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Anemia Flashcards

1
Q

What’s hemoglobin?

A

Protein in RBC that carries oxygen

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2
Q

What’s the normal lifespan of RBC?

A

About 120 days

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3
Q

List the main causes of anemia

A

Impaired RBC production

Increased RBC destruction (hemolysis)

Blood loss

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4
Q

What’s the main cause behind sx experienced in anemia?

A

Tissue hypoxia (tissues not getting enough oxygen-rich blood)

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5
Q

List the sx of anemia.

A

Fatigue

Malaise

Weakness

SOB

Headache

Dizziness

And/or

Pallor

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6
Q

When does a pt typically NOT experience sx of anemia (asymptomatic)?

A

In mild anemia or in beginning stages

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7
Q

What’s sx are experienced in acute blood loss?

A

Chest pain

Angina

Fainting

Palpitations

Tachycardia

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8
Q

List the unique sx that may develop in iron deficiency anemia

A

Glossitis

Koilonychias

Pica

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9
Q

What’s Glossitis?

A

An inflamed, sore tongue

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10
Q

What’s Koilonychias?

A

Thin, concave, spoon-shaped nails

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11
Q

What’s Pica?

A

Craving and eating non-foods such as chalk or clay

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12
Q

How is anemia xterized?

A

Low hemoglobin (Hgb) and low hematocrit (Hct) levels

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13
Q

What’s the most common way to classify the type of anemia?

A

Mean corpuscular volume (MCV)

Or

Average volume of RBCs

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14
Q

While the sx of both microcytic and macrocytic anemia are similar, how can they be differentiated?

A

MCV

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15
Q

Define microcytic anemia

A

MCV is small (< 80um3) dis to small cell size from a lack of iron

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16
Q

Define macrocytic anemia

A

MCV is large (> 80um3) due to folate or Vit b12 deficiency

Also called Megaloblastic anemia

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17
Q

What’s normocytic anemia? How does it normally occur?

A

Anemia with normal MCV (80-100 um3)

From acute blood loss (surgery or trauma)

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18
Q

What’s the normal range of MCV?

A

80 - 100 um3

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19
Q

What’s erythropoietin?

A

Hormone secreted by the kidneys that INCREASES the rate of pdt of RBCs in response to falling levels of oxygen in the tissue

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20
Q

What’s essential for hemoglobin formation?

A

Iron

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21
Q

What should be done b4 initiation of erythropoietin therapy? Why?

A

Iron levels need to be checked

If iron stores are low, erythropoietin-stimulating agents (ESAs) will NOT work

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22
Q

What’s the mainstay of anemia tx?

A

Iron therapy

ESAs

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23
Q

What does majority of pts needing iron replacement use?

A

Oral iron supplement

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24
Q

Why would a pt need iron by injection as replacement?

A

Usually are CKD pts on hemodialysis

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25
Q

What’s the normal adult range for hemoglobin (hgb)?

A

Males: 13.5 - 18 g/dL

Females: 12-16 g/dL

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26
Q

What’s the normal adult range for hematocrit (Hct)?

A

Males: 38-50%

Females: 36-46%

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27
Q

What’s the normal adult range for mean corpuscular volume (MCV)?

A

80-100 um3

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28
Q

What’s the normal adult range for total iron binding capacity (TIBC)?

A

250-400 mcg/dL

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29
Q

What’s the normal adult range for serum ferritin?

A

Males: 30-300 ng/mL

Females: 10-200 ng/mL

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30
Q

What’s the normal adult range for transferrin saturation (TSAT)?

A

Males: 15-50%

Females: 12-45%

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31
Q

What’s the list common type of anemia?

A

Iron-deficiency anemia

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32
Q

Which is more easily absorbed? Heme or non-heme iron?

A

Heme iron is minimally affected by dietary factors

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33
Q

How is microcytic anemia diagnosed?

A

Low hemoglobin and low MCV (<80 um3)

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34
Q

Why may vegetarians still need iron supplement even if they are consuming enough iron?

A

Becuz their iron is non-heme, which is less available than heme iron (from meat)

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35
Q

What’s the first-line tx of iron deficiency anemia? Exception?

A

Ferrous sulfate

Patients on hemodialysis (start with injectable iron)

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36
Q

Which is more readily absorbed, ferrous iron (Fe2+) or ferric (Fe3+)?

A

Ferrous iron (Fe2+)

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37
Q

Duration of iron replacement?

A

3-6 months AFTER anemia has resolved (to allow for iron stores to return to normal and prevent relapse)

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38
Q

What formulations of iron replacement is NOT recommended as initial therapy? Why?

A

Sustained-release formulations or Enteric coated formulation

They reduce amt of iron present for absorption in the duodenum

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39
Q

In what gastric environment is absorption of iron enhanced?

A

Acidic

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40
Q

What may be used with iron to enhance absorption, to a minimal extent?

A

Ascorbic acid (Vit C 200mg)

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41
Q

Should iron be taken with food? Why or why not?

A

Food will DECREASE iron absorption

Take iron at least 1 hr before meals (take iron with meals if GI upset occurs when taking iron on an empty stomach)

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42
Q

What’s the dosing of ferrous sulfate (1st line therapy)?

A

325 mg PO daily to TID (65 mg elemental iron)

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43
Q

What’s the brand name of ferrous sulfate, dried (exsiccated) controlled release? Dose?

A

Slow Fe, Feosol

160mg PO daily to TID

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44
Q

What’s the leaving cause of fatal poisoning in children under 6?

A

Accident overdose of iron-containing pdts

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45
Q

Side effects of oral iron replacement therapy?

A

Nausea

Stomach upset

Constipation (dose related)

Dark and tarry stools

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46
Q

Why are enteric-coated and delayed-release pdts not recommended?

A

Decresaes iron absorption

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47
Q

What’s recommended for iron-induced constipation?

A

Docusate

Although, fiber is 1st line tx for constipation, Docusate is 1st line here

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48
Q

What’s unique about carbonyl iron (Feosol with carbonyl iron, ferracap, ferralet 90)?

A

Highest amt of iron (100% elemental iron)

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49
Q

Effects of antacids and agents that raise pH on iron absorption?

A

They decrease iron absorption (remember, iron needs acidic gastric environment)

50
Q

Effects of antibiotics on iron absorption?

A

Primarily Tetracyclines (less concern with Doxycycline and Minocycline) and Quinolones DECREASE iron absorption through chelation

51
Q

Which tetracyclines are of less concern wrt reducing iron absorption?

A

Doxycycline

Minocycline

52
Q

How to take iron if pt is also on Tetracycline?

A

Take iron 1-2 hrs BEFORE tetracycline

OR

4 hrs AFTER tetracycline

53
Q

How to take iron if pt is also on Ciprofloxacin?

A

Take iron 2hrs BEFORE

OR

6hrs AFTER Cipro

54
Q

How to take iron if pt is also on Levofloxacin?

A

Take iron 2 hrs BEFORE

OR

2hrs AFTER Levofloxacin

55
Q

How to take iron if pt is also on Moxifloxacin?

A

Take iron 4 hrs BEFORE

OR

8hrs AFTER Moxifloxacin

56
Q

How much Vit c is needed to increase gastric acidicity t4 enhance iron absorption?

A

About 200mg or Ascorbic acid

57
Q

By how much does food decrease iron absorption?

A

About 50%

58
Q

List the drugs that iron interacts with and DECREASES their levels. How should they be separated?

A

Levothyroxine

Levodopa

Methyldopa

Cefdinir

Bisphosphonates

Mycophenolate

Seperate doses by 2-4 hrs

59
Q

T/F? If a parent finds that their kid has swallowed iron tablet, they should be directed to the ER?

A

True

60
Q

How much iron do kids need to overdose on iron?

A

As little as 5 tablets of iron can lead to over dose

61
Q

What’s the antidote for oral iron overdose?

A

Deferoxamine

62
Q

What’s the antidote for transfusional iron overdose?

A

Deferiprone (Ferriprox)

63
Q

What conditions may require Parenteral iron therapy?

A

Hemodialysis (most common use of IV iron)

Unable to tolerate oral iron OR losing iron too fast for oral replacement

Intestinal malabsorption, such as Crohn’s

Pts donating large amts of blood for autoinfusion

64
Q

List IV (Parenteral) iron supplements

A

Iron dextran

Sodium ferric gluconate

Iron sucrose

Ferumoxytol

Ferric carboxymaltose

65
Q

What’s the brand name of iron dextran?

A

INFeD

Dexferrum

66
Q

What’s the brand name of Sodium Ferric Gluconate?

A

Ferriecit

Nulecit

67
Q

What’s the brand name of iron Sucrose?

A

Venofer

68
Q

Which IV iron supplement has a black box warning?

A

Iron Dextran (INFeD, Dexferrum)

69
Q

What’s the black box warning ass with iron dextran? How is it prevented?

A

Risk of anaphylactic rxns

A test dose should be given to ALL pts prior to 1st therapeutic dose

70
Q

What factors may be of concern, even if the test dose was tolerated by a pt?

A

Hx of drug allergy

And/or

Concomitant use of ACE-I

71
Q

How should IV iron be given? Why?

A

By slow IV injection

To reduce risk of hypotension

72
Q

What type of anemia is iron replacement therapy used for?

A

Microcytic anemia

73
Q

What’s macrocytic anemia?

A

Is due to either Vit B12 or Folate deficiency OR both

74
Q

What’s the concern with long-term untreated macrocytic anemia?

A

Pt is at risk of NEUROLOGICAL consequences including

Cognitive dysfunction (dementia)
AND
Peripheral nerve damage

75
Q

What’s Pernicious anemia?

A

Type of macrocytic anemia that results in LOW B12 levels due to a lack of intrinsic factor, which is req for adequate B12 absorption on small intestine

76
Q

What’s the tx duration for those with pernicious anemia?

A

Forever!

They req lifelong Vit B12 replacement therapy

77
Q

Which dosage form of Vit B12 is preferred? Why?

A

Vit B12 injections

Becuz macrocytic anemia can lead to neurological complications

78
Q

List the other causes of macrocytic anemia.

A

Alcoholism

Crohn’s dx

Celiac dx

79
Q

Howz macrocytic anemia diagnosed?

A

LOW hemoglobin and HIGH mean corpuscular volume (MCV) >100mm3

80
Q

What other values are considered in diagnosing macrocytic anemia?

A

Vit B12 and/or serum folate levels will be LOW

81
Q

What’s used to diagnosed Vit B12 deficiency specifically?

A

Schilling test

Can pick up lack of intrinsic factor (needed for absorption of Vit B12 in the small intestine )

82
Q

What’s the tx of macrocytic anemia?

A

Tx usually starts with Vit B12 injections and follow with oral supplements

83
Q

List drugs used to treat macrocytic anemia

A

Cyanocobalamin (Vit B12)

Folic acid (folate)

84
Q

What’s contraindication to use of cyanocobalamin?

A

Cobalt allergy

85
Q

What’s formulation of b12 isn’t used?

A

Sustained-release B12 supplements as the absorption is not adequate

86
Q

What’s tne dose of Folic acid (folate) used in macrocytic anemia?

A

0.4-1mg daily

1mg (Rx)

0.4, 0.8mg (OTC)

87
Q

What’s the SE of Folic acid (folate)?

A

Bronchospasm

Flushing

Rash

Pruritus

88
Q

What’s the monitoring for both Vit B12 and Folic acid (folate)?

A

Hgb

Hct

Folate

Vit B12

Iron

89
Q

List drugs that may reduce the absorption of Vit B12

A

Chloramphenicol

Colchicine

Ethanol

Long-term tx with Metformin

90
Q

List drugs that Folic acid may reduce absorption of?

A

Raltitrexed (avoid concurrent use)

91
Q

What’s the effect of CKD on iron?

A

CKD causes anemia due to deficiency in erythropoietin, a hormone produced by healthy kidneys

92
Q

How should ESAs be used in chronic renal failure?

A

At lowest possible dose that reduces need for blood transfusion

93
Q

When should ESA be started and stopped (or reduced)?

A

Start - when hgb < 10 g/dL

Reduce or Stop - when hgb is near 11 g/dL

94
Q

What values should transferrin saturation and ferritin be b4 ESA is started?

A

Transferrin saturation - At least 20%

Ferritin - At least 100 ng/mL

95
Q

What other values need to be assessed before ESA is started?

A

Folate and Vit B12, especially if there’s a poor response to ESA

96
Q

List agents that fall under ESA

A

Epoetin alfa (Epogen, Procrit)

Darbepoetin (Aranesp)

97
Q

Whats the brand name of Epoetin alfa (ESA)?

A

Epoetin

Procrit

98
Q

Whats the brand name of Darbepoetin (ESA)?

A

Aranesp

99
Q

What’s the black box warning on ESAs (Epoetin and Darbepoetin)? When is this a concern?

A

ESAs increase the risk of serious cardiovascular events, thromboembolic events, strokes and mortality.

When ESA is admin to target hgb > 11g/dL

100
Q

What’s the hgb target in CKD pts?

A

11… Black box warning comes in

101
Q

Effect of ESA on cancer survival?

A 
ESA shortens overall survival and/or increased risk of tumor progression or recurrence in pts with 
breast, 
head and neck, 
non-small cell lung, 
lymphoid and 
cervical cancer
102
Q

What’s ESA APPRISE?

A

Oncology program to prescribe and/or dispense agents (Epoetin and Darbepoetin) to cancer pts

103
Q

When should ESA be used in cancer pts?

A

Anemia from myelosuppressive chemotherapy

104
Q

T/F? In cancer pts, ESA (Epoetin, Darbepoetin) is not recommended when the outcome is cure?

A

True

105
Q

T/F? D/c ESA following chemotherapy course?

A

True

106
Q

ESA and perisurgergy?

A

Increases risk of DVT, t/4 DVT prophylaxis is recommended

107
Q

List contradictions to ESA (Epoetin and Darbepoetin) use

A

Uncontrolled HTN

Pure red cell aplasia (PRCA) that begins after tx

108
Q

SE of ESA

A

Hypertension

Thrombosis

Fever
Headache
Arthralgia/ bone pain
Pruritus/ rash
Nausea
Cough
Injection site pain
Edema
Chills
Dizziness
109
Q

What’s the monitoring parameters of ESA?

A

Hgb

Hct

Transferrin saturation

Serum ferritin

BP

110
Q

What’s the preferred route of ESA for pts on hemodialysis?

A

IV route

111
Q

Wheee should ESA be stored?

A

In the refrigerator

112
Q

What’s the cut-off for admin ESA in CKD pts and cancer pts?

A

CKD - stop if hgb is > 11.5

Cancer - stop if Hg. Is 11

113
Q

How will ESA work faster?

A

If taken on empty stomach

114
Q

List nutrients from food that should be limited when on ESA? Their effect on iron absorption?

A

Tannins

Calcium

Polyphenols

Phytates

(Found in legumes and whole grains)

They decrease iron absorption

115
Q

List serious life-threatening conditions that may occur, the longer one is on ESA?

A

Heart or circulation problems including heart attack and stroke

Seek emergency medical help immediately if u feel sx of stroke or heart attack

116
Q

Effect of ESA on cancer remission time?

A

ESA may shorten remission time in pts with breast, non-small lung, head and neck, cervical or lymphoid cancer

117
Q

How does the dr make sure pt is getting best results from medication?

A

By occasionally changing the dose of ESA

118
Q

Should the ESA bottle (vial) be shaken?

A

No

119
Q

List sites of injections of ESA

A

Outer area of upper arms

Abdomen (except 2inches around navel)

Front of the middle thighs

Upper outer area of buttocks

120
Q

What’s anemia?

A

Common blood disorder xterized by a DECREASE in EITHER

hemoglobin

OR

Volume of RBC

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