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Pharm III Heme/Onc > Anemia > Flashcards

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
Q

what are rare adverse effects of B12 therapy

A

hyperuricemia
hypokalemia
sodium retention

26
Q

How are you monitoring their response to B12 tx

A

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
Q

what causes folic acid deficiency

A 
increased demand
poor absorption from small intestine
alcoholism
use of folic acid antagonist meds:
Bactrim, methotrexate
There are no psychiatric symptoms or paresthesias
28
Q

how is folic acid anemia diagnosed?

A

low hgb
increased homocysteine and normal MMA
low serum folic acid conc
low RBC folic acid conc

29
Q

what is the Tx for folic acid anemia

A

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
Q

how is the response to folic acid monitored?

A

Hgb and retic count should see response within 1-2 wks
lack of response may suggest mixed anemia
should normalize in 2 months

31
Q

What drugs can cause lower folic acid levels?

A

all use folic acid pathway:
fosphenytoin, phenytoin, phenobarbital
Other drugs that may contribute to folic acid deficiency:
methotrexate, nitrofurantoin, alcoholol consumption

32
Q

what causes anemia of chronic disease?

A

renal failure
Cancer
HIV

33
Q

what are Tx options for anemia of chronic disease?

A

RBC transfusion

34
Q

what are EPO stimulating agents

A

drugs that mimic the body’s own EPO produced by the kidneys

35
Q

what are the 2 new EPO agents

A

Darbopentin (aranesp)
Epoetin Alfa (Epogen, Procrit)
was: peginesatide removed from market

36
Q

when are EPO stimulating agents recommended?

A 
in anemia secondary to
Cancer (Aranesp, Epogen, Procrit)
Renal (All)
Drug induced (Aranesp, Epogen, Procrit)
Give iron supplement to prevent iron deficiency
37
Q

How do ESA work

A

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
Q

which has a longer half life

Darbepoetin or Epoetin

A

Darbepoetin allow for less frequent dosing
Epoetin 3x a week
There is no difference in efficacy

39
Q

What is the ESA APPRISE program?

A

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
Q

How do you deal with ESA risk

A

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
Q

Use of Iron supplements with ESA use?

A

always check baseline serum about to start ESA
Iron supplements may be needed during ESA Tx
-ESA trigger rapid use of iron stores

42
Q

what is sickle cell anemia

A

group of conditions caused by genetic defects in hemoglobin

RBC form a sickle shape due to abnormal Hgb which results in hemolysis

43
Q

what is the most common type of sickle cell

A

Hgb-s

requires homozygous gene for Hgb-s to cause sickle cell anemia

44
Q

why do sickle cells sickle?

A

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
Q

why are sickle cells bad?

A

don’t flow well in vasculature
impairs circulation, RBC destruction, and stasis blood flow
lead to tissue hypoxia and end organ damage

46
Q

How does sickle cell present in pts?

A

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
Q

How is sickle cell anemia diagnosed?

A

evaluation based on presentation of symptomsL arthralgias in high risk individuals
Peripheral blood smear reveals sickled cells
Increased retic count and platelet count

48
Q

Sickle cell crisis is triggered by

A 
Infection
Dehydration
Hypoxia
Acidosis 
Sudden temp change
49
Q

what are the 4 types of sickle cell crisis?

A

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
Q

why is sickle cell so bad?

A

extensive complications with acute chest syndrome and end organ damage

51
Q

what is the treatment goal for Sickle cell?

A

decrease frequency and duration of crises
prevent or delay long term complications
improve quality of life

52
Q

What are supportive and preventive Tx?

A

Folic acid b/c of increased hyper-EPO
Vaccinations-HIB type B
Prophylactic penicillin upto 5 yrs
Hydroxurea

53
Q

How to manage sickle cell crisis?

A

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
Q

The management of sickle cell is

A

Treat infx
RBC transfusions to dilute Hgb-s
Splenectomy- in severe sequestration

55
Q

what is the follow up with sickle cell anemia?

A 
routine CBC
monitor and track freq of crises
monitor hydroxyurea for myelosupression
monitor analgesic usage
counsel on avoiding triggers
56
Q

what Hgb level for ESA should you never exceed?

A

Hgb>11g/dl

57
Q

What should you do if Hgb response is <10g/dl after 4 wks of epo?

A

increase dose to 600,00 units or keep

58
Q

what should you do if Hgb increased by > 1g/dl with in any 2 wks

A

reduce dose

Pharm III Heme/Onc (2 decks)

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