anemia Flashcards
How do you treat an iron deficient patient?
oral ferrous sulfate/gluconate/fumarate
sulfate = cheapest
gluconate = better GI tolerance
fumarate = most iron
How do you counsel an iron deficient patient?
take w/ vitamin C and NOT with calcium, milk, antacids, caffeine, 3-6 month treatment
take 30 min before a meal and 2 hours before other meds
When is parenteral iron needed?
cannot tolerate or absorb PO or for rapid loss, iron dextran or sodium ferric gluconate complex or iron sucrose
Find the cause of low iron!
What IV iron need test doses?
iron dextran and iron gluconate
What are ADRs of iron?
Gi discomfort, black stools (may obscure continued GI blood loss), acute iron toxicity
How do you treat some of the ADRS of iron?
polyethylene glycol – whole bowel irrigation, iron that hasn’t been asborbed
deferoxamine (iron-chelating compound)
What are some tests to establish B12 deficiency anemia?
IF antibody and antiparietal cell antibody tests (pernicious anemia), schilling test (test B12 GI absorption)
how do you treat symptomatic patients with B12 anemia?
daily PO or monthly IM cyanocobalamin
How do you treat asymptomatic patients in B12 anemia?
eat healthy animal derived foods + multivitamin +/- daily PO or monthly IM cyanocobalamin
What is folate deficiency associated with?
fetal neural tube defects
What test do you have to do with folate deficiency anemia?
must obtain vitamin B12 levels just to verify
What drugs can cause folate deficiency anemia?
trimethoprim, pyrimethamin, methotrexate, sulfasalazine, oral contraceptives, anticonvulsants
How can you treat folate deficiency?
oral folic acid supplement or leucovorin (patients taking anti-folate drugs)
what drugs are used illegally by athletes for increased erythropoiesis and can be used clinically in end-stage renal disease, chemo, or HIV?
erythropoietins
What can erythropoetins cause?
risk of death, heart attack, stroke, thrombosis – use lowest dose
