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oncology > anemia > Flashcards

anemia Flashcards

1
Q

what is a red blood cell called

A

erythrocyte

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2
Q

what is the survival time of an erythrocyte

A

120 days

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3
Q

how are erythrocytes produced?

A

they are produced in the bone marrow and eventually released into the circulation.
erythropoietin is an important stimulus for the production.
hemoglobin & iron are incorporated into maturing erythrocytes prior to their release into the circulation.

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4
Q

______ delivers iron to the bone marrow for incorporation into Hgb

A

transferrin

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5
Q

excess iron is stored as _____

A

ferritin

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6
Q

what is anemia?

A

an objective sign of a disease
a decrease in proportion of RBCs (reduced oxygen carrying capacity of blood)
WHO defines as Hgb <13 (men) or <12 (women) or <11 (children)

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7
Q

in whom is anemia more common?

A

females of reproductive age, pregnancy, elderly (in elderly vastly due to nutritional deficiency or CKD)

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8
Q

GENERAL causes of anemia

A

blood loss
decreased RBC production
increased RBC destruction

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9
Q

classifications of anemia based on MORPHOLOGY?

A

macrocytic (large RBCs): B12/folate deficiency
microcytic (small RBCs): iron deficiency, genetic anomaly
normocytic: blood loss or hemolysis, chronic disease

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10
Q

classifications of anemia based on ETIOLOGY?

A

deficiency: iron, B12, folate, pyridoxine
impaired bone marrow function: chronic disease
peripheral cause: bleeding, hemolysis

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11
Q

classifications of anemia based on PATHOPHYSIOLOGY?

A

blood loss/hemorrhage
RBC production: RBC antibodies, medications, genetics, deficiency in Hgb synthesis
Inadequate production: deficiency of nutrients, endocrine abnormalities, renal disease, inflammation, hepatic disease

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12
Q

what are the mechanisms of anemia

A

increased destruction: blood loss, surgery, trauma, hemorrhage, menses
hemolytic anemia: autoimmune, infectious, sickle cell, G6PD
deficient or defective erythropoiesis

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13
Q

what are some pieces of a patient’s history that may indicate anemia

A

bleeding, diet including alcohol, eating of non foods like ice, stools fatty, hemorrhoids, surgical history, family history, meds

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14
Q

what are some symptoms of anemia

A

skin cool to touch
tachypnea & hypotension
pale
jaundice
glossitis, cheilitis
splenomegaly, hepatomegaly
tachycardia, murmur
decreased perception of vibration
rectal bleeding

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15
Q

what are some objective signs of anemia

A

CBC with differential
Hgb <13 (male), <12 (female)
hematocrit (normal is 41-53% male, 36% female)
absolute reticulocyte count >2% suggests hemolysis or acute blood loss
mean corpuscular volume (normal 80-100)

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16
Q

what is mean corpuscular volume

A

the average volume of RBCs

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17
Q

in microcytic anemia, mean corpuscular volume is ____, and this can mean ______

A

low
iron deficiency, lead poisoning

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18
Q

in normocytic anemia, mean corpuscular volume is ____, and this can mean _____

A

normal
renal failure

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19
Q

in macrocytic anemia, mean corpuscular volume is _____, and this can mean _____

A

high
B12 and folate deficiency

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20
Q

normal content of iron in the body?

A

~3-4 g (2.5 exists in hemoglobin)
~400 mg iron containing proteins (myoglobin)
3-7 mg bound to transferrin
remaining is stored in form of ferritin

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21
Q

iron is absorbed in which form?

A

the ferrous (Fe2+) form
normally it is in the diet as ferric (3+) form and ionized by the stomach acid

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22
Q

how is iron absorption correlated to iron intake?

A

it is not a direct correlation
as physiologic iron levels decrease, GI absorption of iron increases

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23
Q

which type of anemia is the most common nutritional deficiency

A

iron deficiency anemia

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24
Q

who is at highest risk for iron deficiency anemia

A

children <2, adolescent girls, pregnant females, elderly >65, malabsorptive syndromes, diet, blood loss

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25
Q

which foods contain dietary iron

A

leafy greens, tofu, red meat, raisins, dates

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26
Q

what is the recommended iron dietary allowance for the following groups:
Males, postmenopausal females, menstruating females, pregnant females, lactating females, children

A

adult males, postmenopausal females: 8 mg
menstruating females: 18 mg
pregnant females: 27 mg
lactating females: 9 mg
children: 1-2 mg/kg/day (up to 20 mg/day)

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27
Q

what is a normal range of serum iron

A

male ~ 50-160
female ~ 40-150

28
Q

treatment of iron deficiency anemia?

A

if life threatening blood loss: PRBC transfusion is indicated
if not life threatening: oral or IV iron

29
Q

how to dose PO iron??

A

65 mg every other day (or MWF)
(all products are equally effective, avoid enteric coated)

ferrous sulfate, gluconate, fumarate, maltol

30
Q

why is PO iron not recommended to be dosed TID?

A

as iron levels increase, absorption decreases, so less frequent dosing is just as effective and reduces ADEs

31
Q

notable counseling for iron

A

GI effects: constipation, n/v, diarrhea
metallic taste
administer 1 hour before meals

32
Q

drugs interactions that decrease iron absorption

A

antacids (Al, Mg, Ca)
tetracyclines
H2RAs
PPIs
cholestryramine

33
Q

drugs that are affected by iron

A

tetracyclines
quinolones
synthroid
methyldopa, levodopa
penicillamine
mycophenolate

34
Q

when is IV iron replacement preferred over PO?

A

poor GI absorption
failed PO iron (didn’t respond, poor tolerability)
CKD
IBD
chronic, excessive blood loss
gastric bypass

35
Q

IV iron products: efficacy and safety?

A

all equally effective but differ by concentration of iron, administration details. ex: iron sucrose (Venofer)
infusion reactions usually self limiting: fever, arthralgias, muscle spasms, anaphylaxis (rare)

36
Q

how to calculate total iron replacement dose?

A

mg of iron= 0.6 x wt (kg) x [100-(actual hemoglobin/12 x 100)]

37
Q

when does full repletion of iron stores occur after administration of iron therapy?

A

~6-8 weeks

38
Q

what is megaloblastic anemia?

A

macrocytosis caused by abnormal DNA metabolism resulting from vitamin B12 or folate deficiency

39
Q

what kind of drugs can cause megaloblastic anemia?

A

chemo
phenytoin
methotrexate

40
Q

_______ is required for vitamin B12 absorption

A

intrinsic factor

41
Q

what are risk factors for vitamin B12 deficiency?

A

inadequate absorption (vegan, alcoholics, elderly)
pernicious anemia (absence of intrinsic factor- gastric bypass surgery)
cobalamin malabsorption (prolonged use of PPIs, H2RAs, metformin)

42
Q

signs & symptoms of B12 deficiency anemia

A

neuro findings: numb, paresthesias, peripheral neuropathy, ataxia, diminished vibratory sense, decreased proprioception, imbalance, vision changes, psychiatric
glossitis (inflamed tongue)
muscle weakness

43
Q

source & storage of B12?

A

NOT synthesized: have to obtain it through dietary sources. best sources are organs, beef, chicken, pork, fish, dairy, seafood, yeast, fortified cereal
liver stores B12 for a 3 year supply

44
Q

RDA of B12 in children, adults, pregnant

A

children- 0.2 mcg/d
adults- 1 mcg/d
pregnant- 1.5 mcg/d

45
Q

how long does vit B12 deficiency take to develop

A

YEARS

46
Q

treatment of vitamin B12 deficiency anemia??

A
  1. dietary modifications
  2. oral 1-2 mg daily if marginally low
  3. IM B12 if severe, symptomatic, or neuro findings: 1000 mcg daily x 1 week, then 1000 mcg weekly x 1 month, then monthly thereafter.
47
Q

lab tests for B12

A

a normal serum B12 level is 100-900
but elders can have neurological sx with low normal levels and no anemia

48
Q

monitoring for B12 treatment?

A

resolution of anemia: Hgb, Hct, reticulocyte, B12, MCV
neurological symptom improvement

49
Q

normal folic acid in the body?

A

5-10 mg, primarily in the liver

50
Q

folic acid is necessary for _____
is destroyed by ____

A

necessary for production of nucleic acids, proteins, amino acids, purine– and hence RNA and DNA
water soluble vitamin destroyed by cooking/processing

51
Q

sources of folic acid?

A

humans unable to synthesize
depends on dietary sources
mandated fortification of grain products with folic acid

52
Q

daily recommended allowance of folic acid for the following groups: general population, non-pregnant females, pregnant females, lactating females

A

general population: 50-100
non-pregnant females: 400 mcg
pregnant females: 600 mcg
lactating females: 500 mcg

53
Q

a congenital abnormality caused by folic acid deficiency

A

neutral tube defects

54
Q

how to prevent neural tube defects

A

all women take 0.4 mg folic acid daily beginning 1 month pre-conception.
increase to 4 mg/day if previous NTD pregnancy

55
Q

which drugs are associated with risk of NTD?

A

anti-epileptics such as valproic acid

56
Q

risk factors for folic acid deficiency anemia

A

eating habits, malabsorptive syndromes, pregnancy, hemolytic anemia, chronic inflammatory disorders (RA), long-term dialysis, drugs

57
Q

which drugs can cause folic acid deficiency anemia

A

azathioprine, 6MP, 5FU
MTX, pentamidine, TMP
phenytoin, phenobarbital, primidone

58
Q

signs & symptoms of folic acid deficiency anemia

A

decr exercise tolerance, fatigue, dizziness, irritable, weak, palpitations, vertigo, SOB, chest pain, tachypnea
sensitivity to cold, decreased mental acuity, pale, glossitis, muscle weakness, dysphagia, anorexia

59
Q

lab tests for folic acid deficiency anemia?

A

folic acid: reference range 3-20
MCV>100 (macrocytic)
absolute reticulocyte count

60
Q

treatment of folic acid deficiency anemia

A

dietary modifications
oral folic acid: 1 mg daily in most cases, 1-5 mg daily in malabsorption, 500 mcg with anticonvulsant drugs

61
Q

duration of treatment for folic acid deficiency

A

~4 months if underlying cause can be corrected
long term in chronic conditions

62
Q

which anemia causes a decreased perception of vibration

A

B12

63
Q

menstruating females need ____ iron

A

18 mg

64
Q

pregnant females need ____ iron

A

27 mg

65
Q

what is pernicious anemia

A

body can’t absorb B12 because it lacks intrinsic factor (gastric bypass)

oncology (19 decks)

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