate deficiency anemia?
-psychiatric
-muscle weakness
-glossitis
-anorexia
What is the treatment for folate deficiency anemia?
folic acid 1 mg daily for about 4 months because their our stores in our body
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
What are the causes of anemia of inflammation?
-critical illness
-infection
-inflammation
-autoimmune
-malignancy
-liver disease
-renal disease
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
When would transfusion be indicated for anemia of inflammation?
Hgb < 8g/dL AND symptomatic
What are the risks associated with transfusions?
-blood-born infection
-development of antibodies
-transfusion reactions
-iron overload
What medications can treat iron overload?
-DEFEROXAMINE
-deferasirox
-deferiprone
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
What are the complications of Sickle Cell Anemia?
-vaso-occulusive crisis
-anemia
-infection
-acute chest syndrome
-stroke
