anemia Flashcards
Red blood cells last how long
120 days
About how many RBC are produced each day
About 200 million
released into peripheral blood
What is anemia?
A condition characterized by a decrease in Hgb or RBC
How is anemia classified? (3)
• Mild = hgb 10-12
Moderate = 8- 12
severe- <8
Morphological Classes of anemia? (3)
– Megaloblastic
normocytic
microcytic
Megaloblastic are what?
large nucleated RBC precursors
What is megaloblastic usually associated with?
Typically associated with folic acid or vit B12 deficiency
inadequate intake
decreased absorption
inadequte utilization
Microcytic RBC are what?
Small RBC
Microcytic anemia is usually associated with?
Typically associated with iron deficiency due to inadequate iron intake inadequate iron absorption increased iron demand blood loss chronic disease
lack of 3 nutrients to make RBCs that could cause anemia?
– Iron
– Folic
–vit B12
what can cause a loss of RBC that could cause anemia?
– Hemorrhage
– Hemolytic
Etiology Reduced lifespan of RBC
– Chronic diseases
hemolysis
Lack of stimulus to make RBC’s
Lack of ability to make RBC
stimulus= decreased erythropoiten production make= impaired bone marrow function
Acute onset of anemia consists of 3 symptoms
Tachycardia, lightheadedness, breathlessness
6 symptoms of chronic anemia?
Fatigue, H/A
vertigo, faintness, cold sensitivity,
pallor, loss of skin tone
What are some diagnostic labs for anemia?
• CBC, WBC, HCT, Hgb, platelets stool guiac peripheral blood smear reticulocyte count mean corpuscular volume mean corpuscular hemoglobin conc mean corpuscular hemoglobin
Iron deficiency Anemia
• Results from a negative iron balance
very small amount of iron are eliminated each day
What are some symptoms of iron deficiency
spooning of nails brittle nails cheilosis fatigue pallor
Risk factors of iron deficiency anemia
– Premature infants children in rapid growth periods pregnant and lactating women after gastrectomy menstruation GI bleed chronic hemodialysis
Labs seen in patients with iron deficiency anemia
– Low MVC Low MCHC, MCH Low serum ferritin Low transferrin saturation increase TIBC increase transferrin
What is TIBC
increase amount of iron able to bind to transferrin
Why is there low transferrin saturation in iron def anemia?
due to less iron to transport on more transferrin available
what are 4 goals to treatment of iron deficiency anemia?
– Alleviate symptoms
correct iron def
increase Hgb
prevent recurrence
What needs to be included in someone with iron def anemias DIET?
– Meat, fish, poultry
plant sources are more difficult for body to extract iron
What are 4 types of oral supplements used for treatment of iron deficiency anemia?
• Ferrous sulfate** (60 mg elemental) ferrous gluconate (37) ferrous fumarate (33) polysaccharide iron complex (100)
What is the aim for oral iron supplements?
Approximately 200 mg/day elemental iron
Parenteral Iron is used in cases of? (3)
– iron malabsorption
intolerance oral therapy
chronic non compliance
What are some examples of parenteral iron? (4)
iron dextran sodium ferric gluconate (ferrlecit) iron sucrose (venofer) ferumoxytol (feraheme) all given IV used for maintence and prevention
How do you monitor iron deficiency anemia?
weekly CBC, iron panel, Hgb
What should you expect to see in the first few weeks of treatment for iron deficiency anemia?
see increase in reticulocyte count within 7 days due to increase RBC synthesis
increase in Hgb in 1-2 weeks
3-6 months to normalize everything
Side effects of iron treatment includes? (4)
Nausea
black tarry stools
ab discomfort
constipation or diarrhea
Symptoms of Vitamin B12 def anemia? (5)
– Typical symptoms of anemia – Neuropsychiatric abnormalities – Paresthesias – Ataxia – Memory loss
What does vit B12 deficiency anemia result from? (3)
– Chronic low dietary intake over years
– Poor absorption due to lack of intrinsic facto rin gastric cells
– Contributing conditions may include Whipple disease, Zollinger‐Ellison syndrome, Tropical sprue, gastrectomy, inflammatory bowel disease
Labs seen in pts with vit B12 deficiency anemia?
– Macrocytosis/megaloblastic cells increase MCV - low Hgb low serum B12 schilling test increase homocysteine and methylmalonic acid
What are 3 goals of treatment for vit B 12 deficiency anemia
– Resolve symptoms
increase Hgb
prevent recurrence
First line treatment for vitamin B12 deficiency anemia
cyanocobalamin PO daily
What is second line treatment for it b12 deficiency anemia?
cyanocobalamin IM/SC daily for 1-2 weeks
then weekly for 4 weeks
then monthly for life
Nasal spray treatment for vit B12 deficieny anemia
Given weekly for maintenance therapy for patients who have responded to vit B12 treatment
*must be administered 1 hour prior to ingestion of hot foods or beverages to ensure absorption
EXPENSIVE
3 Rare adverse effects of vit B12 therapy
– Hyperuricemia
– Hypokalemia
– Sodium retention
Monitoring response to treatment for vit B12 deficiency anemia?
Reticulocyte count should increase after 2-5 days
Hgb should rise in 1-2 weeks and normalize in 1-2 months
after normalization of everything recheck every 3-6 months
What can cause folic acid deficiency anemia?
– Increased demand
poor absorption from small intestine
ETOH
folic acid antagonist medication
Diagnosis of folic acid deficiant anemia
• Typical symptoms of anemia low Hgb increase homocysteine low serum folic acid conc low RBC folic acid conc
How do you treat folic acid deficiency anemia?
oral folic acid
Monitoring response to treatment of folic acid anemia?
Hgb and reticulocyte count
should normalize in 2 months
What is the cause of anemia of chronic disease
Cause often uncorrectable
renal disease–hemodialysis
cancer–chemo
HIV- antivirals
Treatment options for anemia of chronic disease?
RBC transfusions
Hgb between 8-10
What are side effects of blood transfusions?
– Limited resource immunologic concerns expensive short term treatment infection risk
Erythropoiesis stimulating agent
Drugs that mimic the bodys own erythropoiten produced by the kidneys
Two recombinant DNA drugs available IV/ SC in use
– Darbepoetin (Aranesp®)
– Epoetin alfa
Erythropoiesis are indicated for what?
– Cancer
renal disease
drug induced anemia
*given with iron supplements
How do ESA work?
mimic erythropoiten in the blood and circulates body until reaches bone marrow
bind to receptors on hematopoiten stem cells
stimulus results in new RBC
Darbepoetin (Aranesp®)
Longer half life which allows less dosing
renal dosing
Epoetin (Epogen®,
3 times a week
renal doses
Epo and Darbe dosing
Use lowest/ effective dose to achieve and maintain lowest Hgb to prevent transfusion
D/C if no response in Hgb or still require RBC transfusion after 8 weeks for epo/ 9 weeks for darbe
What are the max doses for EPO and Darbe?
EPO= 60,000 units per week Darbe= 500 mcg per week
What are warnings seen for EPO and Darbe?
Increased mortality, Cardiovascular risk, thromboembolotic events, increased risk of tumor progression/ recurrence
ESA Apprise Program
FDA required this program to ensure the benefits outweigh the risks for using ESA’s
prescribers and hospitals have to be enrolled in this program in order to prescribe the med
What are 1 thing to remember about ESA
in oncology patients ESA should only be used for treatment of anemia due to concomitant myelosuppressive chemo
What needs to be monitored with ESA?
• Monitor iron regularly
Hgb, HCT
BP, # blood transfusions
ESA dose
What is sickle cell anemia?
A group of conditions caused by genetic defects in Hgb
RBC forms sickle shape due to abnormal Hgb
hemolysis of RBC
What is the pathophys of sickle cell anemia?
Amino acid substitution of B polypeptide chain of Hgb
MC type= Hgb- S
requires homogenous gene for Hgb-S to cause sickle cell
Why do the cells sickle?
Cells impaired ability to maintain water and potassium balance
cell dehydrate causing increase in Hgb-S leading to molecular interactions that alter the form of Hgb- S
causing the sickle shape
Why are sickle cells bad?
blood does not flow well through capillaries
leads to impaired circulation, RBC destruction, hypoxia, and end organ damage
What are few early signs of acute sickle cell?
pain
swelling in hands and feet
splenomegaly
What are some chronic symptoms of sickle cell anemia?
– Anemia – Fever – Pallor – Arthralgia weakness anorexia fatigue cardio/hepatomegaly
How to make a diagnosis of sickle cell anemia?
symptoms and history
• Peripheral blood smear
increase reticulocyte count, platelets
screening of newborns
Sickle Cell Crisis can be triggered by what?
– Infection – Dehydration – Hypoxia – Acidosis – Sudden
What are 4 types of sickle cell crisis?
• Vaso-occlusive crisis
aplastic crisis
hemolytic crisis
splenic sequestration
Vaso- occlusive crisis symptoms?
MC
cells get clogged, not allowing blood to get through
– Pain in hands, feet, jts, and, liver, lungs, extremities
3 goals of treatment for sickle cell anemia?
– Decrease frequency/ duration of crisis
prevent/ delay long term complications
improve QOL
Supportive and preventive treatment used for sickle cell anemia?
folic acid
immunizations/ vaccines
prophylactic PCN till age 5
hydroxyurea–> increase Hgb- F
What are some complications with treating sickle cell anemia
RBC transfusions during life threatening situations increase the risk of reaction and iron overload
Hematopoietic stem cell transplantation
– Only potential curative treatment
limited success
limited availability
significant risk for treatment related toxicity
Management of a sickle cell crisis?
IV saline 3-4L
Pain management (NSAIDs/Acetominophen for mild- mod)
opioids for mod- severe
What are 3 managements used in sickle cell anemia?
Treat infections
RBC transfusions
splenectomy
Follow up for patients with sickle cell anemia? (4)
routine CBC
monitor/ track frequency + severity of crises
monitor pain meds
counsel patients on triggers
Criteria of ESA for patient
anemic
chemo induced anemia/ other approved tx
cure for cancer not likely
