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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
iron deficiency specific symptoms
spoon nails: koilonychias inflamed tongue: glossitis pica: craving substances like ice (pagophagia)
26
oral or IV iron for iron deficient?
oral preferred IV if: ESRD, cant tolerate, cant absorb, HF
27
iron dosing for iron deficient anemia
65 mg elemental iron every other day 120-200 mg elemental iron (BID/TID)
28
how long does it take to replete iron stores in iron def anemia
3-6 months
29
how much elemental in ferrous fumarate
100 mg (33%)
30
how much elemental in ferrous sulfate
65 mg (20%)
31
how much elemental in ferrous gluconate
30 mg (10%)
32
iron has increased absorption with or without food
without food
33
iron absorption can be increased by taking it with what
vitamin C
34
oral iron side effects
constipation dark stools
35
indications of IV iron
HF malabsorption ESRD failed oral iron
36
side effects of IV iron
hypotension during infusion skin tattooing
37
B12 deficiency anemia Hgb MCV ferritin TSAT B12
Hgb decreased MCV increased ferritin unchanged TSAT unchanged B12 decreased
38
B12 low levels
< 200 pg/mL
39
causes of B12 deficiency
pernicious anemia metformin, PPIs vegan / vegetarian alcoholism
40
do our bodies make B12?
no, from diet
41
consequences of B12 deficinecy
weakness, numbness, cognitive dysfunction
42
treatment of B12 deficiency
B12 replacement IM/SC: daily x 1-2 weeks then week/month Oral: 1000-2000 mcg/day
43
which B12 deficiency cause would oral B12 not be as effective
pernicious anemia
44
can we OD on B12?
no its water soluble so we just pee the excess out
45
is oral or IM/SC preferred in B12 def
both are same IM/SC if pernicous anemia
46
folic acid deficiency Hgb MCV RDW folate
Hgb decreased MCV increased RDW increased folate decreased
47
folate level low
< 5 ng/mL
48
causes of folic acid deficiency
malabsorption no green veggies, orange juice, cereal, flour, milk alcoholism meds (methotrexate, phenytoin, Bactrim)
49
treatment of folic acid deficiency
oral folic acid 1-5 mg daily until Hgb normalizes
50
folic acid, oral or IV?
oral is well absorbed
51
what do we need to do before treating folic acid deficiency
check B12 levels neurologic deficits will remain if its off
52
chronic diseases common for anemia
CHF CKD HIV/AIDS cancer
53
what stimulates production of RBCs
erythropoetin
54
why does anemia occur in CKD
decreased erythropoetin production chronic inflammation nutritional deficiencies
55
anemia CKD treatment
avoid blood transfusions correct nutritional deficiencies: B12/folate/iron ESAs
56
IV iron in CKD for who
hemodialysis patients
57
target TSAT in CKD
>30%
58
when to use ESAs
after replenishing iron stores in CKD
59
goal Hgb to maintain while on ESAs
Hgb >10 usinging minimal dose
60
how often can we titrate ESAs
must wait 4 weeks
61
ESA risk
CV events stroke death
62
oral vs IV iron in HF patients
IV is better
63
goal ferritin and TSAT in HF patients
ferritin >100 TSAT >20%
64
can we use ESAs in HF?
no
65
which HF patients would benefit from iron
HF II and III
66
does iron increase survival in HF patient
no, decrease hospitalizations
67
treatment of blood loss anemia
stop the bleeding transfuse RBCs
68
when to transfuse RBCs and how much iron in each unit
Hgb < 7 250 mg iron
69
what is hemolytic anemia
RBCs destroyed before 120 days
70
types of hemolytic anemia
intertied: sickle cell, G6PD def acquired: drug induced
71
sickle cell anemia is what
RBCs shaped weird destroyed faster than they can be produced inherited, homozygotes get anemia
72
treatment of sickle cell anemia
folic acid: 1 mg/day blood transfusions: sx hydroxyurea: 10-15 mg/kg/day immunizations pain control

PHRM 864 (28 decks)

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