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PHRM 825 > Anemia > Flashcards

Anemia Flashcards

1
Q

Anemia

A

lack of blood and oxygen

decrease in RBC and decrease Hgb

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2
Q

Define Signs and Symptoms of Anemia

A

exertional dyspnea- shortness of breath with exercise

angina-not enough oxygen to the heart leading to chest pain

tachycardia-not enough blood or oxygen getting into tissue, the body will try to fix it by pumping faster

fatigue-not enough oxygen, feel tired and weak
pallor
anemia may be asymptomatic especially if it develops slowly

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3
Q

RBC Lab Value (normal)

A

of RBCs estimate oxygen carrying capacity

males: 4.5-5.5 x 10^6
females: 4.1-4.9 x 10^6

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4
Q

Hgb Lab Value (normal)

A

oxygen carrying capacity

males: 13.5-18g/dL
females: 12-16g/dL

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5
Q

Hematocrit Lab Value (normal)

A

volume of RBCs per unit of blood

38-50%: male
36-46.6%: female

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6
Q

Mean Corpuscular Volume (normal)

A

average volume of RBCs help determine what might be the case of anemia

80-100mm^3

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7
Q

RDW Lab Value (normal)

A

Red blood cell distribution width

11.5%-14.5%

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8
Q

T/F: Iron Supplementation is the first line treatment of anemia

A

F: iron supplementation is not the first line treatment of anemia
-you have to assess what is causing the anemia, it will only be useful for iron deficiency anemia

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9
Q

Decreased RBC Production

cause of anemia

A

caused by chronic diseases
(CKD, cancer, CHF)
nutritional deficiency-lack building blocks to make RBCs
iron, folic acid, vitamin B12

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10
Q

Increased RBC Destruction

cause of anemia

A

drugs
sickle cell anemia
thalassemia

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11
Q

Increased Red Blood Cell Loss

cause of anemia

A

acute blood loss

chronic NSAIDs/ ASA (aspirin)

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12
Q

Microcytic Anemia

A

MCV <80

iron deficiency, sickle cell, thalassemia

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13
Q

The most common cause of microcytic anemia and anemia in general

A

Iron deficiency

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14
Q

Normocytic Anemia

A

MCV 80-100

anemia of chronic disease, blood loss, hemolysis

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15
Q

Macrocytic Anemia

A

MCV >100

folic acid or B12 deficiency

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16
Q

Consequences of Anemia

A

what providers want to prevent happening

impaired cognitive function 
atrial fibrillation 
falls
heart failure
cardiovascular events
mortality
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17
Q

Goals of Therapy

A

increase Hgb
relieve symptoms: fatigue
reduce morbidity
improve the quality of life

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18
Q

Iron Deficiency Anemia

A 
decreased Hgb
decreased MCV
decreased ferritin 
increased TIBC/transferrin 
increased/ normal RDW
decreased/ normal serum iron
decreased TSAT

(next step is to conduct iron studies)

19
Q

Ferritin

A

15-200ng/mL
decreased in iron deficiency
tells you about the stores you have in your body
ferritin <15 you for sure have iron deficiency anemia
ferritin <50 iron deficiency anemia and you still treat it

20
Q

Iron

A

40-160mcg/dL
decreased in iron deficiency

tells you the concentration of iron bound to transferrin

21
Q

Transferrin

A

200-360 mg/dL
increased in iron deficiency

  • protein that delivers iron throughout the body
  • body is triyng to compensate and get an elevated transferrin
22
Q

TIBC (Total Iron Binding Capacity)

A

250-400 mcg/dL
increased in iron deficiency

-concentration of iron if all transferrin was bound to iron

23
Q

TSAT (Transferrin Saturation)

A

20-50%
decreased in iron deficiency

-amount of iron ready for eryhtropoeisis

24
Q

Causes of Iron Deficiency

A
  • blood loss-mensturation/donation
  • decreased absorption -celiac disease, gastric bypass, maxnimal absorption in the duodenum
  • vegetarian diet-dietary iron heme, non-heme
  • increased consumption-pregnancy
25
Additional Signs and Symptoms
- koloinychias-spoon shaped nails - inflammed tongue- glossitis - pica- craving substances that don't have nutritional value pagophagia: ice geophagia: dirt, soil, clay
26
Iron Deficiency Anemia Treatment
Oral Iron preferred over IV IV used: - cannot tolerate (side effects) - cannot absorb - end stage renal disease (ESRD) need 120-200 mg elemental iron per day
27
Counseling Points
- taken once daily-three times daily - increased absorption on empty stomach - causes upset stomach-can take with food or split doses - causes constipation-increases fluid, activity, and fiber - causes dark stools-may be mistaken for GI bleed - can be mistaken for candy by kids-can result in overdose in children-fatal
28
IV Iron
indications: ESRD, failed oral iron, malabsorption | side effects: hypotension during infusion (common), skin tattooing
29
Vitamin B12 Deficiency Anemia
- decreased Hgb - increased MCV - increased RDW - decreased B12 (<200pg/mL) - normal ferritin/TIBC/transferrin - normal serum iron/transferrin saturation (TSAT) - increased homocysteine /methylmalonic acid
30
Causes of Vitamin B12 Deficiency Anemia
``` a vegan/vegetarian diet alcoholism decreased absorption (Crohn's disease) lack of intrsinsic factor (pernicious anemia) -positive shilling test medication ``` our bodies cannot make enough Vit B12-must absorb from diet consequences: neurologic, weakness, numbness, cognitive dysfunction
31
Treatment of Vitamin B12 Deficiency Anemia
Vit B12 replacement (not effective in pernicious anemia: lack intrinsic factor to absorb Vit B12) IM or Deep SC: 100-1000 mcg (regimens vary) often daily for 1-2 weeks, then weekly or monthly as maintenance H20 soluble vitamin *oral is as effective as parenteral*
32
Folic Acid Deficiency Anemia
``` decreased Hgb increased MCV increased RDW normal ferritin/transferrin normal serum iron/TSAT decreased folate increased homocysteine ```
33
Causes of Folic Acid Deficiency Anemia
malabsorption malnutrition: found in green vegetables, orange juice, cereal, and milk alcoholism: no nutrients in alcohol medications: antibiotics work by inhibiting folic acid (methotrexate, phenytoin, sulfasalazine, sulfamethoxazole/trimethoprim)
34
Treatment of Folic Acid Deficiency Anemia
oral folic acid supplement 1-5mg daily until Hgb normalizes well absorbed, rarely need IV treat the underlying cause/continue to supplement never replace folic acid without checking vitamin B12 deficiency
35
Anemia of Chronic Disease
one of the most common causes of anemia patients with chronic disease lasting months to years: CKD, CHF, Cancer, HIV/AIDS
36
Anemia of CKD
erythropoietin is produced in the kidneys and stimulates the production of RBCs - decreased RBC production - chronic inflammatory state which causes anemia of chronic disease - nutritional deficiencies (iron, folate, Vit B120)
37
Treatment of Anemia of Chronic Disease
avoid blood transfusions-more at risk of allosensitization -correct nutritional deficiencies: folate B12 and iron ESAs: help prevent blood transfusions maintain Hgb> 10- once this level is achieved, no need to keep going due to increased risk of adverse effects
38
Blood Loss Anemia
treatment: stop bleeding transfuse packaged RBCs when Hgb is <7: each unit of RBCs ~250 mg iron medications may be indicated for specific conditions
39
Hemolytic Anemia
RBCs are destroyed before the 120-day lifespan inherited: sickle cell anemia, glucose-6-phosphate (G6PD) dehydrogenase acquired: drug induced
40
Sickle Cell Anemia
RBCs are irregular in shape (sickled) RBCs collect in spleen and are destroyed faster than they can be produced sickle cell trait: asymptomatic sickle cell anemia: both genes are sickle cell Hgb (homozygous)
41
Treatment of Sickle Cell Anemia
folic acid increased the need for folic acid due to accelerated erythropoiesis blood transfusions symptomatic episodes of acute or chronic anemia iron overload from frequent transfusions hydroxyurea: fetal hemoglobin inducer decreases sickling 10-15mg/kg/day
42
Immunizations-Sickle Cell Anemia
impaired splenic function risk of infection from encapsulated organisms influenza, pneumococcal, and meningococcal vaccinations
43
Pain Control -Sickle Cell Anemia
acetaminophen/NSAIDS opioids in pain crisis -may use patient controlled analgesia
44
Drug Induced Anemia
drugs can cause anemia and they can do it in several different ways drug aplastic anemia drug induced immune hemolytic anemia drug induced oxidative hemolytic anemia: (patients with G6PD enzyme deficiency) drug induced megaloblastic anemia

PHRM 825 (4 decks)

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