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*OldPharm > Anemia > Flashcards

Anemia Flashcards

1
Q

Reduction of volume of red blood cells (RBC) or hemoglobin (Hgb) concentration

A

Anemia

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2
Q

what are the three types of anemia (based on MCV)

A

microcyte
normocytic
macrocytic

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3
Q

when can you see microcytic anemia

A 
Iron deficiency
Sickle cell
Heavy metal poisoning (lead)
Chronic disease
Thalasemia
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4
Q

when can you see normocytic anemia

A 
Blood loss
Hemolysis
Aplastic anemia
Marrow failure
Chronic disease 
Renal failure
Endocrine disorders
Acute infection
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5
Q

what can cause macrocytic anemia

A

B12 deficiency
Folic acid def.
Alcoholism

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6
Q

neurologic finds with anemia usually indicated what?

A

B 12 deficiency anemia

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7
Q

If MCV is normal, and reticulocyte count is high what can it indicate?

A

decreased RBC survival
blood loss
hemolysis

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8
Q

most common type of microcytic anemia

A

iron deficiency

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9
Q

Production of abnormal Hgbβchain

Autosomal recessive genetic disorder

A

sickle cell disease

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10
Q

what type of anemia is sickle cell disease

A

microcytic

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11
Q

what form is most dietary iron?

A

Ferric form (Fe3+)

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12
Q

what is the best absorbed form of iron

A

Ferrous form (Fe2+)

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13
Q

Having what type foods with iron can help it be absorbed better.

A

Acidic

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14
Q

what can reduce iron abosprtion

A

Phytates from vegetables/grains
polyphenols from tea/coffee
calcium

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15
Q

Dietary tx for iron deficiency anemia

A 
encourage intake of foods high in iron
heme iron (and ferrous form) easiest to absorb
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16
Q

Two most commonly used iron replacements

A

ferrous sulfate

ferrous gluconate

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17
Q

How is iron best absorbed?

A

without food, with acidic drink

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18
Q

ADRs with iron supplementation

A

N/V
constipation
dark stool

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19
Q

Interactions w/ supplemental iron

A 
Antacids
Tetracycline antibiotics
Histamine-2 antagonists
Proton pump inhibitors
Cholestyramine
Fiber
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20
Q

how long does it take for Hgb to rise after supplementation

A

3 weeks, resolution in 1-2 months

iron stores back in 3-6 months

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21
Q

what are 2 forms of IV iron used

A

Iron sucrose

Iron dextran

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22
Q

when do you use IV iron

A

problem with GI, can’t absorb the iron properly

significant blood loss

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23
Q

if giving IV iron faster than giving PO

A

No

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24
Q

ADRs of IV iron

A

Flushing, HPOTN
fever/ chills
myalgia
iron overlaod

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25
Q

Black box warning with IV iron

A

anaphylaxis

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26
Q

what do you check weekly with IV iron?

A

Hgb
Hct
Ferritin
Transferrin saturation

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27
Q

resulting RBCs from macrocytic anemias are what?

A

macrocytic and immature

28
Q

what meds are associated w/ megaloblastic anemia

A 
Azathioprine
6 – mercaptopurine
Cytarabine
Fluorouracil
Methotrexate
Pentamidine
Trimethoprim
Triamterene
Hydroxyurea 
Zidovudine
Phenytoin
Phenobarbital
29
Q

who is at high risk for Vit B12 deficiency

A

women
elgerly
using gastric-acid suppressing therapy
alcoholics

30
Q

What does Vit B 12 do?

A 
DNA synthesis (W/ folate)
myeline synthesis (integrity of neuro system)
fatty acid biosynthesis and conversion of some amino acids
31
Q

what is needed for B12 to be absorbed?

A

intrinsic factor

32
Q

what is necessary for endocytosis of Vit B12 into cells including bone marrow and liver

A

Transcobalamin-II

33
Q

what converts vit B12 to coenzyme B12?

A

liver

34
Q

what is coenzyme B12 used for?

A

Hematopoesis
Myelin maintenance
Epithelial cell production

35
Q

who has inadequate intake of Vit B12?

A

strict vegas

chronic alcoholics

36
Q

what conditions cause malabsorption of VIt B12?

A 
Pernicious anemia
Gastric atrophy
Gastrectomy/ileectomy
Acid-suppressing therapy
Inflammatory bowel disease
37
Q

what is a condition where there is an absence of intrinsic factor?

A

pernicious anemia

38
Q

what causes pernicious anemia?

A

Due to autoimmune parietal cell destruction, gastric atrophy, surgery

39
Q

what type cancer is there higher risk of with pernicious anemia?

A

gastric cancer

40
Q

what are symptoms of pernicious anemia?

A

Glossitis (bloody, big, red tongue)

numbness, paresthesias in extremities

41
Q

when do you use IM/SC route of Vit B 12 (cyanocobalamin)

A

if neurologic symptoms are present

42
Q

ADRS of VIt B12 supplementation (more common with IV admin)

A

rebound thrombocytosis
fluid retention
anaphylaxis

43
Q

who are at high risk for a folate deficiency?

A

Adolescents/teens
Elderly
Pregnant women
Alcoholics

44
Q

folate functions

A

DNA synthesis
Protein, amino acid, purine & pyrimidine synthesis
Important in fetal development

45
Q

where is folate absorbed?

A

small intestine and converted to active form via B 12 -depending rxn

46
Q

what are some drugs that can cause folate deficiency?

A

sulfa drugs (folic acid antagonist)
methotrexate (folic acid antagonist)
phenytoin

47
Q

if you are suspecting a folate acid deficiency, what must you rule out?

A

B 12 deficiency

48
Q

Secondary causes of normocytic anemias

A

Renal failure
Endocrine disorders
Anemia of chronic disease

49
Q

common source of blood loss leading to normocytic anemia

A

Injury

GI bleed

50
Q

One unit of blood is how many packed cells of RBCs

A

300 cc

51
Q

1 unit of blood to raise Hgb by __ mg/dL and Hct by __%

A

1 mg/dL and Hct by 3%

52
Q

when do you do a blood transfusion

A

Hgb 30% blood loss

53
Q

2nd most common anemia after iron deficiency

A

anemia of chronic disease

54
Q

chronic infections that can cause anemia of chronic disease

A

Tuberculosis
HIV
Subacute bacterial endocarditis
Osteomyelitis

55
Q

chronic inflammatory conditions that can cause ACD

A

Rheumatoid arthritis
SLE
IBD
Gout

56
Q

malignancies that can lead to ACD

A

Carcinoma
Lymphoma
Leukemia
Multiple Myeloma

57
Q

how to treat ACD

A

treat underlying disease
replace iron if deficient
blood transfusion if severe anemia and symptomatic
EPO

58
Q

FDA approved indications for erythropoeitic agents

A

Anemia associated with chronic renal failure
Anemia due to chemotherapy for non-myeloid malignancies
Anemia associated with HIV therapies causing myelosupression

59
Q

EPO drug options

A

Epoetin

Darbopoetin

60
Q

Do not begin in chemo patients with Hgb > ______

A

10 g/dL

61
Q

goal of EPO agents

A

maintain Hgb to avoid RBC transfusions

Get Hgb to 10-12 in chronic renal failure

62
Q

Hgb should NOT exceed _____ in any patient

A

12 g/dL

63
Q

you should discontinue EPO agents if inadequate response in ___ weeks

A

12

64
Q

what do you monitor when giving EPO agents

A

Hgb/Hct weekly
Resolution of symptoms
Iron studies
Side effects

65
Q

ADRS with EPO agents

A

Infusion reactions: fever, chest pain, N/V, back pain
Edema
Severe hypertension (renal failure patients)
Seizures
Allergic reactions

66
Q

Black box warnings for EPO agents

A

shortened time to tumor progression and increased mortality in breast, cervical, head and neck, lymphoid and non-small cell ung cancer (especially Hgb >12)
increased risk of death, serious CV events in renal failure patients if higher Hgb (>13.5 especially)

*OldPharm (12 decks)

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