Anemia

Question 1

Why does CKD cause anemia?
Kidneys are responsible for 90% of the production of __________

Answer 1

erythropoietin

Question 2

Erythropoeitn stimulates production of red blood cells and those red bloods cells will help with oxygen rich blood and we have somewhere for hemoglobin to bind to

Question 3

Reduced kidney–> reduced EPO–>reduced number of red bloods cells=

Answer 3

reduced oxygen

Question 4

If you have hypoxia due to decreased red blood cell count, decreased availability of O2 which reduces oxygen in blood and prompts kidney to release erythropoietin then its going to stimulate production in red bone marrow and that erythropoiesis is going to stimulate production of red blood cells and your going to increase the oxygen carrying ability of your blood and brings you back to normal state

Question 5

When pt has Chronic kidney disease then Kidney function declines less release of erythropoietin, less stimulus of red bone marrow less erythropoiesis,fewer blood cells, less O2 in the blood

Question 6

Causes of anemia in CKD

decreased ___________

Blood loss (GI bleeds)

Absolute iron deficiency (malnutrition and poor absorption)

deficiencies of vitamin B12 and folate

Mineral and bone disorder

Bone marrow suppression

Answer 6

erythropoietin production

Question 7

Normal Iron Absorption and metabolism

Dietary iron that can get absorbed and you have iron losses that naturally occur but you have iron transferrin that works with your liver and spleen and they will help stimulate your _______ to provide red blood cells…you have macrophages that reabsorb and reuptake this iron and transfer it into your bone marrow and red blood cells and so you have that whole process kind of occurring here

Answer 7

bone marrow

Question 8

Hgb normal value

Answer 8

11.0-12.0g/dL

Question 9

Our body needs iron to help with carrying hemoglobin on our red blood cells

Question 10

Fe normal value is what?

Answer 10

greater than 30 mcg/dL

Question 11

TIBC (Total iron binding capacity): amount of Fe to which transferrin is capable binding

what is the normal value?

Answer 11

less than 400

Question 12

What is the normal value of TSAT

Answer 12

must greater than or equal to 20%

Question 13

normal value of ferritin

Answer 13

200-799ng/mL

Question 13

Iron Supplementation

Provide the elemental iron required for production of __________

Increased iron demands associated with the initiation of erythropoietic therapy

Answer 13

hemoglobin

Question 13

Iron deficiency in CKD

Causes

___________or poor dietary intake

Chronic blood loss

Chronic inflammation

Potential need for increased iron with ESA use (pt on ESA creates more of a demand for iron so there’s a deficit in those pts..we need to make sure pts have enough available iron if we give ESA to pt )

Answer 13

malabsorption

Question 13

What foods contain iron? meat, spinach, certain cereals can be fortified

Answer 13

beans

Question 14

___________supplementation
First line therapy for anemia of CKD if ron deficiency is diagnosed TSAT <20%

Answer 14

Iron supplementation

Question 14

What drugs can help iron supplementation? ferrous sulfate, ferrous gluconate, iron drops