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Therapeutics 1 > Anemia > Flashcards

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
Q

What laboratory values are indicative of iron deficiency anemia?

A

-decreased Hgb, MCV, MCHC, serum ferritin, serum iron, reticulocytes, % transferrin sat
-increased TIBC, RDW (early or new)

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26
Q

What is iron dosing for adults?

A

up to 150-200 mg/day divided every 8-24 h

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27
Q

What is the iron dosing for pediatrics?

A

-mild to moderate: 3 mg/kg/day divided every 12-24h
-severe: 4 to 6 mg/kg/day divided every 8h

28
Q

What percent of ferrous sulfate is elemental iron?

A

20%, 65mg elemental iron

29
Q

What percent of polysaccharide-iron complex is elemental iron?

A

100%, 150mg

30
Q

What are the side effects of oral iron?

A

-dark, discolored feces
-constipation or diarrhea
-nausea/vomiting
-abdominal cramping
-epigastric pain

31
Q

What can decrease the absorption of oral iron?

A

-coffee, tea, milk, eggs, whole-grain breads
-medications, such as: antacids, H2 blockers, PPIs, tetracycline and doxycycline, and sustained release products

32
Q

What can increase the absorption of oral iron?

A

-ascorbic acid (vitamin C)
-citric acid
-empty stomach

33
Q

What are important patient counseling points for oral iron?

A

-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
Q

What iron preparation (oral v IV) leads to a quicker “response”?

A

neither, hemoglobin will return to reference range at same rate using either product

35
Q

What are the indications for parenteral (IV) iron?

A

-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
Q

What IV iron requires a test dose and why?

A

Iron Dextran requires a 25mg test dose due to risk of anaphylaxis

37
Q

What are the monitoring parameters for Iron Deficiency Anemia?

A

-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
Q

What are the prevention of iron deficiency anemia iron dosing?

A

-healthy non-menstruating adults: 10mg/day
-menstruating patients: 18mg/day
-vegetarians: 16mg/day
-blood donors: 20mg/day

39
Q

What foods contain Vitamin B12?

A

meat, dairy, fish, fortified cereals

40
Q

What is the goal dietary intake of vitamin B12?

A

5-15 mcg/day

41
Q

How is Vitamin B12 absorbed?

A

B12-intrinsic complex is absorbed in ileum

42
Q

How can Vitamin B12 deficiency anemia occur?

A

-impaired absorption
-inadequate intake (vegans, heavy/chronic alcohol use, elderly)
-inadequate utilization (transcobalamin II deficiency)

43
Q

What diseases can cause impaired absorption of Vitamin B12?

A

-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
Q

What are the signs and symptoms of vitamin B12 deficiency anemia?

A

neurological
-abnormal deep tendon reflexes
-paraesthesia
-ataxia
-loss of vibration sense
-loss of proprioception
-developmental delays (pediatrics)
muscle weakness
psychiatric
glossitis
anorexia

45
Q

What laboratory values are indicative of vitamin B12 deficiency anemia?

A

-decreased Hgb, Hct, reticulocytes, B12
-increased MCV, homocysteine, MMA

46
Q

What is the treatment for vitamin B12 deficiency anemia?

A

cyanocobalamin

47
Q

What are the indications for oral vs parenteral (IV) cyanocobalamin?

A

-oral= prefered in pt without neurologic symptoms
-IV= prefered in pt with neurologic symptoms

48
Q

What are the side effects of cyanocobalamin?

A

-headache
-infection
-asthenia
-rebound thrombocytosis
-fluid retention
-anaphylaxis (rare)
-arthralgia

49
Q

What are the important patient counseling points for oral cyanocobalamin?

A

-take without regard to food
-multiple dosage forms available
-life-long therapy

50
Q

What are the monitoring parameters for vitamin B12 deficiency anemia?

A

-reticulocytes in 1-2 weeks
-CNS symptoms
-CBC and vitamin B12 levels 1-2 months after initiation then every 3-6 months

51
Q

What foods contain folic acid?

A

green vegetables, citrus fruits, yeast, dairy products, animal organs

52
Q

What is the goal dietary intake of folic acid?

A

50-100 mcg/day

53
Q

What conditions may cause folate deficiency through inadequate intake?

A

elderly or heavy alcohol use

54
Q

What conditions may cause folate deficiency through hyperutilization?

A

pregnancy

55
Q

What medications may cause folate deficiency?

A

-methotrexate
-trimethoprim
-phenytoin
-pyrimethamine
-oral contraception

56
Q

What lab values indicate folate deficiency anemia?

A

increased MCV, decrease folate, increased homocystine, decreased reticulocyte, normal MMA

57
Q

What are the signs and symptoms of folate deficiency anemia?

A

-psychiatric
-muscle weakness
-glossitis
-anorexia

58
Q

What is the treatment for folate deficiency anemia?

A

folic acid 1 mg daily for about 4 months because their our stores in our body

59
Q

What are the monitoring parameters for folate deficiency anemia?

A

-reticulocytes in 1 week
-CBC at 2 weeks then at 2-6 months
-uncommon to recheck folate

60
Q

What are the causes of anemia of inflammation?

A

-critical illness
-infection
-inflammation
-autoimmune
-malignancy
-liver disease
-renal disease

61
Q

What is the treatment for anemia of inflammation?

A

treat the underlying cause!!! but erythropoiesis stimulating agent (ESAs) may be used, iron if needed or possibly transfusion

62
Q

When would transfusion be indicated for anemia of inflammation?

A

Hgb < 8g/dL AND symptomatic

63
Q

What are the risks associated with transfusions?

A

-blood-born infection
-development of antibodies
-transfusion reactions
-iron overload

64
Q

What medications can treat iron overload?

A

-DEFEROXAMINE
-deferasirox
-deferiprone

65
Q

What is the goal of treatment of sickle cell anemia?

A

-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
Q

What are the complications of Sickle Cell Anemia?

A

-vaso-occulusive crisis
-anemia
-infection
-acute chest syndrome
-stroke

67
Q
A

Therapeutics 1 (16 decks)

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