Anemia Flashcards
Reduction of volume of red blood cells (RBC) or hemoglobin (Hgb) concentration
Anemia
what are the three types of anemia (based on MCV)
microcyte
normocytic
macrocytic
when can you see microcytic anemia
Iron deficiency Sickle cell Heavy metal poisoning (lead) Chronic disease Thalasemia
when can you see normocytic anemia
Blood loss Hemolysis Aplastic anemia Marrow failure Chronic disease Renal failure Endocrine disorders Acute infection
what can cause macrocytic anemia
B12 deficiency
Folic acid def.
Alcoholism
neurologic finds with anemia usually indicated what?
B 12 deficiency anemia
If MCV is normal, and reticulocyte count is high what can it indicate?
decreased RBC survival
blood loss
hemolysis
most common type of microcytic anemia
iron deficiency
Production of abnormal Hgbβchain
Autosomal recessive genetic disorder
sickle cell disease
what type of anemia is sickle cell disease
microcytic
what form is most dietary iron?
Ferric form (Fe3+)
what is the best absorbed form of iron
Ferrous form (Fe2+)
Having what type foods with iron can help it be absorbed better.
Acidic
what can reduce iron abosprtion
Phytates from vegetables/grains
polyphenols from tea/coffee
calcium
Dietary tx for iron deficiency anemia
encourage intake of foods high in iron heme iron (and ferrous form) easiest to absorb
Two most commonly used iron replacements
ferrous sulfate
ferrous gluconate
How is iron best absorbed?
without food, with acidic drink
ADRs with iron supplementation
N/V
constipation
dark stool
Interactions w/ supplemental iron
Antacids Tetracycline antibiotics Histamine-2 antagonists Proton pump inhibitors Cholestyramine Fiber
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
what are 2 forms of IV iron used
Iron sucrose
Iron dextran
when do you use IV iron
problem with GI, can’t absorb the iron properly
significant blood loss
if giving IV iron faster than giving PO
No
ADRs of IV iron
Flushing, HPOTN
fever/ chills
myalgia
iron overlaod
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
12
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)
