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anemia 439B Flashcards

1
Q

regular Hgb levels

A

hbg <11 non prego females

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2
Q

MCV

A

mean corpuscular volume

mcv100

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3
Q

INTIAL lab approach

A
  • is patient bld now or in the past? old cbc… anisocytosis or pokilocytosis or wbc ab
  • is there evidence for increased RBC
  • bone marrow suppressed?
  • iorn deficient- yes? why?
  • deficient in Folic acid or Vit b12- why?
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4
Q

reasons for microcytic anemia

A 
MCV <80
iron def
thalessemia
anemia of chronic disease
siderblastic anemia
lead poisoning
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5
Q

reasons for normocytic anemia

A 
mcv 80-99
 sickle cell disease
aplastic anemia
anemia of chronic disease
hemolytic anemias
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6
Q

reasons for macrocytic anemia

A

mcv >100
vit b12 def
folate def

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7
Q

IDA- s&s

A

asymptomatic usually
s&S- fatigue, decreased exercise tolerance, weakness, palpitations, irritability, HA
conjunctival pallor, angular cheilitis, decreased tongue papillae, pallor of palms and hands, koilonychia (lines in nails)

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8
Q

etiologies of IDA

A 
abnormal uterine bld
LT use of NSAIDS
colon CA
GI issue- PUD, h plyoria, gastrectomy etc.
other- hematuria /epistaxis
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9
Q

Reticulocyte count

A

determine RBC underproduction from hemolysis
- high- bone marrow responding normally to bld loss, hemolysis or replacement of iron
norm 0.5-1.5%
with iron therapy 7-10 days increase and MCV normalize

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10
Q

IDA indicator

A

low ferritin level earliest indicator

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11
Q

Anemia of chronic disease

A 
serum iron low (iron not released from storage)
Transferrin TIBC low or normal
Transferrin Sat low
Ferritin high or normal
inflammatory markers- very high!
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12
Q

IDA levels

A 
serum iron- low
TIBC- very high  (iron stores depleted, empty binding sites)
Transferrin sat- low
Ferritin- low (depleted iron stores)
Inflammatory markers- normal
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13
Q

both acute and IDA anemia

A 
serum iron- low
TIBC- low
transferrin sat- low
Ferritin- normal or slighly low
Inflammatory markers- very high
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14
Q

ferritin

A

iron stores

low- depleted stores

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15
Q

TIBC

A

capacity is how many of those receptors available with binding
insuf iron- more space available

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16
Q

special characteristics of cells

A

spur cells, burr cells, schistocytes, spherocytes, target cells, teardrop cells, basophilic stippling
- more than iron def if these are reported in RBC

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17
Q

Iron Therapy considerations PO

A

NOT with food
2 hours before 4 hrs after ingestion of antacids
elemental iron 150-200mg daily
best absorbed with mildly acidic so add ascorbic acid tablet (250mg) or half glass or OJ to enhance

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18
Q

foods to avoid with iron supp

A

phosphates, phyates, and tannates in food
bind with iron and impair absorption
ca foods, tea, coffee, milk, eggs, fiber cereals

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19
Q

meds to avoid with iron supp

A

antacids, h2b, ppi, ca supp, abx (quinolones and tetracyclines)
iron fortified cereals, fiber, tea, coffee

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20
Q

ferrous fumarate

A

324 mg total
106mg element
bid daily

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21
Q

ferrous gluconate

A

300mg total
38 mg element
1-3 tabs TID daily

22
Q

ferrous sulfate

A

325mg total
65mg element
1 tab TID

23
Q

geri ferrous sulfate elixir

A

44mg elemental per 5cc

24
Q

SE of iron supp

A

N/V/D, constipation epigastric distresss
- try smaller dose of elemental irion (sulfate to gluconate) or tab to liquid prep
only increase slowly
if must - take with food but decrease abp by 40%

25
Q

Expected response to Iron suppl

A
  • Immediate disappearance of PICA or RLS
  • Improved feeling of well being within first few days of treatment
  • For mod-severe anemia: modest reticulocytosis will be seen in 7-10 days (those w mild have no reticulocytosis).
  • Hgb will rise slowly after approx. 1-2 weeks and will rise 2g/dL over approx. 3 weeks.
  • Hgb deficit should be halved by approx. 1 month and hgb level should return to normal by 6-8 weeks.
26
Q

Failure to respond to PO therapy

A

1) co-exisiting diseases
2) IDA incorrect dx- thalessemia, lead posiiong, etc)
3) non-adherence
4) not absorbed- malapsorbtion of iron
5) continued blood loss or need in excess iron dose being ingested (PUD) - tx underlying problem

27
Q

H.Pylori causes IDA

A
  • increased iron loss d/t active hemorrhage secondary gastrtitis, PUD, CA
  • achlorhydria induced by chronic gastritis resulting ( reduced iron absorption)
  • reduced secretion of ascorbic acid to gastric muscosa
  • iron utilization by bacterium (using for their own work)
28
Q

common causes of normocytic anemia

A
  • increased RBC loss i.e. acute bleed, hemolysis
  • decreased production of normal sized RBCs i.e. aplastic anemai, chronic disease anemai, endocrine DO
  • overexpansion of plasma volume
    i. e. prego or fld overload
29
Q

Macrocytic anemias

A

slide

30
Q

anemia of chronic disease/inflammation patho

A

infection, chronic inflam
macrophages stim and activate cytokine release i.e. IL-6, induces hepcidin which inhibits iron release- protective measurement

31
Q

anemia of chronic disease tx

A
  • tx underlying condition- infection/inflam

check ESR/c-reactive protien

32
Q

sickle cell

A

normochromic but not normocytic- decreased rbc loss

33
Q

vitamin b12 needed

A

DNA synthesis
formation of myelin sheaths- neuro deficits
synthesis of neurotransmitters - depression with vit b12 def.
erythropoiesis

34
Q

PE of vit b12 def

A
  • numbness/paresthesisas
  • cognitive impairment and depression
  • symmetrically decreased vibration and proprioception in feet.
  • absent or decreased DTR in LE
35
Q

cobalamin

A

vit b12

a water soluble vitamin req for proper RBC function, neuro function and DNA synthesis

36
Q

late biomarker of vit b12

A

serum vit b12- low sen/spe when used alone

37
Q

earliest bio marker of vit b12

A

holotranscobalamin aka active b12

elevated homocysteine >13 and elevated MMA (>0.4) are seen in vit b12

38
Q

MMA

A

methylamolonic acid >0.4

most specific for vit b12

39
Q

Vitamin B12 Deficiency lab Levels look..

A 
MCV >100
macrocytosis with hypersegmented
pernicious anemia - poss
homocystine- elevated
MMA- elevated
40
Q

Folate Def lab levels….

A 
>100 MCV
macrocytosis with hypersegmented neutrophils
per anemia- NO
homocystine- elevated
MMA- NORMAL**
41
Q

risk factors Vit b12

A 
decreased ileal absorption
decreased intrinsic factor
genetic
inadq intake
prolonged med use (h2b, metformin, PPI)
food/vit b12 malabsorption
42
Q

best dietary food for Vitamin B 12

A

fortified breakfast cereals

43
Q

tx vit b12 def

A

1000ug daily x1 week then weekly x 1month then monthly for life- unless underlying cause tx
- 1000-2000 mcg of crystalline cobalamin PO daily

44
Q

Folate normal level

A

> 4ng/ml

45
Q

folate def dx level

A

<2ng/ml as long as anorexia or fasting

46
Q

tx folate def by…

A

prevent neural tube deficits
1mg PO daily
r/o vit b12 before folic aacid begins- dont want to mask symptoms of vit b12 def

47
Q

older adults vit b12 reason 1

A

low or normal b12 and elevated metabolites
due to age (decrease gastric acid) and atrophic gastritits (food bound malabsorption)
** inabiliyt to release b12 from food or binding protein

48
Q

older adults vit b12 reason 2

A

small intestinal bacterial overgrowth from decreased gastric acid and reduced intestinal motility
h.plylori most common

49
Q

vitamin b12 reason 3

A
  • PPI
    H2B
    exacerbating impairment of b12 absorption from food
50
Q

vitamin b12 reason 4

A

nitrous oxide induce def by oxidizing and sub inactivating b12

51
Q

meds that inhibit vit b12 absorption

A 
pPI
H2B
metformin
colchine
abx
anti-convulsants
52
Q

dietary intake of vit b12

A

2.4 ug per day

body store- 2-5mg in liver

239B (14 decks)

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