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Anemia Flashcards

1
Q

Anemia definition

A

decreased hemoglobin and hematocrit conc below normal levels

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2
Q

Immature RBC’s

A

reticulocytes

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3
Q

mature RBC

A

erythrocytes

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4
Q

lifespan of RBC

A

120 days

Recycled by spleen

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5
Q

Common causes of anemia

A

iron, folate, b12 deficiencies
CKD
Malignancy

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6
Q

Symptoms of anemia

A 
Fatigue 
weakness
SOB
exercise intolerance 
HA 
dizziness
anorexia
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7
Q

Specific symptoms of iron deficiency anemia

A

glossitis (inflamed, sore tonuge)
thin, concaved nails
pica (craving and eating non-foods (ie chalk) WTF

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8
Q

Specific symptoms of B12 anemia

A

neurologic symptoms

psychiatric symptoms

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9
Q

What lab value is used to determine the type of anemia?

A

Mean corpuscular volume (MCV) - size of RBCs
Low MCV - microcytic
High MCV- macrocytic

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10
Q

Normal MCV value

A

80 - 100

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11
Q

Microcytic anemias

A

iron

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12
Q

Macrocytic anemias

A

Folate of Vit B12

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13
Q

Normocytic anemias

A

caused by some comorbid condition

CKD, cancer, etc

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14
Q

recommended dose for iron deficiency anemia

A

100- 200 mg elemental iron per day

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15
Q

Things that decrease iron absoprtion

A

food (take on empty stomach unless GI upset occurs)

acid suppressing agents (PPIs)

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16
Q

% elemental iron of ferrous gluconate

A

12%

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17
Q

% elemental iron of ferrous sulfate

A

20 %

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18
Q

% elemental iron of ferrous fumurate

A

33%

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19
Q

% elemental iron of carbonyl iron/polysaccharide iron complex

A

100 %

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20
Q

Main side effects of oral iron therapy

A

nausea, stomach upset
constipation
Dark and tarry stools

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21
Q

Preferred agent to treat iron-induced constipation

A

docusate

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22
Q

Antidote for iron overdose (common in children)

A

deferoxamine (Desferal)

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23
Q

Coadmin of iron and antacids/PPIs/H2RAs

A

take iron 2 hours before or 4 hours after antacids

24
Q

Drug classes that should be separated from iron

A

quinolones and tetracycline (2 hrs before 4-8 hrs after)
bisphosphonates (take iron 60 mins after)
Levothyroxine (2-4 hrs after)

25
What can increase the absorption of iron?
Vit C --> creates more acidic environment in stomach
26
When might IV iron be used?
Pts with CKD on hemodialysis
27
Ferrlecit
sodium ferric gluconate IV
28
Venofer
Iron sucrose IV
29
Feraheme
ferumoxytol IV
30
Pernicious anemia definition
most common cause of B12 anemia | lack of intrinsic factor -- decr absorption of vit b 12
31
Long-term (> 2 yrs) use of which drugs decr B12 absorption?
metformin H2RAs PPIs
32
Folic acid/B 12 anemias are classified as what type of anemia?
Macrocytic anemia | MVC > 100 (large RBCs)
33
Which anemia can lead to serious neurlogic issues if not treated?
B 12 deficiency
34
What admin route is first line for treating B 12 anemia with severe deficiency or neurologic symptoms?
IM or deep SC injection Don't have to worry about variable oral absorption
35
Dose of cyanocobalamin injection
1000 mcg
36
dose of oral cyanocobalamin
1000- 2000 mcg daily
37
Vit b12 nasal spray
Nascobal | 500 mcg in one nostril once weekly
38
folic acid dose
0.4-1 mg daily
39
Underlying cause of anemia in CKD
deficiency of erythropoietin, which is produced by the kidneys and stimulates bone marrow to produce RBCs
40
Epogen | Procrit
epoetin alfa
41
When would you initiate Epogen?
when HGB is < 10
42
When would you decr or stop dose of Epogen
when Hgb > 11 (on HD) | WHen Hgb > 10 (not on HD)
43
How often can you increase the dose of Epogen?
Every 4 weeks
44
How often is Epogen dosed?
Usually 3X/week
45
Darbepoetin
Aranesp
46
How often is Aranesp dosed?
once weekly (longer t 1/2)
47
Aranesp and Epogen are classified as....
Erythropoiesis-stimualting agents (ESAs)
48
ESAs are still effective if Iron stores are low (t/f)
False | most supplement iron too
49
1st line iron treatment for pts on HD?
IV iron
50
Aplastic anemia
bone marrow does not make enough RBCs, WBCs, platelets
51
What medications can be used to treat aplastic anemia?
immunosuppressants stem cell transplant/ blood transfusion Eltrombopag (Promacta) - incr platelet coount
52
Hemolytic anemia
develops when RBCs are prematurely destroyed | commonly drug-induced or autoimmune
53
Test for hemolytic anemia
Coombs test | detects antibodies that bind to RBCs
54
Genetic cause of hemolytic anemia
G6PD deficiency G6PD - protects RBCs from being destroyed by reactive oxygen species and more
55
Various drugs that can cause hemolytic anemia
``` Beta-lactamase inhibitors Cephalosporins penicllins rifampin platinum based chemo Levodopa Methyldopa isoniazid ```

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