Anemia Flashcards
what is anemia
low RBC count
symptoms of anemia
exertional dyspnea
angina
tachycardia
fatigue
pallor (looking pale)
can be asymptomatic
Hgb levels normal
male: 13.5-18 g/dL
female: 12-16 g/dL
what is hemoglobin
oxygen carrying capacity
what is MCV level noraml
80-100 mm3
what is MCV
mean corpuscular volume, volume of RBCs
what is hematocrit
volume of RBCs per unit of blood
what do we need to diagnose with anemia
low Hg level
causes of anemia
decreased RBC production
increased RBC destruction
increased RBC loss
decreased RBC production causes
chronic diseases
nutritional deficiencies: iron, folate, B12
increased RBC destruction causes
drugs
sickle cell anemia
increased RBC loss causes
acute blood loss
chronic NSAID/ASA
microcytic
MCV < 80
iron deficiency, sickle cell
normocytic
MCV 80-100
chronic disease, blood loss, hemolysis
macrocytic
MCV > 100
folic acid, B12 deficiency
consequences of anemia (6)
decrease in cognitive function
falls
HF
atrial fib
CV events
mortality
most common cause of anemia
iron deficient
iron deficiency anemia
Hbg
MCV
iron
TSAT
Hgb decreased
MCV decreased
ferritin decreased
TSAT decreased
what ferritin level is deficient
<45
what is ferritin
measure of iron stores
what is TSAT
amount of iron ready for erythropoesis
normal TSAT value
20-50%
causes of iron deficiency
blood loss: menstuation, blood donation
decreased absorption: celiac, gastric bypass
vegetarian
pregnancy
can iron deficiency come from drug causes
not likely
iron deficiency specific symptoms
spoon nails: koilonychias
inflamed tongue: glossitis
pica: craving substances like ice
(pagophagia)
oral or IV iron for iron deficient?
oral preferred
IV if: ESRD, cant tolerate, cant absorb, HF
iron dosing for iron deficient anemia
65 mg elemental iron every other day
120-200 mg elemental iron (BID/TID)
how long does it take to replete iron stores in iron def anemia
3-6 months
how much elemental in ferrous fumarate
100 mg (33%)
how much elemental in ferrous sulfate
65 mg (20%)
how much elemental in ferrous gluconate
30 mg (10%)
iron has increased absorption with or without food
without food
iron absorption can be increased by taking it with what
vitamin C
oral iron side effects
constipation
dark stools
indications of IV iron
HF
malabsorption
ESRD
failed oral iron
side effects of IV iron
hypotension during infusion
skin tattooing
B12 deficiency anemia
Hgb
MCV
ferritin
TSAT
B12
Hgb decreased
MCV increased
ferritin unchanged
TSAT unchanged
B12 decreased
B12 low levels
< 200 pg/mL
causes of B12 deficiency
pernicious anemia
metformin, PPIs
vegan / vegetarian
alcoholism
do our bodies make B12?
no, from diet
consequences of B12 deficinecy
weakness, numbness, cognitive dysfunction
treatment of B12 deficiency
B12 replacement
IM/SC: daily x 1-2 weeks then week/month
Oral: 1000-2000 mcg/day
which B12 deficiency cause would oral B12 not be as effective
pernicious anemia
can we OD on B12?
no its water soluble so we just pee the excess out
is oral or IM/SC preferred in B12 def
both are same
IM/SC if pernicous anemia
folic acid deficiency
Hgb
MCV
RDW
folate
Hgb decreased
MCV increased
RDW increased
folate decreased
folate level low
< 5 ng/mL
causes of folic acid deficiency
malabsorption
no green veggies, orange juice, cereal, flour, milk
alcoholism
meds (methotrexate, phenytoin, Bactrim)
treatment of folic acid deficiency
oral folic acid
1-5 mg daily until Hgb normalizes
folic acid, oral or IV?
oral is well absorbed
what do we need to do before treating folic acid deficiency
check B12 levels
neurologic deficits will remain if its off
chronic diseases common for anemia
CHF
CKD
HIV/AIDS
cancer
what stimulates production of RBCs
erythropoetin
why does anemia occur in CKD
decreased erythropoetin production
chronic inflammation
nutritional deficiencies
anemia CKD treatment
avoid blood transfusions
correct nutritional deficiencies: B12/folate/iron
ESAs
IV iron in CKD for who
hemodialysis patients
target TSAT in CKD
> 30%
when to use ESAs
after replenishing iron stores in CKD
goal Hgb to maintain while on ESAs
Hgb >10 usinging minimal dose
how often can we titrate ESAs
must wait 4 weeks
ESA risk
CV events
stroke
death
oral vs IV iron in HF patients
IV is better
goal ferritin and TSAT in HF patients
ferritin >100
TSAT >20%
can we use ESAs in HF?
no
which HF patients would benefit from iron
HF II and III
does iron increase survival in HF patient
no, decrease hospitalizations
treatment of blood loss anemia
stop the bleeding
transfuse RBCs
when to transfuse RBCs and how much iron in each unit
Hgb < 7
250 mg iron
what is hemolytic anemia
RBCs destroyed before 120 days
types of hemolytic anemia
intertied: sickle cell, G6PD def
acquired: drug induced
sickle cell anemia is what
RBCs shaped weird
destroyed faster than they can be produced
inherited, homozygotes get anemia
treatment of sickle cell anemia
folic acid: 1 mg/day
blood transfusions: sx
hydroxyurea: 10-15 mg/kg/day
immunizations
pain control
