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PHRM 864 > Anemia > Flashcards

Anemia Flashcards

1
Q

what is anemia

A

low RBC count

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2
Q

symptoms of anemia

A

exertional dyspnea
angina
tachycardia
fatigue
pallor (looking pale)
can be asymptomatic

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3
Q

Hgb levels normal

A

male: 13.5-18 g/dL
female: 12-16 g/dL

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4
Q

what is hemoglobin

A

oxygen carrying capacity

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5
Q

what is MCV level noraml

A

80-100 mm3

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6
Q

what is MCV

A

mean corpuscular volume, volume of RBCs

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7
Q

what is hematocrit

A

volume of RBCs per unit of blood

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8
Q

what do we need to diagnose with anemia

A

low Hg level

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9
Q

causes of anemia

A

decreased RBC production
increased RBC destruction
increased RBC loss

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10
Q

decreased RBC production causes

A

chronic diseases
nutritional deficiencies: iron, folate, B12

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11
Q

increased RBC destruction causes

A

drugs
sickle cell anemia

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12
Q

increased RBC loss causes

A

acute blood loss
chronic NSAID/ASA

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13
Q

microcytic

A

MCV < 80
iron deficiency, sickle cell

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14
Q

normocytic

A

MCV 80-100
chronic disease, blood loss, hemolysis

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15
Q

macrocytic

A

MCV > 100
folic acid, B12 deficiency

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16
Q

consequences of anemia (6)

A

decrease in cognitive function
falls
HF
atrial fib
CV events
mortality

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17
Q

most common cause of anemia

A

iron deficient

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18
Q

iron deficiency anemia
Hbg
MCV
iron
TSAT

A

Hgb decreased
MCV decreased
ferritin decreased
TSAT decreased

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19
Q

what ferritin level is deficient

A

<45

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20
Q

what is ferritin

A

measure of iron stores

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21
Q

what is TSAT

A

amount of iron ready for erythropoesis

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22
Q

normal TSAT value

A

20-50%

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23
Q

causes of iron deficiency

A

blood loss: menstuation, blood donation
decreased absorption: celiac, gastric bypass
vegetarian
pregnancy

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24
Q

can iron deficiency come from drug causes

A

not likely

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25
Q

iron deficiency specific symptoms

A

spoon nails: koilonychias
inflamed tongue: glossitis
pica: craving substances like ice
(pagophagia)

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26
Q

oral or IV iron for iron deficient?

A

oral preferred
IV if: ESRD, cant tolerate, cant absorb, HF

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27
Q

iron dosing for iron deficient anemia

A

65 mg elemental iron every other day
120-200 mg elemental iron (BID/TID)

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28
Q

how long does it take to replete iron stores in iron def anemia

A

3-6 months

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29
Q

how much elemental in ferrous fumarate

A

100 mg (33%)

30
Q

how much elemental in ferrous sulfate

A

65 mg (20%)

31
Q

how much elemental in ferrous gluconate

A

30 mg (10%)

32
Q

iron has increased absorption with or without food

A

without food

33
Q

iron absorption can be increased by taking it with what

A

vitamin C

34
Q

oral iron side effects

A

constipation
dark stools

35
Q

indications of IV iron

A

HF
malabsorption
ESRD
failed oral iron

36
Q

side effects of IV iron

A

hypotension during infusion
skin tattooing

37
Q

B12 deficiency anemia
Hgb
MCV
ferritin
TSAT
B12

A

Hgb decreased
MCV increased
ferritin unchanged
TSAT unchanged
B12 decreased

38
Q

B12 low levels

A

< 200 pg/mL

39
Q

causes of B12 deficiency

A

pernicious anemia
metformin, PPIs
vegan / vegetarian
alcoholism

40
Q

do our bodies make B12?

A

no, from diet

41
Q

consequences of B12 deficinecy

A

weakness, numbness, cognitive dysfunction

42
Q

treatment of B12 deficiency

A

B12 replacement
IM/SC: daily x 1-2 weeks then week/month
Oral: 1000-2000 mcg/day

43
Q

which B12 deficiency cause would oral B12 not be as effective

A

pernicious anemia

44
Q

can we OD on B12?

A

no its water soluble so we just pee the excess out

45
Q

is oral or IM/SC preferred in B12 def

A

both are same
IM/SC if pernicous anemia

46
Q

folic acid deficiency
Hgb
MCV
RDW
folate

A

Hgb decreased
MCV increased
RDW increased
folate decreased

47
Q

folate level low

A

< 5 ng/mL

48
Q

causes of folic acid deficiency

A

malabsorption
no green veggies, orange juice, cereal, flour, milk
alcoholism
meds (methotrexate, phenytoin, Bactrim)

49
Q

treatment of folic acid deficiency

A

oral folic acid
1-5 mg daily until Hgb normalizes

50
Q

folic acid, oral or IV?

A

oral is well absorbed

51
Q

what do we need to do before treating folic acid deficiency

A

check B12 levels
neurologic deficits will remain if its off

52
Q

chronic diseases common for anemia

A

CHF
CKD
HIV/AIDS
cancer

53
Q

what stimulates production of RBCs

A

erythropoetin

54
Q

why does anemia occur in CKD

A

decreased erythropoetin production
chronic inflammation
nutritional deficiencies

55
Q

anemia CKD treatment

A

avoid blood transfusions
correct nutritional deficiencies: B12/folate/iron
ESAs

56
Q

IV iron in CKD for who

A

hemodialysis patients

57
Q

target TSAT in CKD

A

> 30%

58
Q

when to use ESAs

A

after replenishing iron stores in CKD

59
Q

goal Hgb to maintain while on ESAs

A

Hgb >10 usinging minimal dose

60
Q

how often can we titrate ESAs

A

must wait 4 weeks

61
Q

ESA risk

A

CV events
stroke
death

62
Q

oral vs IV iron in HF patients

A

IV is better

63
Q

goal ferritin and TSAT in HF patients

A

ferritin >100
TSAT >20%

64
Q

can we use ESAs in HF?

A

no

65
Q

which HF patients would benefit from iron

A

HF II and III

66
Q

does iron increase survival in HF patient

A

no, decrease hospitalizations

67
Q

treatment of blood loss anemia

A

stop the bleeding
transfuse RBCs

68
Q

when to transfuse RBCs and how much iron in each unit

A

Hgb < 7
250 mg iron

69
Q

what is hemolytic anemia

A

RBCs destroyed before 120 days

70
Q

types of hemolytic anemia

A

intertied: sickle cell, G6PD def
acquired: drug induced

71
Q

sickle cell anemia is what

A

RBCs shaped weird
destroyed faster than they can be produced
inherited, homozygotes get anemia

72
Q

treatment of sickle cell anemia

A

folic acid: 1 mg/day
blood transfusions: sx
hydroxyurea: 10-15 mg/kg/day
immunizations
pain control

PHRM 864 (23 decks)

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