Anemia Flashcards
Signs and symptoms of anemia and how it is diagnosed
Shortness of breath (exertional dyspnea)
Angina (chest pain)
Tachycardia
Fatigue (most commonly seen)
Pallor
some patient may be asymptomatic especially if their anemia develops slowly over time
For diagnosis must get Hgb and MCV
Hgb normal range for males is 13.5- 18g/dl and females is 12-6g/dl (anything below is anemic)
MCV normal range is 80-100 mm^3 (this tells us the size of the red blood cells
Causes of anemia
Chronic diseases like CKD, HF, cancer, COPD that cause decrease RBC production
Could be due to nutritional deficiences (iron, folic acid, and vitamin B) that cause decreased RBC production
Could be drug induced that causes increased destruction of RBC
Could be sickle cell anemia/thalassemia which also increase destruction of RBC
Could be acute blood loss that causes increased RBC loss
Could be chronic NSAID/ASA that increase RBC loss
What are the 3 size classifications of RBC and what type of anemia causes these size changes
Microcytic: MCV <80, seen in iron deficiency, sickle cell, and thalassemia
Normocytic: MCV 80-100, seen in anemia of chronic disease, blood loss, hemolysis
Macrocytic: MCV >100, seen in Folic acid or B12 deficiency
What are the consequences of untreated anemia
Imparied cognitive function, falls seen especially in elderly, worsening HF and Afib, Cardiovascular events, mortality
Goals of treatment
Improve Hgb levels
relieve symptoms, reduce morbidity, improve QOL, reduce mortality
Iron deficiency anemia: what is it, what are the causes, symptoms specific to iron deficiency anemia, what are the abnormal lab values and how we treat it, counseling points
This is the most common anemia - low Hgb and low iron
caused by blood loss, menstration, frequent blood donation, celiac disease, and gastric bypass (these procedures cause decreased absorption), vegetarian diet, pregnancy
Symptoms:
Spoon-shaped nails
inflamed tongue
Pica - the desire to eat non-nutritional food like ice, clay, dirt
Lab value abnormalities
Hgb <12 or 13.5
MCV <80
RDW increased
Ferritin <45
TSTAT <20%
Treatment:
Usually always start out with oral Iron tend to do ferrous sulfate 325mg every other day (gives patent 65mg of elemental iron every other day)
Only go to IV if the patient cannot tolerate side effects, cannot absorb the drug, Start IV right away if they are end stage renal disease, and heart failure
Counseling: Take on an empty stomach or with orange juice as it will help with absorption, if patient expereicnes upset stomach while taking on empy stomach they can take with food, Side effects include: constipation and Dark stool (could mask signs of GI bleed)
IV side effects include: Hypotension, and skin tattooing (if drug gets out of bag and onto skin it will stain)
Vitamin B12 Deficiency anemia what is it, what are the causes, symptoms, what are the abnormal lab values and how we treat it, counseling points
Our bodies do not naturally make b12 so we get it from our diet (eggs, fish, meat, dairy)
Caused by Diet (vegitarian, vegan), alcoholism, lack of intrinsic factor which leads to pernicious anemia, decreased absorption (crohns disease)
Medications (PPI and Metformin)
abnormal labs
Hgb: <12 or 13.5
MCV >100
RDW increased
B12: <200
Homocysteine acid levels increased
If patient is left untreated of deficiency they will have neurologic symptoms like weakness, numbness, and cognitive dysfunction
Treatment:
Options are Oral, IM, or subQ
Usually preferred to give oral first which is 1000mcg daily
IM and subQ is 100-1000mcg given daily, then weekly, then monthly
Start with IM or subQ if patient has intrinsic factor antibody
Folic acid deficiency what is it, what are the causes, symptoms, what are the abnormal lab values and how we treat it, counseling points
Caused by malabsorption, malnutrition, alcoholism and medications (methotrexate, phenytoin, sulfasalazine)
Labs
Hgb <12 or 13.5
MCV >100
RDW increased
Serum folate: <5 is severely deficient
Homocysteine increased (>15 mcmol/L)
Treatment:
ALWAYS test patient for B12 deficiency before we just go with folic acid deficiency
if patient has folic acid deficiency treat with 1mg of folic acid daily
Anemia of Chronic kidney disease what is it, what are the causes, symptoms, what are the abnormal lab values and how we treat it, counseling points
This occurs in CKD patients because Erythropoietin is produced in the kidneys and this is needed to stimulate production of RBC so with damaged kidneys erythropoietin production is decreased. Can also accur due to chronic inflammatory state which causes anemia of chronic disease, or nutritional deficiencies
Labs
Hgb <12 or 13.5
RBC low
TIBC <250 (250-400mcg/dL)
EVERYTHING ELSE IS NORMAL
Treatment:
Avoid blood transfusions
If patient has nutritional deficiencies treat them
If patient has iron deficiency use oral iron in stage 3-5 CKD, if patient is on dialysis use IV iron with a target TSTAT of 30%
Can also use ESA is patients Hgb is less than 9 but do not want to target a Hgb above 10 as it can cause increased risk of cardiovascular events
Blood loss anemia treatment
Important to stop the bleeding first if patient has a hgb <7 do blood transfuse
- each blood transfusion bag has 250mg of iron so no need to supplement iron on top of that
- for these patients we can give other medications if indicated (example would be if patient comes in with a GI bleed from an ulcer we can give a PPI)
Anemia of Heart Failure what is it, what are the causes, symptoms, what are the abnormal lab values and how we treat it, counseling points
Labs: Ferritin <100, OR ferritin is 100-300 AND TSTAT <20%
If patient has these labs treat with IV iron (no benefit shown when using oral iron)
Counseling point: IV iron has show to reduce hospitalization stay time but has no effect on mortality
RBC normal range in male and female
Male 4.5-5 x 10^6
female 4.1-4.9 x 10^6
Sickle cell anemia what is it, what are the causes, symptoms, what are the abnormal lab values and how we treat it, counseling points
Sicle cell anemia is usually an inherited disease
RBC are an abnormal shape and collect in the spleen where they are distroyed faster than they are being produced
Treatment
Folic acid 1mg a day
Blood transfusion could be needed
Hydroxyurea: can be used to decrease the sickling of the red blood cells usually 10-15mg/kg/day and gradually titrate to max dose of 35mg/kg/day
Some patients will have sickle cell crisis where the RBCs will collect in areas of the body and cause tremendous pain and if this is the case we will start HIGH doses of opioids
Counseling: important to stay up to date on vaccines, can take NSAIDS/acetaminophen to help with any pain caused by the sickle cell disease
Drug induced anemia - APLASTIC ANEMIA
bone marrow failure that causes the body to stop producing enough red blood cells
Drug induced anemia - IMMUNE HEMOLYTIC ANEMIA
antibodies form against your own bodies red blood cells and destroy them
