Anemia Flashcards
What is anemia?
Loss of RBCs or low Hemoglobin
How do I know if my patient has anemia?
Low hemoglobin
S/sx
Signs and symptoms of anemia
Exertional dyspnea
Angina
Tachycardia
Fatigue
Pallor
May be asymptomatic, especially if developing slowly
Normal hemoglobin levels
Male: 13.5-18 g/dL
Female: 12-16 g/dL
Normal MCV
80-100 mm^3
Normal RDW
11.5-14.5%
Decreased RBC production
Chronic diseases: CKD, Cancer, CHF
Nutritional deficiencies: iron, folic acid, vitamin B12
Increased RBC destruction
Drugs
Sickle cell anemia/thalassemia
Increased RBC loss
Acute blood loss
Chronic NSAIDS/ASA
Microcytic
MCV < 80
Iron deficiency, sickle cell, thalassemia
Normocytic
MCV 80-100
Anemia of chronic disease, blood loss, hemolysis
Macrocytic
MCV > 100
Folic acid and or B12 deficiency
Consequences of anemia
Impaired cognitive function
Falls
HF
Afib
CV events
Increased mortality
Iron deficiency anemia
Microcytic anemia
Low Hgb
Low MCV
High RDW
Low ferritin
Low TSAT
Normal Ferritin
Iron deficiency is still likely for ferritin < 45 ng/mL
acute phase reactant- elevated in acute inflammation or chronic disease
Normal TSAT
20-50%
Iron deficiency < 20%
Causes of iron deficiency
Blood loss
Decreased absorption: maximal absorption in the duodenum
Vegetarian diet
Increased consumption (pregnancy)
Additional symptoms for iron deficiency anemia
Spoon-shaped nails
Inflamed tongue
Pica: pagophagia–>ice
Treatment of iron deficiency anemia
Oral is preferred
IV if: cannot tolerate, cannot absorb, ESRD, HF
Oral iron
65 mg of elemental iron every other day
120-200 mg of elemental iron per day (often BID or TID)
Why might every other day dosing be better?
Hepcidin is increased after a dose of oral iron for 24 hours and normalizes within 48 hours
Counseling points for oral iron
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
IV iron
ESRD, HF, failed oral iron, malabsorption
SE: hypotension, skin tattooing
Vitamin B12 deficiency anemia
Macrocytic anemia
Low Hgb
High MCV
High RDW
Serum B12 is low ( < 200pg/mL
Causes of Vitamin B12 deficiency
Diet: vegan/vegetarian, alcoholism
Lack of intrinsic factor–>pernicious anemia
Crohn’s
Metformin, PPI’s
Consequences of B12 deficiency anemia
Neurologic symptoms: weakness, numbness, cognitive dysfunction
B12 supplements
Oral, IM or deep SC
Oral: 1000-2000 mcg/day
Folic acid deficiency anemia
Macrocytic
Low Hgb
High MCV
High RDW
Serum folate < 5ng/mL
Causes of Folic acid deficiency
Malabsorption
Malnutrition
Alcoholism
Medications: methotrexate, phenytoin, sulfasalazine, bactrim)
Treatment of folic acid deficiency
Oral folic acid supplement
1 mg
Never replace folic acid without checking Vitamin B12
Anemia of chronic disease
CKD, HF, Cancer, HIV/AIDS
Anemia of CKD
Decreased erythropoietin production
Chronic inflammatory state
Nutritional deficiencies
Treatment of Anemia of CKD
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
Blood loss anemia
Stop the bleeding
Transfuse packed RBCs when Hgb < 7
Hemolytic anemia
RBCs are destroyed before 120 days
Types: sickle cell anemia, G6PD anemia, drug induced
Sickle cell anemia
RBC’s are irregular shape
Treatment of sickle cell anemia
Folic acid: 1 mg/day
Blood transfusions: iron overload from frequent transfusions
Hydroxyurea: 10-15 mg/kg/day
Immunizations
Pain control: NSAIDS/Tylenol, PCA
