Anemia Flashcards by Meg Dolohanty

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

Anemia

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

microcyte
normocytic
macrocytic

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when can you see microcytic anemia

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

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when can you see normocytic anemia

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

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what can cause macrocytic anemia

B12 deficiency
Folic acid def.
Alcoholism

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neurologic finds with anemia usually indicated what?

B 12 deficiency anemia

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

decreased RBC survival
blood loss
hemolysis

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most common type of microcytic anemia

iron deficiency

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Production of abnormal Hgbβchain

Autosomal recessive genetic disorder

sickle cell disease

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what type of anemia is sickle cell disease

microcytic

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what form is most dietary iron?

Ferric form (Fe3+)

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what is the best absorbed form of iron

Ferrous form (Fe2+)

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

Acidic

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what can reduce iron abosprtion

Phytates from vegetables/grains
polyphenols from tea/coffee
calcium

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Dietary tx for iron deficiency anemia

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

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Two most commonly used iron replacements

ferrous sulfate

ferrous gluconate

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How is iron best absorbed?

without food, with acidic drink

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ADRs with iron supplementation

N/V
constipation
dark stool

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Interactions w/ supplemental iron

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

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how long does it take for Hgb to rise after supplementation

3 weeks, resolution in 1-2 months

iron stores back in 3-6 months

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what are 2 forms of IV iron used

Iron sucrose

Iron dextran

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when do you use IV iron

problem with GI, can’t absorb the iron properly

significant blood loss

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if giving IV iron faster than giving PO

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ADRs of IV iron

Flushing, HPOTN
fever/ chills
myalgia
iron overlaod

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Black box warning with IV iron

anaphylaxis

what do you check weekly with IV iron?

Hgb Hct Ferritin Transferrin saturation

resulting RBCs from macrocytic anemias are what?

macrocytic and immature

what meds are associated w/ megaloblastic anemia

``` Azathioprine 6 – mercaptopurine Cytarabine Fluorouracil Methotrexate Pentamidine Trimethoprim Triamterene Hydroxyurea Zidovudine Phenytoin Phenobarbital ```

who is at high risk for Vit B12 deficiency

women elgerly using gastric-acid suppressing therapy alcoholics

What does Vit B 12 do?

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

what is needed for B12 to be absorbed?

intrinsic factor

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

Transcobalamin-II

what converts vit B12 to coenzyme B12?

liver

what is coenzyme B12 used for?

Hematopoesis Myelin maintenance Epithelial cell production

who has inadequate intake of Vit B12?

strict vegas | chronic alcoholics

what conditions cause malabsorption of VIt B12?

``` Pernicious anemia Gastric atrophy Gastrectomy/ileectomy Acid-suppressing therapy Inflammatory bowel disease ```

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

pernicious anemia

what causes pernicious anemia?

Due to autoimmune parietal cell destruction, gastric atrophy, surgery

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

gastric cancer

what are symptoms of pernicious anemia?

Glossitis (bloody, big, red tongue) | numbness, paresthesias in extremities

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

if neurologic symptoms are present

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

rebound thrombocytosis fluid retention anaphylaxis

who are at high risk for a folate deficiency?

Adolescents/teens Elderly Pregnant women Alcoholics

folate functions

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

where is folate absorbed?

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

what are some drugs that can cause folate deficiency?

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

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

B 12 deficiency

Secondary causes of normocytic anemias

Renal failure Endocrine disorders Anemia of chronic disease

common source of blood loss leading to normocytic anemia

Injury | GI bleed

One unit of blood is how many packed cells of RBCs

300 cc

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

1 mg/dL and Hct by 3%

when do you do a blood transfusion

Hgb 30% blood loss

2nd most common anemia after iron deficiency

anemia of chronic disease

chronic infections that can cause anemia of chronic disease

Tuberculosis HIV Subacute bacterial endocarditis Osteomyelitis

chronic inflammatory conditions that can cause ACD

Rheumatoid arthritis SLE IBD Gout

malignancies that can lead to ACD

Carcinoma Lymphoma Leukemia Multiple Myeloma

how to treat ACD

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

FDA approved indications for erythropoeitic agents

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

EPO drug options

Epoetin | Darbopoetin

Do not begin in chemo patients with Hgb > ______

10 g/dL

goal of EPO agents

maintain Hgb to avoid RBC transfusions | Get Hgb to 10-12 in chronic renal failure

Hgb should NOT exceed _____ in any patient

12 g/dL

you should discontinue EPO agents if inadequate response in ___ weeks

what do you monitor when giving EPO agents

Hgb/Hct weekly Resolution of symptoms Iron studies Side effects

ADRS with EPO agents

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

Black box warnings for EPO agents

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)