Anemia

Question 0

Patients at risk for microcytic anemia due to iron deficiency

Answer 0

Pregnant women, preterm and low birth weight infants, older infants and toddlers, teenage girls, women with heavy menstrual periods, and renal failure patients

G.I. disease including Crohn’s, cilia disease and weight-loss surgery can reduce absorption and require replacement therapy as well

Treatment: first line is ferrous sulfate 325 mg by mouth daily to 325 mg by mouth three times a day

Hemoglobin level should increase 1 g/dL every 2 to 3 weeks of iron therapy

Question 1

Types of anemia

Answer 1

Low hemoglobin and low hematocrit

1. Microcytic: MCV less than 80 µm^3 (iron deficiency anemia)
2. Macrocytic: MCV greater than 100 µm (megaloblastic anemia due to folate vitamin B12 deficiency)
3. Normocytic anemia: MCV 80–100 commonly caused by a cute blood loss, hemolysis, bone marrow failure or anemia of chronic disease

Question 2

Iron formulations

Answer 2

1. Ferrous sulfate: 20% elemental iron
2. Ferrous fumarate (Hemocyte): 33% elemental iron
3. Ferrous gluconate (Fergon): 12% elemental iron
4. Carbonyl iron (Feosol,Ferracap): 100% elemental iron

Warning: accidental overdose of iron containing products is a leading cause of fail poisoning in children under six

Side effects: nausea, stomach upset, constipation, dark and tarry stools

Notes: enteric-coated products are not recommended and all fiber supplement should be taken without food preferably one hour before as food decreases absorption

Question 3

Anemia of chronic disease

Answer 3

Due to a deficiency and erythropoietin a hormone produced by healthy kidneys

Use ESA’s at a lowest dose possible. Start one hemoglobin is less than 10 g/dL and reduce or stop therapy when the hemoglobin is near 11 g/dL (iron levels must be within normal range prior to initiation or the ESA will not work appropriately)