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PHRM 864 Exam 3 > Anemia > Flashcards

Anemia Flashcards

1
Q

What is anemia?

A

Loss of RBCs or low Hemoglobin

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2
Q

How do I know if my patient has anemia?

A

Low hemoglobin
S/sx

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3
Q

Signs and symptoms of anemia

A

Exertional dyspnea

Angina

Tachycardia

Fatigue

Pallor

May be asymptomatic, especially if developing slowly

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4
Q

Normal hemoglobin levels

A

Male: 13.5-18 g/dL
Female: 12-16 g/dL

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5
Q

Normal MCV

A

80-100 mm^3

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6
Q

Normal RDW

A

11.5-14.5%

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7
Q

Decreased RBC production

A

Chronic diseases: CKD, Cancer, CHF

Nutritional deficiencies: iron, folic acid, vitamin B12

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8
Q

Increased RBC destruction

A

Drugs

Sickle cell anemia/thalassemia

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9
Q

Increased RBC loss

A

Acute blood loss

Chronic NSAIDS/ASA

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10
Q

Microcytic

A

MCV < 80

Iron deficiency, sickle cell, thalassemia

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11
Q

Normocytic

A

MCV 80-100

Anemia of chronic disease, blood loss, hemolysis

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12
Q

Macrocytic

A

MCV > 100

Folic acid and or B12 deficiency

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13
Q

Consequences of anemia

A

Impaired cognitive function

Falls

HF

Afib

CV events

Increased mortality

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14
Q

Iron deficiency anemia

A

Microcytic anemia

Low Hgb

Low MCV

High RDW

Low ferritin

Low TSAT

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15
Q

Normal Ferritin

A

Iron deficiency is still likely for ferritin < 45 ng/mL

acute phase reactant- elevated in acute inflammation or chronic disease

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16
Q

Normal TSAT

A

20-50%

Iron deficiency < 20%

17
Q

Causes of iron deficiency

A

Blood loss

Decreased absorption: maximal absorption in the duodenum

Vegetarian diet

Increased consumption (pregnancy)

18
Q

Additional symptoms for iron deficiency anemia

A

Spoon-shaped nails

Inflamed tongue

Pica: pagophagia–>ice

19
Q

Treatment of iron deficiency anemia

A

Oral is preferred

IV if: cannot tolerate, cannot absorb, ESRD, HF

20
Q

Oral iron

A

65 mg of elemental iron every other day

120-200 mg of elemental iron per day (often BID or TID)

21
Q

Why might every other day dosing be better?

A

Hepcidin is increased after a dose of oral iron for 24 hours and normalizes within 48 hours

22
Q

Counseling points for oral iron

A

Taken every other day to TID

Increased absorption on empty stomach

Causes stomach upset: take at bedtime or with food

Absorption is increased with vitamin C

Causes constipation

Causes dark stools: IMPORTANT IF PT IS ALSO ON BLOOD THINNER

23
Q

IV iron

A

ESRD, HF, failed oral iron, malabsorption

SE: hypotension, skin tattooing

24
Q

Vitamin B12 deficiency anemia

A

Macrocytic anemia

Low Hgb

High MCV

High RDW

Serum B12 is low ( < 200pg/mL

25
Q

Causes of Vitamin B12 deficiency

A

Diet: vegan/vegetarian, alcoholism

Lack of intrinsic factor–>pernicious anemia

Crohn’s

Metformin, PPI’s

26
Q

Consequences of B12 deficiency anemia

A

Neurologic symptoms: weakness, numbness, cognitive dysfunction

27
Q

B12 supplements

A

Oral, IM or deep SC

Oral: 1000-2000 mcg/day

28
Q

Folic acid deficiency anemia

A

Macrocytic

Low Hgb

High MCV

High RDW

Serum folate < 5ng/mL

29
Q

Causes of Folic acid deficiency

A

Malabsorption

Malnutrition

Alcoholism

Medications: methotrexate, phenytoin, sulfasalazine, bactrim)

30
Q

Treatment of folic acid deficiency

A

Oral folic acid supplement

1 mg

Never replace folic acid without checking Vitamin B12

31
Q

Anemia of chronic disease

A

CKD, HF, Cancer, HIV/AIDS

32
Q

Anemia of CKD

A

Decreased erythropoietin production

Chronic inflammatory state

Nutritional deficiencies

33
Q

Treatment of Anemia of CKD

A

Avoid blood transfusions

Correct nutritional deficiencies

Folate/B12

Iron
-Use oral iron in stage 3-5 CKD if possible
-Use IV iron in HD patients

Target TSAT above 30%

Do not target normal Hgb levels: > 10

ESA’s should not be used

34
Q

Blood loss anemia

A

Stop the bleeding

Transfuse packed RBCs when Hgb < 7

35
Q

Hemolytic anemia

A

RBCs are destroyed before 120 days

Types: sickle cell anemia, G6PD anemia, drug induced

36
Q

Sickle cell anemia

A

RBC’s are irregular shape

37
Q

Treatment of sickle cell anemia

A

Folic acid: 1 mg/day

Blood transfusions: iron overload from frequent transfusions

Hydroxyurea: 10-15 mg/kg/day

Immunizations

Pain control: NSAIDS/Tylenol, PCA

PHRM 864 Exam 3 (10 decks)

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