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Anemia Flashcards

1
Q

how many RBC’s are produced each day in the bone marrow

A

200 billion

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2
Q

what is anemia

A

a condition characterized by a decrease in hemoglobin (Hgb) or red blood cells (RBC)

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3
Q

what are the normal Hgb values for
Males
Females

A
  • Adult males: 13.5‐17.5 g/dL

* Adult females: 12‐16 g/dL

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4
Q

anemia is has a Hgb level of what?

A

Hgb<12g/dl

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5
Q

Megaloblastic

A

large nucleated RBC

Typical associated with folic acid or vitamin B12 deficiency

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6
Q

what are the causes for megaloblastic anemia

A

Inadequate intake
decreased absorption
Inadequate utilization

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7
Q

Microcytic

A 
small RBCs
associtated with inadequate iron intake
inadequate iron absorption
Increased iron demand
blood loss
chronic disease
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8
Q

what factors that affect normal process of RBC

A 
lack of nutrients use to make RBC:
Iron, Folic acid, Vit B12
Lack of Stimulus to make RBC:
decreased EPO prod
lack of ability to make RBC: bone marrow dysfunction
Reduced RBC life span:
Chronic dz, hemolysis
Loss of RBC:
Hemorrhage
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9
Q

what is the presentation of anemia like?
Acute onset
Chronic onset?

A

varies depending on the acuity of onset and cause
Acute onset:
Tachycardia, light-headed, breathless
Chronic onset:
fatigue, HA, vertigo, faintness, cold sensitivity, pallor, loss of skin tone
SYMPTOMS MAY OVERLAP

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10
Q

what are the 2 types of macrocytic anemia

A

folic acid

B12

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11
Q

what is a type of microcyctic anemia

A

Iron deficiency

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12
Q

what are the causes of an iron deficiency anemia

A

acute or chronic blood loss or insufficient iron intake

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13
Q

where is iron stored

A

intestinal mucosal cells

liver, spleen and bone

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14
Q

what are symptoms of iron deficiency anemia?

A

spooning of nails
cheilosis
brittle nails

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15
Q

what will lab values look like for a iron deficiency anemia

A 
Low MCV
Low MCH
low serum ferritin
increased Transferrin
increased TIBC
decreased transferrin saturation
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16
Q

what are the Tx goals of iron deficient anemia

A

alleviate symptoms
correct iron deficiency
increase Hgb
prevent recurrence

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17
Q

what are Tx options for iron deficiency?

A 
Ferrous sulfate
Ferrous gluconate
Ferrous Fumarate
Polysaccharide iron complex 
Diet: meat, fish, poultry
plants are harder for body to extract iron
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18
Q

when is parenteral iron used

A

iron malabsorption
Intolerance of oral therapy
Chronic non-compliance
Iron Dextran is used

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19
Q

Vit B12 anemia

A

chronic low intake over years
poor absorption d/t lack of intrinsic factor in gastric cells
contributing conditions: Wipple dz, gastrectomy, IBD

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20
Q

what are symptoms of B12 deficient anemia

A

neuropsychiatric abnorm
paraesthesisa
ataxia
memory loss

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21
Q

how is the diagnosis of B12 made?

A 
macrocytic
low Hgb
Low serum B12
Schilling test-assess intrinsic factor
increased homocysteine and methmalonic acid
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22
Q

what is the Tx goal of B12 anemia

A

resolve symtpoms
increase Hgb
prevent recurrence

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23
Q

what are the Tx options for B12 deficiency?

A

1st line:cyanocobalamin PO
2nd:line cyanocobalamin IM
Oral can be used in intrinsic factor deficiency since alternative absorption exists

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24
Q

What other types of Vit B12 replacement are there?

A

nasal spray

used for maintenance therapy

25
what are rare adverse effects of B12 therapy
hyperuricemia hypokalemia sodium retention
26
How are you monitoring their response to B12 tx
retic count should increase after 2-5 days Hgb should increase within 1-2wks and normalize within 1-2months Symptoms should resolve within a week
27
what causes folic acid deficiency
``` increased demand poor absorption from small intestine alcoholism use of folic acid antagonist meds: Bactrim, methotrexate There are no psychiatric symptoms or paresthesias ```
28
how is folic acid anemia diagnosed?
low hgb increased homocysteine and normal MMA low serum folic acid conc low RBC folic acid conc
29
what is the Tx for folic acid anemia
Oral folic acid IV/PO Long term therapy is sometime indicated in slow response cases Maintenance dose of .4mg may be used if pts continued risk of folic acid deficiency
30
how is the response to folic acid monitored?
Hgb and retic count should see response within 1-2 wks lack of response may suggest mixed anemia should normalize in 2 months
31
What drugs can cause lower folic acid levels?
all use folic acid pathway: fosphenytoin, phenytoin, phenobarbital Other drugs that may contribute to folic acid deficiency: methotrexate, nitrofurantoin, alcoholol consumption
32
what causes anemia of chronic disease?
renal failure Cancer HIV
33
what are Tx options for anemia of chronic disease?
RBC transfusion
34
what are EPO stimulating agents
drugs that mimic the body's own EPO produced by the kidneys
35
what are the 2 new EPO agents
Darbopentin (aranesp) Epoetin Alfa (Epogen, Procrit) was: peginesatide removed from market
36
when are EPO stimulating agents recommended?
``` in anemia secondary to Cancer (Aranesp, Epogen, Procrit) Renal (All) Drug induced (Aranesp, Epogen, Procrit) Give iron supplement to prevent iron deficiency ```
37
How do ESA work
endogenous erythropoietin is normally produced by kidneys in response to low oxygen levels in blood Epoetin and Darbepoetin mimic endogenous erytheopoietin and circulate through the vasculature and into the bone marrow These agents bind receptors on hematopoietic stem cells which stimulates eryhtrogenesis
38
which has a longer half life | Darbepoetin or Epoetin
Darbepoetin allow for less frequent dosing Epoetin 3x a week There is no difference in efficacy
39
What is the ESA APPRISE program?
Helps providers and Cancer pts with risk infromation and safe use of ESA used to ensure the benefits of ESA outweigh the risks Prescribers and Hospital must enroll in and comply with ESA APPRISE oncology program
40
How do you deal with ESA risk
use lowest dose needed to avoid RBC transfusion In cancer pts only use ESA for treatment for anemia in myelosuppressive chemotherapy D/C following completion of a chemo course
41
Use of Iron supplements with ESA use?
always check baseline serum about to start ESA Iron supplements may be needed during ESA Tx -ESA trigger rapid use of iron stores
42
what is sickle cell anemia
group of conditions caused by genetic defects in hemoglobin | RBC form a sickle shape due to abnormal Hgb which results in hemolysis
43
what is the most common type of sickle cell
Hgb-s | requires homozygous gene for Hgb-s to cause sickle cell anemia
44
why do sickle cells sickle?
cell contain Hgb-s have impaired ability to maintain potassium and water balance when cells become dehydrated, the concentration of Hgb-s increased leading to the molecular interaction that alter the form of Hgb-s this changes the shape of RBC
45
why are sickle cells bad?
don't flow well in vasculature impairs circulation, RBC destruction, and stasis blood flow lead to tissue hypoxia and end organ damage
46
How does sickle cell present in pts?
may appear as early as 4-6 months of age with Hgb-F begins to decline Swelling in hands and feet, spleenomegaly Also can have: Scleral Icterus, Heaturia, Hepatomegaly, Arthralgia, Pallor
47
How is sickle cell anemia diagnosed?
evaluation based on presentation of symptomsL arthralgias in high risk individuals Peripheral blood smear reveals sickled cells Increased retic count and platelet count
48
Sickle cell crisis is triggered by
``` Infection Dehydration Hypoxia Acidosis Sudden temp change ```
49
what are the 4 types of sickle cell crisis?
Vaso-occlusive crisis (MC)- pain in hands, feet, joints, extremities, abdomen, liver and lungs Aplastic crisis Hemolytic crisis Splenic sequestration- big cause of death
50
why is sickle cell so bad?
extensive complications with acute chest syndrome and end organ damage
51
what is the treatment goal for Sickle cell?
decrease frequency and duration of crises prevent or delay long term complications improve quality of life
52
What are supportive and preventive Tx?
Folic acid b/c of increased hyper-EPO Vaccinations-HIB type B Prophylactic penicillin upto 5 yrs Hydroxurea
53
How to manage sickle cell crisis?
Hydration with saline 3-4L/day and avoid over hydration Pain management options: NSAID/Aceto for mild to mod pain Opioids for mod to severe pain morphine, fentanyl
54
The management of sickle cell is
Treat infx RBC transfusions to dilute Hgb-s Splenectomy- in severe sequestration
55
what is the follow up with sickle cell anemia?
``` routine CBC monitor and track freq of crises monitor hydroxyurea for myelosupression monitor analgesic usage counsel on avoiding triggers ```
56
what Hgb level for ESA should you never exceed?
Hgb>11g/dl
57
What should you do if Hgb response is <10g/dl after 4 wks of epo?
increase dose to 600,00 units or keep
58
what should you do if Hgb increased by > 1g/dl with in any 2 wks
reduce dose

Pharm III Heme/Onc (2 decks)

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