Anemia Flashcards

1
Q

Define anemia in men and women. Which has a higher risk of anemia?

A

Women: Hgb < 11.9 g/dL OR Hct <35%
Males: Hgb <13.6 g/dL OR Hct <40%

Women more likely to have, geography and age also affects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are some sx of anemia?

A

Fatigue
Dizziness
Weakness
Dyspnea on exertion
Headache
Angina
Tachycardia/palpitations
Pale mucous membranes
Ischemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What labs should be measured to diagnose anemia? What are the normal levels?

A

RBCs
Hgb (male NL = 13.6-16.9 female NL = 12-15)
Hct (male NL = 40-50% female NL = 35-43%)
Low Hct = Reduction in # or size of RBCs OR increase plasma volume
MCV (mean cell volume) (NL = 80-100 fL)
[microcytic - low volume, macrocytic - high volume]
Total reticulocyte count (NL = 0.5 - 1%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is total reticulocyte count?

A

Assesses new RBC production
(when you bleed -> stimulates increased RBC production -> increased TRC)
Low = impaired RBC production
High = acute blood loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What causes macrocytic anemia?

A

Vit B12 or FOLATE deficiency (or both)
Vit B12 deficiency = PERNICIOUS ANEMIA
(Lack of intrinsic factor for B12 absorption)
(Requires lifelong parenteral B12 supp)

Other:
EtOH, poor nutrition, GI disorders, Pregnancy, long term metformin/acid reducer use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What labs are seen in MACROCYTIC anemia?

A

Low Hgb
High MCV
Low Reticulocytes
Low B12 or folate
Methylmalonic acid [elevated in B12 deficiency anemia only!]
Homocysteine [increased in B12 and folate anemia]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the clinical presentation of B-12 macrocytic anemia?

A

Jaundice
Leukopenia/thrombocytopenia
NEURO
- Cognitive impairment like dementia
- Gait abnormalities
- Peripheral neuropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How do you treat B-12 deficient macrocytic anemia?

A

Oral or IM/SQ B12 (cyanocobalamin)
SQ is Rx only, oral is OTC
po is as effective as injectable
Rare AEs: hyperuricemia, hypokalemia

Dietary B12 = meats, dairy, eggs, fortified cereal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How do you treat folic acid deficient macrocytic anemia? What are possible AEs? What is the duration of therapy?

A

Normal - oral 1 mg daily (Rx only)

Pregnant:
prevention = 0.4 -0.8mg/day
Family hx of neural tube defects = 4 mg/day

Rare AEs - Flushing, malaise, pruritis/rash

For normalizing RBC count, continue therapy for ≥ 4 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the causes of microcytic anemia?

A

Iron deficiency
Sickle cell anemia
Thalassemia (genetic deficiency of B-chains in Hgb)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are some diagnostic labs for microcytic anemia?

A

Ferritin - storage for iron (male NL = 15-200, female NL = 12-150)
- Iron-deficiency anemia < 15 but below 41 could also be anemic
- can be elevated in inflammation (use TSAT instead)

Serum Total Iron Binding Capacity - Transferrinin levels
(Inverse relationship with ferritin, it carries iron in BLOOD)
NL = 250-400 mcg/dL
Elevated in iron deficient anemia! [ >400]
TSAT (transferrin saturation)
NL = 25-45%
Iron deficiency anemia level <15%

Low Hgb
Low MCV
Low reticulocytes
Low iron/ferritin/TSAT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the treatment of iron-deficient microcytic anemia? Should the iron be taken with or without food? What else can be taken to enhance absorption? How long should it be used after normal Hgb achieved?

A

100-200 mg elemental iron/day
take on EMPTY stomach, need acidic environment
Increase vitamin C for enhanced absorption

Goal: increase Hgb 1g/dL q2-3 weeks, use iron 3-6 months after normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Name the THREE iron products that must be taken on an empty stomach and what % elemental iron they are. (Microcytic anemia)

A

Ferrous gluconate (12%)
Ferrous sulfate (20%)
Ferrous fumarate (33%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Name the TWO iron products that DO NOT have to be taken on an empty stomach and what % elemental iron they are. (Microcytic anemia)

A

Ferric citrate (100%)
Polysaccharide iron complex (100%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Most people only take oral iron supplementation, however who SHOULD receive IV iron (microcytic anemia)?

A

CKD patients on HEMODIALYSIS
CKD patient on erythropoietin-stimulation agents (ESAs)
Unable to tolerate oral iron
Patients who refuse blood transfusions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are some options for IV iron (microcytic anemia)?

A

Iron sucrose (can be used in pregnant)
Ferumoxytol
Iron Detran Complex (must do a test dose)
Sodium ferric (contains benzyl alcohol)
Ferric carboxymaltose

17
Q

What is a MAIN cause of normocytic anemia?

A

CKD - deficiency in erythropoietin (EPO)

18
Q

ESAs (erythropoietin stimulating agents) help maintain Hgb levels & reduce blood transfusions BUT they are ineffective if _________________

A

The body’s IRON stores are LOW
AKA - correct iron before giving ESA

19
Q

What are two products that can be used as ESAs in normocytic anemia? What are the major BBWs? What should be monitored?

A

Epoetin alfa
Darbapoetin

Initiate when Hgb<10
Used in CKD pts w anemia and cancer pts

BBW: death, MI, stroke, VTE (use smallest dose possible!)
Monitor - Hgb (weekly), Hct, TSAT, ferritin, BP